THE GERONTOLOGIST

INNOVATION IN AGING
AnAOpen Access
Journal Journal
of The of The Gerontological
Gerontological Society Society of America
of America

EDITORIAL BOARD
Steven M. Albert, PhD Joseph E. Gaugler,
Katherine PhD
Abbott, PhD* Loretta Pecchioni, PhD
University of Pittsburgh University
Miami of Minnesota
University Louisiana State University
Kathleen Abrahamson, RN, PhD*
Rebecca S. Allen, PhD Laura N. Gitlin,
Purdue PhD
University Nancy J. Petersen, PhD
The University of Alabama Johns Hopkins University Department of Veterans Affairs Medical
Tamara A. Baker, PhD
Jacqueline L. Angel, PhD University of Kansas
Kathy E. Green, PhD Center, Houston
The University of Texas at Austin Scott R. Beach,
University PhD*
of Denver
University of Pittsburgh Carl F. Pieper, DrPH
Tamara A. Baker, PhD R. Turner Goins,
Sara J. Czaja, PhD
PhD* Duke University Medical Center
University of South Florida WestUniversity
VirginiaofUniversity
Miami
Larry Polivka, PhD
Adam Davey, PhD*
Daniel Bland Leslie K. Hasche,
University PhD,
of Delaware, MSW
Newark Claude Pepper Center
Johnson-Shoyama Graduate School of Public Policy University of Denver
Nancy R. Gee, PhD
SUNY, Fredonia
Thomas R. Prohaska, PhD
Jennifer Bellot, PhD, RN, MHSA William E. Haley, PhD University of Illinois at Chicago
Megan Gilligan, PhD
Thomas Jefferson University University of South
Iowa State Florida
University
Jill Quadagno, PhD
MaryHendricks,
Jon Ann Johnson,PhD
PhD The Florida State University
Mercedes Bern-Klug, PhD, MSW The University of Georgia
The University of Iowa Oregon State University
Yoshinori Kamo, PhD Anna Rahman, PhD
Louisiana
Pamela State
Herd,University
PhD
Richard Birkel, PhD University of Southern California
National Council on Aging University
Giyeonof Wisconsin
Kim, PhD
University of Alabama Ruth E. Ray, PhD
Christine E. Bishop, PhD Robert B. Hudson,
Min-Ah Lee, PhD PhD Wayne State University
Brandeis University Boston University
Chung-Ang University
David A. Nace, MD, MPH Virginia E. Richardson, PhD, MSW
Jamila Bookwala, PhD Kathryn Hyer,
University PhD, MPP
of Pittsburgh The Ohio State University
Lafayette College University of South
Marcia Ory, PhD* Florida
Texas A&M Sara E. Rix, PhD
Hayden Bosworth, PhD Marshall B. Kapp, JD, MPH
Karen A. Roberto, PhD* AARP Public Policy Institute
Durham VA Medical Center and Florida State University
Virginia Polytechnic Institute and State University
Duke University Medical Center Karen A. Roberto, PhD
Brian
Noah J.Kaskie,
Webster,PhD
PhD
University of Michigan Virginia Polytechnic Institute and State University
Barbara J. Bowers, PhD, RN, FAAN University of Iowa
Richard Winett, PhD
University of Wisconsin-Madison Nancy Kelley-Gillespie,
Virginia Tech PhD Miriam S. Rose, MEd
University ofB.Nebraska Benjamin Rose Institute on Aging
Margaret P. Calkins, PhD Jeremy Yorgasson,atPhD
Omaha
Brigham Young University
IDEAS Consulting Inc. Mary Ann Kluge, PhD Michael J. Rovine, PhD
Anna Zajacova, PhD*
University ofWestern
Colorado, Colorado Springs
University
Pennsylvania State University
Francis Caro, PhD
University of Massachusetts Boston Peter A. Lichtenberg, PhD, ABPP Laura P. Sands, PhD
Wayne State University Purdue University
Nicholas G. Castle, PhD
University of Pittsburgh *Fellow ofPhoebe S. Liebig,Society
The Gerontological PhD of America Andrew Scharlach, PhD
University of Southern California University of California- Berkeley
Barbara B. Cochrane, PhD, RN, FAAN
University of Washington Rebecca G. Logsdon, PhD Rick J. Scheidt, PhD
University of Washington Kansas State University
Constance L. Coogle, PhD
Virginia Commonwealth University Ronald J. Manheimer, PhD Richard Schulz, PhD
The Manheimer Group University of Pittsbugh
Teresa Cooney, PhD
University of Missouri Graham J. McDougall Jr., PhD, Debra Sheets, PhD, MSN, RN
RN, FAAN, FGSA University of Victoria
Katrina Cubit, PhD The University of Texas at Austin
Australian Nursing & Midwifery A. Lynn Snow, PhD
Lisa C. McGuire, PhD University of Alabama
Accreditation Council
Center for Disease Control and
Sara J. Czaja PhD Prevention Avron Spiro, PhD
University of Miami Miller School of Medicine VA Boston Healthcare System and
Kate de Medeiros, PhD
Boston University Medical Center
Jeanette M. Daly, RN, PhD Miami University
The University of Iowa Maximiliane E. Szinovacz, PhD
Suzanne Meeks, PhD
University of Massachusetts-Boston
Kara Bottiggi Dassel, PhD University of Louisville
Arizona Association of AAAs Claudia Meyer, MPH Jeanne A. Teresi, EdD, PhD
National Ageing Research Institute Columbia University and Research Division,
Adam Davey, PhD Hebrew Home, Riverdale
Temple University Edward Alan Miller, PhD, MPA
University of Massachusetts Boston Jennifer L. Troyer, PhD
Howard B. Degenholtz, PhD University of North Carolina at Charlotte
University of Pittsburgh Nancy Morrow-Howell, PhD, MSW, ACSW
Washington University in St. Louis Jim Vanden Bosch, MA
David J. Ekerdt, PhD Terra Nova Films
Naoko Muramatsu, PhD, MHSA
 Abstracts
International Association of Gerontology and Geriatrics
21st World Congress of Gerontology and Geriatrics
July 23-27, 2017
San Francisco, California, USA

Abstracts are arranged numerically by session and in the order of presentation within each session.

SESSION 5 (SYMPOSIUM)
ENHANCING RECOGNITION OF GERIATRIC
SYNDROMES BY PRIMARY CARE HEALTH
PROFESSIONALS
Chair: J.E.Morley, Saint Louis University, St. Louis,
Missouri
Co-Chair: H.Arai, National Center for Geriatrics and
Gerontology, Nagoya, Japan
B.Vellas, CHU Toulouse, Toulouse, France
There is a shortage of geriatricians around the world. In
the USA the number of geriatricians has grown smaller. This
is in the face of the increased aging of the baby boomer popu-
lation. Many primary care health professionals have had lim-
ited training in geriatrics. There is increasing understanding
that early recognition of the new geriatric giants frailty,
sarcopenia, anorexia of aging and cognitive dysfunction
can lead to a decrease in disability and hospitalization with
appropriate management. This has led to the development of
a number of brief comprehensive screening processes for geri-
atric conditions. Examples of these include the Easy Care in
the United Kingdom which has been widely disseminated; the
Kihon Checklist (KCL) in Japan; the Gerontopole screen tool
in Toulouse, and the Rapid Geriatric Assessment that has been
developed as part of the Medicare Wellness Visit in Missouri.
Professor Arai will discuss experience with the Kihon Checklist
which is used by the Japanese Long-Term Care Insurance sys-
tem. He will focus on how this index can be used to classify
person into robust, frail and prefrail and its predictive value.
He will also provide evidence of an exercise intervention for
improving outcomes. Professor Vellas will explain the short
Gerontopole screening questionnaire used by family practition-
ers as a tool to find persons in need of a referral to geriatricians.
He will report on the outcomes of 1,108 older patients (mean
age 82.5) that were screened by their family physicians. The
necessary interventions in this group included medical condi-
tions with a new intervention (32%), nutritional intervention
(62%), physical activity intervention (57%) and a social inter-
vention (26%). Professor Morley will describe the RGA con-
sisting of 4 rapid screens the FRAIL for frailty, SARC-F for
sarcopenia, SNAQ for anorexia of aging and Rapid Cognitive
Screen for MCI and dementia. These tests have been validated
in from 2 to 5 continents and are available in up to 30 lan-
guages. Over 2,000 persons have undergone the test. Results
show that both screening and case finding produce similar
deficits. Acomputer assisted screening and management pro-
gram has been developed and in addition handouts for lifestyle
intervention are available. These examples suggest that high
quality geriatric screening can be carried out by primary care
health professionals with positive outcomes.
RAPID GERIATRIC ASSESSMENT
J.E.Morley, Saint Louis University, St. Louis, Missouri
The Rapid Geriatric Assessment (RGA) is a tool developed
to quickly identify four geriatric syndromes viz frailty, sarco-
penia, anorexia of aging and cognitive dysfunction as well as
to enquire if the person has advanced directives. It was devel-
oped to be used in conjunction with the Annual Medicare
Wellness Visit. It takes less than 4 minutes to administer.
The components of the RGA are the FRAIL for frailty,
SARC-F for sarcopenia, SNAQ for anorexia of aging and
the Rapid Cognitive Screen which is derived from the St.
Louis University Mental Status Examination. All the screen-
ing tools have been validated in multiple continents and are
available in up to 30 languages.
We have ongoing educational interventions in rural coun-
ties, inner city clinics and academic centers. To date over
2,000 persons have been evaluated either as case finding in
physicians offices or screening in the community. Preliminary
results show the prevalence of frailty to be 23%; sarcopenia
32.8%; Anorexia 34.7%, MCI 19.3% and dementia 23.9%.
In a group of diabetics both the SARC-F and FRAIL were
highly predictive of new disability and hospitalization.
In addition to the screening tool we have developed a
computerized assessment and management program for phy-
sicians offices. This program specifically provides a diagnos-
tic plan for each component of the FRAIL, and diagnostic
and management programs for the other syndromes. This
approach is well accepted by primary care physicians.
We believe that this is a simple intervention secondary pre-
vention program that will enhance the health of older persons.
FAMILY PHYSICIAN SCREENING FOR GERIATRIC
SYNDROMES
B.Vellas, CHU Toulouse, Toulouse, France
The GFST (Gerontopole Frailty Screening Tool) has been
developed to help health care professional to target older
adults at risk for frailty. The GFST does not aim to measure
frailty, but only to detect those at risk to be frail, to refer them
to a frailty clinic for more precise assessment of frailty, and to
look after the cause of frailty to propose targeted interventions.
The GFST includes few questions: is your patient living
alone, had involuntary weight loss in the past 3 months,
fatiguability, mobility difficulty, memory complaints, slow

IAGG 2017 World Congress 1

2 Innovation in Aging, 2017, Vol. 1, No. S1
gait speed (see fig 1)? After that, most importantly the GFST
asks in your own clinical opinion, do you feel that your
patient is frail and at risk for further disabilities? If the health
professional feels it, the subject must be referred to a frailty
or geriatric clinic for further assessment. It was found that
95% of the subjects referred to the Gerontopole frailty clinic
(n=1108) using the GFST were frail or pre-frail.
THE KIHON CHECKLIST: IS IT ARELIABLE
ASSESSMENT OF FRAILTY?
H.Arai, National Center for Geriatrics and Gerontology,
Obu, Japan
The Japanese Long-term Care Insurance (LTCI) system
classifies older adults as vulnerable, dependent or independ-
ent. According to the LTCI systems criteria, vulnerable older
adults are community-dwelling people who are at high risk of
becoming dependent in the near future, as identified through
a health check-up questionnaire, the Kihon Checklist (KCL).
This checklist is comprehensive for assessing physical, social,
and mental functions of seniors lives. Therefore, it is conceiv-
able for us to use it for screening frailty in a clinical setting
as well as in the community. Based on the total KCL scores
we could classify older adults into 3 groups, robust, pre-frail
and frail, with a significant predictive ability for adverse health
outcomes, such as an incidence of dependency or mortality, in
a population-based longitudinal observational study. We also
found that higher KCL scores were associated with higher inci-
dence of adverse health outcomes such as incident disability
and mortality in older diabetic patients. Thus the KCL also can
be easily administered by healthcare professionals and used to
evaluate the effectiveness of interventions.
SESSION 10 (SYMPOSIUM)
DESIGN, RESULTS, AND IMPLEMENTATION OF
AWHOLE PERSON INTERVENTION FOR LATE LIFE
CARE
Chair: P.Bingham, Alllina Health, Minneapolis, Minnesota
Discussant: S.Schroeder, University of California, San
Francisco, California
In the next decade and a half, communities in the US will
care for the same number of individuals over the age of 65
as they have over the past combined nine decades. Seven in
ten of these individuals will live with a progressive serious ill-
ness that will last not weeks but months to years. While tra-
ditional palliative care services provided through inpatient
settings and community-based models have demonstrated
positive impacts on symptom management and experiences
of care, there exists a woefully small number of palliative
trained providers to enable sufficient support for the grow-
ing population. The need for innovative, upstream palliative
care models that can be deployed wide scale and sustainably
is critical. A large healthcare delivery system in the upper
Midwest has developed an innovative modelLifeCourse
to support patients facing advanced serious illness and
their key friends and families. The model is being evalu-
ated in partnership with 900 intervention and usual care
patients and their key friends and family (total n=1,800).
In an effort to close the widening gap between the produc-
tion of positive research results from new interventions and
ultimate systematic implementation of those interventions,
the community-based care system testing this approach has
moved to rapid deployment of the model across its primary
and specialty care service areas. This symposium will offer
an overview of the development of the LifeCourse model,
the components of the model, the results to date from the
research trial, and lessons from the rapid deployment of
LifeCourse across the healthcare system.
CREATING AWHOLE PERSON INTERVENTION
FOR PATIENTS WITH SERIOUS ILLNESS AND THEIR
CAREGIVERS
E.W.Anderson1, S.Schellinger1, K.White2, M.Frazer1,
K.Radel1, D.Elumba1, J.Roberts1, J.Blomberg1, 1.
Allina Health, Minneapolis, Minnesota, 2. University of
Minnesota, Minneapolis, Minnesota
This presentation describes the LifeCourse intervention
and the human-centered research approach used to create
it. Meetings were conducted with 183 patients, caregivers,
and care professionals who experienced and/or worked with
serious illness to systematically gather perspectives on opti-
mal care delivery for persons diagnosed with serious illness.
Participant feedback was shaped into care components that
attend to how illness is lived, the care relationship is experi-
enced, and care is delivered. Care components guided crea-
tion of protocols for a trained lay healthcare worker who
meets with patients and caregivers in their home, earlier in
the patients illness trajectory, to holistically understand the
patients experience and goals for living well, and to enhance
supportive relationships in ones family, community, and
health care teams. Drawing upon the experiences of those
who have lived and worked with serious illness may yield an
approach that more fully supports patients and caregivers so
they can live well.
UTILIZATION, QUALITY OF LIFE, AND CARE
EXPERIENCE OF PATIENTS IN LIFE COURSE
H.Britt1, N.Shippee2, T.P.Shippee2, P.Mobley1,
K.Fernstrom1, A.Jones1, J.Taghon1, C.L.Cain3, 1.
Allina Health, Minneapolis, Minnesota, 2. University
of Minnesota, Minneapolis, Minnesota, 3. University of
California, Los Angeles, California
Based upon current data from 450 intervention and 448
comparison patients, we find a 25% reduction in inpatient
days (p=0.003) and a 57% reduction in number of ICU
stays (p=0.004) for intervention compared to usual care
patients. Of deceased patients, 49% of those in the interven-
tion group enrolled in hospice compared to 42% of usual
care patients; median length of stay in hospice for interven-
tion patients was 23days, compared to 15.5 for usual care
patients (p=0.05). Examination of quality of life (QOL) of
patients enrolled in LifeCourse (using the FACIT-Pal) reveals
consistently more positive QOL for intervention patients
than comparison patients, especially in the emotional, func-
tional and palliative domains and among patients with
lower starting QOL values. An experience survey designed
specifically for the longitudinal nature of LifeCourse reveals
consistently more positive experience, both overall and
across many experience domains, for intervention compared
to usual care patients.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
LIFE COURSE BEYOND RESEARCH: LEARNING
THROUGH IMPLEMENTATION AND EVALUATION
P.Bingham, V.Anugwom, S.Curran, A.Hunt,
M.Hutchison, S.Nelson, L.Sutter, A.Betzner, Allina
Health, Minneapolis, Minnesota
Strong research results and supportive funding propelled
leadership of a healthcare system to implement LifeCourse
across multiple clinics and collaborating community sites.
LifeCourse relies upon lay healthcare workers, called care
guides. The implementing primary and specialty care clinics
hired care guides to provide whole person care for clinic
patients living with serious illness. During implementation,
clinic leaders were solicited to be part of a team which met
over several weeks to help prepare the clinics, hire the care
guides, and champion LifeCourse. The program materials
were adapted from the research intervention to support the
specific patient population and clinic processes. In addition
to following a detailed implementation strategy, an evalua-
tion plan was created to measure the effectiveness and pro-
vide feedback on the process and outcomes. The presentation
will describe the implementation and evaluation framework
for systematic deployment and will summarize the successes
and challenges of integrating research into practice.
SESSION 15 (PAPER)
FACTORS AND DECISION-MAKING AFFECTING
POST-ACUTE CARE AND READMISSIONS
CARE TRANSITIONS: AN INTEGRATED MODEL OF
CARE FOR ELDERLY PATIENTS AT HIGH RISK FOR
READMISSIONS
U.Ohuabunwa1,2, E.Johnson2, J.Turner2, Q.Jordan2,
S.Cruel2, 1. Emory University, Atlanta, Georgia, 2. Grady
Hospital, Atlanta, Georgia
The peri-discharge period constitutes a critical time for
older adults. Several successful care transitions models entail
the use of advanced practice nurses, often cost prohibitive.
The role of non medical personnel such as community health
workers (CHWs) in improving transitions of care has not
been widely studied. We sought to determine the effective-
ness of a care transitions model utilizing CHWs in reducing
readmissions and emergency room visits (ERVs).
A patient care model evaluation was done using a pre
and post intervention design with follow-up at 3, 6, 9 and
12 months. Eligible patients were at high risk for readmis-
sion or with up to 4 emergency room visits in 1month. They
participated in the model designed to provide the patients
with self management skills, and the support of a CHW
who assisted in coordination of their care and followed
the patient for a period of 1 year post discharge, achieved
through predischarge interdisciplinary team meetings,regular
home visits, weekly phone contact, accompaniment to PCP
appointments, support with transportation, and medica-
tions, self management education aimed at promoting inde-
pendence and good health behaviors at the time of discharge
from the program.
Main Outcome Measures were readmissions, ERVs,
increased primary care utilization.
Of 126 patients enrolled in the study, 117 patients par-
ticipated actively, 65% males; 35% females. There was a
IAGG 2017 World Congress
3
reduction in ERVs in 83.9% of patients, reduction in read-
missions in 76.6% of patients, increased primary care utiliza-
tion with established PCPs in up to 86.6% of patients. There
was also a 65% reduction in healthcare cost.
Use of non healthcare personnel such as community
health workers during transitions of care may be helpful in
reducing healthcare utilization and probably costs.
IMPLEMENTING AN ACUTE CARE FOR THE
ELDERLY SERVICE IN AN URBAN SAFETY NET
HOSPITAL
U.Ohuabunwa1, J.Turner2, K.Shah2, J.Alexander2,
R.Walton Mouw2, J.Brandi2, S.Everett2, 1. Emory
University, Atlanta, Georgia, 2. Grady Hospital, Atlanta,
Georgia
Background: Older adults who are hospitalized are prone
to multiple hazards such as falls, delirium, pressure ulcers,
malnutrition, hospital-acquired infections and functional
decline resulting in institutionalization, and readmission
to the hospital after discharge. Geriatric-focused models of
inpatient care offer effective ways to transform inpatient care
for older adults and have been shown to improve outcomes.
The role of these models of care in urban safety net hospitals
has not been reported. We sought to determine the effective-
ness of an Acute Care for the Elderly Service at our safety net
hospital established 9mos ago.
Project Setting is a 953 Bed academically affiliated safety
net hospital.
Participants were older adults 75yrs and older or patients
65 years and older identified to have 1 or more geriatric
syndromes.
All patients who met criteria were admitted to the ACE
Service run by an interdisciplinary team constituting of a
Geriatrician, Nurse Practitioner. Pharmacist, Dietitian, Case
Management/ Social Work, Nursing Staff, Rehab personnel
including PT, OT, ST, Team members reviewed the patients
and made recommendations regarding the patients care. The
focus of he service was to manage the following aspects of
patient care cognition, mood, functional status, nutrition,
medication safety, skin care, transitions of care, A team of
volunteers from our Senior Services Division also focused on
involving patients in individual and congregate functional
and cognitive activities to help preserve cognition and func-
tional status. Community Health Workers provided support
regarding the patients transition to other care settings with
their providing support and care coordination immediately
pre-discharge and in the discharge care setting for a period of
6months post discharge for patients meeting criteria.
Initial data show a significant improvement in delirium
and cognition scores as measured by the Nudesc and Six
Item screen scores, on admission compared to discharge.
There was a drop in the Nudesc Scores by 14.9% at dis-
charge compared to admission scores. There was also sig-
nificant improvement in mobility scores for patients pre ACE
intervention and post intervention., though there was some
decline in the Katz and Lawton functional scores, There was
also a positive response by the primary hospital teams in
reducing the number of beers medications that the patient
was taking.
An ACE service with its care processes is a useful mecha-
nism to improve cognition, mobility and medication safety in
hospitalized older adults in a safety net hospital
4 Innovation in Aging, 2017, Vol. 1, No. S1
IMPROVING DECISION-MAKING AND OUTCOMES
IN TRANSITIONS TO POST-ACUTE CARE FACILITIES
R.E.Burke1, E.Whitfield2, C.Levy2, E.Hess2, 1. Research
and Hospital Medicine Sections, Denver VA Medical Center,
Denver, Colorado, 2. Denver VA Center of Innovation,
Denver, Colorado
The number of older adults discharged to post-acute care
(PAC) facilities after hospitalization is increasing rapidly, but
their clinical course is uncertain. We sought to identify prog-
nostic factors linked to outcomes of older adults discharged
to PAC using a retrospective analysis of the 20032009
Medicare Current Beneficiary Survey (MCBS), a nationally-
representative survey of Medicare recipients matched with
claims data. Community-dwelling adults age 65 and older
who were hospitalized and discharged to a PAC facility were
included. The primary outcome was a composite of events
representing failure to return to the community, including
death, readmission to the hospital, or remaining in a PAC
facility 100 days post-hospital discharge. Of 1416 eligible
patients, 510 (35.9%) did not return to the community. In
multivariable analysis, the most important factors included
the presence of dyspnea (OR 1.46; 95% CI 1.091.96),
cognitive impairment (1.12; 1.021.24), use of antipsy-
chotics (1.10; 1.041.17), number of physician visits in the
PAC facility (1.09; 1.031.14), index hospital length of stay
(1.02 per day; 1.011.03), PAC facility length of stay (0.99
per day; 0.980.99), and better functional status (0.80;
0.750.85). The c-statistic was 0.694. More than one-third
of older adults discharged to PAC facilities are readmitted,
die, or remain in the PAC facility 100 days post-discharge.
Several factors that influence these outcomes may be modifi-
able. Their predictive value is similar to most readmission
prediction models, which have been successfully used to
target interventions to high-risk groups. These findings may
serve as a starting point for better informing decision-mak-
ing and improving outcomes.
GERIATRIC CO-MANAGEMENT FOR CARDIOLOGY
PATIENTS IN THE HOSPITAL (G-COACH):
DEVELOPMENT AND FEASIBILITY
M.Deschodt1,2,3, B.Van Grootven1, K.Milisen1,3,
J.Flamaing3,1, 1. KU Leuven, Leuven, Belgium, 2.
University of Basel, Basel, Switzerland, 3. University
Hospitals Leuven, Leuven, Belgium
The need to explore innovative care models that are able
to sustain or improve healthcare outcomes for older hospi-
talized adults is urging. G-COACH is a multi-phase mixed
methods research project that aims to test the efficacy of a
geriatric-cardio co-management model of care. Geriatric co-
management is characterized by collaboration and shared
decision-making between the interdisciplinary geriatric team
and treating physician. The G-COACH project incorporates:
1) a systematic literature review; 2) a two-round interna-
tional Delphi study to determine quality indicators; 3)model
development based on local stakeholder involvement and
4)a pre-post intervention study to test the efficacy of a geri-
atric co-management intervention.
The systematic review and meta-analysis including 12
prospective experimental studies showed that geriatric co-
management reduced overall length of stay (MD, -1.88 [95%
CI, -2.44 - -1.33]) and resulted in a trend towards reduced in-
hospital mortality (OR, 0.72 [95% CI, 0.50 - 1.03]). There
was no effect on the number of patients discharged home,
post-discharge mortality and readmission rate. The Delphi
study resulted in 8 structure, 7 process and 16 outcome
indicators that 28 international experts found feasible and
appropriate to evaluate geriatric co-management programs.
Based on the information from the review and Delphi-study,
a theoretical geriatric co-management intervention was
designed. This theoretical model was adapted into a practical
co-management program based on participant observation,
focus groups, interviews and an observational pilot and fea-
sibility study including 80 patients. Finally, the practical co-
management program will be evaluated in a large pre-post
intervention study including 170 participants in each cohort.
LATE MOBILIZATION IN ELDERLY SURGICAL
PATIENTS PREDICTS READMISSION OR DEATH
AFTER DISCHARGE
J.L.Pederson1, R.S.Padwal2,3, L.Warkentin1, J.Holroyd-
Leduc4, A.Wagg5, R.G.Khadaroo1,6, 1. Department of
Surgery, Faculty of Medicine & Dentistry, University
of Alberta, Edmonton, Alberta, Canada, 2. Division
of General Internal Medicine, Faculty of Medicine &
Dentistry, University of Alberta, Edmonton, Alberta,
Canada, 3. Alberta Diabetes Institute, Edmonton, Alberta,
Canada, 4. Faculty of Medicine, University of Calgary,
Calgary, Alberta, Canada, 5. Capital Health Chair of
Healthy Ageing, Department of Medicine, University of
Alberta, Edmonton, Alberta, Canada, 6. Division of Critical
Care Medicine, Faculty of Medicine & Dentistry, University
of Alberta, Edmonton, Alberta, Canada
Acute surgical services are increasingly treating seniors
with complex care needs who are at high risk for hospi-
tal readmission and functional decline. Yet, the prognostic
importance of early post-operative mobilization remains
unclear. We investigated whether time to post-operative
mobilization among older surgical patients predicts read-
mission or death. Mobilization after emergency abdominal
surgery in a prospective cohort of patients aged 65years
requiring help pre-operatively with < 3 activities of daily
living were followed after discharge from 2 Canadian ter-
tiary-care hospitals. Late mobilization was defined as 36
hours following surgery. The primary outcome was 30-day
all-cause readmission or death. Patients (N=306) had a
mean age of 767.7 years, 55% were women, 41% were
vulnerable-to-moderately frail. Gallstones (23%), intestinal
obstruction (21%), or hernia (17%) were the most common
reasons for admission. Twenty-four percent were mobilized
36 hours after surgery. Late mobilized patients were more
often readmitted or died within 30-days [19 (26%) vs 22
(10%), p<0.001] and within 6-months [38 (51%) vs 64
(28%), p<0.001], compared to early mobilized patients.
Late mobilization remained associated with increased risk
of readmission or death within 30-days [adjusted odds ratio
(aOR) 2.50, 95%CI 1.165.40, p=0.02] and at 6-months
(aOR 1.85, 95%CI 0.993.5, p=0.055) in multivariable
logistic regression adjusting for age, sex, comorbidities,
total medications, hemoglobin, and frailty. Late mobiliza-
tion is common in elderly patients following emergency
abdominal surgery and identifies heighted risk of readmis-
sion or death after discharge. Interventions targeted at early
mobilization may decrease risk for adverse events in this
vulnerable population.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 20 (PAPER)
UNDERSTANDING AND TREATING MEMORY LOSS
AND DEMENTIA
COGNITIVE DECLINE AND ITS DETERMINANTS IN
DIVERSE ETHNO-REGIONAL GROUPS: THE COSMIC
COLLABORATION
P.Sachdev, 1. Centre for Healthy Brain Ageing, School of
Psychiatry, University of New South Wales, Sydney, New
South Wales, Australia, 2. Neuropsychiatric Institute, Prince
of Wales Hospital, Randwick, New South Wales, Australia
The Cohort Studies of Memory in an International
Consortium (COSMIC) (BMC Neurol. 2013 Nov 6;13:165)
is a consortium of population-based longitudinal studies of
ageing and dementia, which currently comprises 27 studies
with >50,000 participants. The main objectives of COSMIC
are to harmonise shared, non-identifiable data from cohort
studies in older individuals (60+ years), and perform joint
or mega-analyses using combined, harmonised data sets. An
earlier project applied uniform criteria to the prevalence of
MCI in 11 studies, and estimate the prevalence to be 6.7%
(range 3.2 to 10.8%), in contrast to the published estimates of
5.0% to 36.7% (PLOS One. 2015 Nov 5;10(11):e0142388).
The current study examined rates of cognitive decline in 14
studies from 12 countries. It showed that cognitive function
declined significantly with age for nearly every study and
neuropsychological test, with processing speed exhibiting
the greatest median decline (0.77 IQ points per year). No
consistent relationships between test type and rate of decline
were observed, however. The effects of sex and apolipopro-
tein E gene (APOE) were inconsistent in different studies.
Each extra year of education conveyed enhanced scores for
every test in every study. Language tests received the largest
benefit (0.802.75 IQ points). The effects of other putative
risk factors are currently being analysed and will be pre-
sented. COSMIC represents a truly international collabora-
tion to establish the epidemiology of age-related cognitive
decline and dementia.
THE CINGULATE CORTEX OF OLDER ADULTS WITH
EXCELLENT MEMORY CAPACITY
F.V.Lin1, P.Ren1, M.Mapstone2, T.Baran1, 1. University age, relative to 203 normal control subjects and 128 subjects
of Rochester Medical Center, Rochester, New York, 2.
University of California-Irvine, Irvine, California
Memory deterioration is the earliest and most devas-
tating cognitive deficit in normal aging and Alzheimers
disease. Some older adults, known as Supernormals, main-
tain excellent memory. This study examined relationships
between cerebral amyloid deposition and functional connec-
tivity (FC) within the cingulate cortex (CC) and between CC
and other regions involved in memory maintenance between
Supernormals, healthy controls, and those at risk for
Alzheimers disease (amnestic mild cognitive impairment).
Supernormals had significantly stronger FC between anterior
CC and R-hippocampus, middle CC (MCC) and L-superior
temporal gyrus, and posterior CC and R-precuneus, while
weaker FC between MCC and R-middle frontal gyrus and
MCC and R-thalamus than other groups. These FC were
significantly related to memory and global cognition in
IAGG 2017 World Congress
5
all participants. Amyloid deposition did not differ among
groups. Relationships between global cognition and FC were
stronger among amyloid positive participants. Relationships
between memory and FC remained regardless of amyloid
level. This revealed how CC-related neural function partici-
pates in cognitive maintenance in the presence of amyloid
deposition, potentially explaining excellent cognitive func-
tion among Supernormals.
MILD COGNITIVE IMPAIRMENT DETECTION
BY SIMULTANEOUS USE OF SCALES: ANEURAL
COMPUTING SOLUTION
C.Surez-Araujo1, P.Garca Bez5, A.Prochazka8,
N.Rodrguez Espinosa7,6, C.Fernndez Viadero3,
1. Instituto Universitario de Ciencias y Tecnologas
Cibernticas, Universidad de Las Palmas de Gran Canaria,
Las Palmas de Gran Canaria, Las Palmas, Spain, 3. Unidad
de Atencion a la Dependencia de Santander, Gobierno de
Cantabria, Santander, Santander, Spain, 5. Departamento
de Ingenieria Informatica y de Sistemas, Universidad de
La Laguna, La Laguna, Spain, 6. Unidad de Neurologia,
Conducta y Memoria, La Laguna, Spain, 7. Hospital
Nuestra Seora de la Candelaria, Sta. Cruz de Tenerife,
Spain, 8. University of Chemistry and Technology, Prague,
Czech Republic
At present there is an increase in the elderly population
and more persons with cognitive troubles, where dementia is
a socio-sanitary challenge. Mild cognitive impairment (MCI)
may be a prodromal state of Alzheimers disease and other
dementias. It is considered an optimal target for diagnosis,
likely to be highly prevalent in the future, worldwide.
MCI diagnosis is principally based in cognitive and daily
living functional activities assessment. However, in clinical
settings, essentially primary care setting, MCI is challeng-
ing because of time, consulting restrictions and even diffi-
culties understanding cognitive test cut-off points, mainly
when diagnosis depends on two or more scales, and it is
underdiagnosed.
An intelligent system to assist in MCI diagnosis, based
on hybrid neural architectures, the counter-propagation net-
work (CPN), with a wrapper approach, has been designed.
The dataset includes scores of three commonly used scales,
MMSE, GDS and FAQ, along with years of education and
who revealed a MCI, from ADNI database.
The efficiency of the proposed CPN-based system, with
MMSE, FAQ and age, was evaluated using several perfor-
mance measurements and the clinical utility index (CUI).
Its diagnostic performance was compared with a geriatri-
cian, a neurologist and two family physicians. Our pro-
posal achieved the highest score amongst all, AUC: 95,11%,
Accuracy: 86,84%, Sensitivity: 90%, Specificity:84,78%,
CUI: 0,715. These results were also better than optimum cut-
off over each one of the tests.
Neural computing methods may be useful tools in clinical
settings even when employing brief screening tests.
BIDDING THE MEDICAL MODEL GOODBYE! NEW
WAYS OF THINKING ABOUT DEMENTIA
A.J.Astell2,1,3, A.M.Hernandez2, 1. School of Health
and Related Research, University of Sheffield, Whitby,
6 Innovation in Aging, 2017, Vol. 1, No. S1
Ontario, Canada, 2. Ontario Shores Centre for Mental
Health Sciences, Whitby, Ontario, Canada, 3. University of
Toronto, Toronto, Ontario, Canada
Although dementia is a medical diagnosis, there are cur-
rently no disease-modifying therapies and health services
have little to offer people who receive a dementia diagnosis.
However, the Medical Model exerts a powerful grip on think-
ing about dementia, limiting the exploration of other models
and approaches that may be of benefit. This opportunis-
tic study explored the ease at which alternate models from
other areas of health and disability could be explained to and
understood by a range of health professionals. Data were cap-
tured from 40 staff in a psychiatric hospital during an inter-
active Grand Rounds session. Atrue case scenario was used
with phased presentation of four different theoretical mod-
els: Medical Model, Recovery, Self-Management and Rights-
Based. The session concluded with a video of the individual
describing his life after adopting technology. Understanding
was assessed through written answers regarding benefits and
limitations of each approach to the case scenario and a final
question asking which approach best explained his experi-
ence. The results suggested that conveying conceptual alter-
natives to the Medical Model is possible in a simple and
accessible way. The written answers conveyed understanding
of the three alternate models and their application to the case
scenario. Fewer than 10% of respondents proposed that the
Medical Model best explained the experience of the partici-
pant loving every minute of his life. This suggests the time
has come to explore alternate models and lessons learnt from
other fields to enable people to live well with dementia.
INTERVENTIONS FOR THE TREATMENT OF
BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS
OF DEMENTIA: AN OVERVIEW
S.Harrison1,2, S.Dyer1,2, K.Laver1,2, C.Whitehead1,2, members of an urban LGBTQ senior center. Second, prelimi-
M.Crotty1,2, 1. NHMRC Cognitive Decline Partnership
Centre, Syndey University, Syndey, New South Wales,
Australia, 2. Department of Rehabilitation, Aged and
Extended Care, Flinders University, Adelaide, South
Australia, Australia
Behavioural and psychological symptoms of dementia
(BPSD) are common amongst people with dementia and can
have a large impact on public health by potentially reduc-
ing quality of life, increasing caregiver impact and increas-
ing costs associated with dementia care. The objective of this
study was to synthesise the findings of systematic reviews of
randomised controlled trials of interventions for the treat-
ment of BPSD (PROSPERO CRD42016039477). Asystem-
atic search of The Cochrane Database of Systematic Reviews,
DARE, Medline, EMBASE and PsycINFO retrieved 3467 cita-
tions. Systematic reviews of randomised controlled trials of
interventions aimed at treating BPSD in patients with demen-
tia of any type including Alzheimers disease or Alzheimers
disease only were included. The most comprehensive and up-
to-date reviews for acetylcholinesterase inhibitors, antipsy-
chotics, antidepressants, benzodiazepines, mood stabilisers,
melatonin, caregiver interventions, exercise, music therapy,
cognitive stimulation and psychological interventions were
included. For the majority of the interventions, included
reviews were of moderate to high quality according to the
AMSTAR checklist and the evidence was of low to moderate
quality as rated using GRADE criteria. Reported effect sizes
for atypical antipsychotics on global BPSD measures were
very small (SMD 0.17, 95%CI 0.08 to 0.25; moderate qual-
ity evidence). Cognitive enhancers also had very small effects;
reviews reported non-significant trends in favour of done-
pezil or memantine (4 and 2 studies, respectively) and a small
but significant effect for galantamine based on high quality
evidence from two studies. Effect sizes have been compared
across interventions and interpreted in light of the severity of
dementia in study populations.
SESSION 25 (SYMPOSIUM)
PROMOTING HEALTHY AGING IN DIVERSE
OLDER COMMUNITIES THROUGH ACADEMIC-
COMMUNITY RESEARCH
Chair: N.M.Giunta, Hunter College, New York, New York
Discussant: D.Gardner, Hunter College, New York, New
York
As global aging brings increased diversity in race/ethnicity,
language and culture, ability, sexual orientation, gender iden-
tity, and access to economic and other resources, supporting
the health and well-being of older adults and their communi-
ties is complicated by cultural and geographic diversity, and
growing structural inequities. Community-based scholarship
plays an essential role in understanding and addressing the
needs that emerge from disparities and intersectionalities that
shape the lives of older adults in multicultural communities.
This symposium highlights innovative research and describes
the challenges and rewards of academic-community relations
that build knowledge and promote healthy aging through
community-based inquiry. First, we present a study exploring
long-term and advanced care planning among multicultural
nary findings are shared from a community-based initiative
to address knowledge and service-utilization gaps regarding
Alzheimers disease among urban Latino elders. Third, we
describe a university-community collaboration using social
network analysis to improve provider knowledge and support
for caregivers of individuals with dementia. Fourth, results are
shared from a study of intergenerational transmission of cul-
tural identity among older Pacific Islanders in Hawaii. Finally,
we present an ethnographic study of academic-community
relationships in a rural U.S.college town, and perceptions of
multiple stakeholders who influence the aging experience in
their community. Through a variety of methods, these studies
share a commitment to community-based research that aims
to support collaboration, empower communities, and ulti-
mately transform practice and policy to better meet the diverse
needs of urban and rural older adults around the globe.
LONG-TERM CARE PLANNING AND THE
CHANGING LANDSCAPE OF LGBTQ AGING
J.McGovern1, D.Gardner2,3, 1. Lehman College, City
University of New York, New York, New York, 2. Silberman
School of Social Work, Hunter College, City University of
New York, New York, New York, 3. Brookdale Center for
Healthy Aging, New York, New York
Older LGBTQ adults are twice as likely to grow old with-
out a spouse or adult child and more often act as caregivers
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
for family members or friends than their non-LGBTQ peers.
These distinct caregiving experiences may contribute to
health and quality-of-life disparities for aging LGBTQ adults,
including increased rates of isolation, depression, chronic ill-
ness, and shortened life expectancy. Findings are presented
from a qualitative study examining long-term care and end-
of-life planning among members of an LGBTQ senior center
in the Bronx, New York. Focus groups and in-depth inter-
views with the primarily African American, Afro-Caribbean,
and Latino participants explored plans and concerns regard-
ing their future and advanced care needs. Findings suggest
considerable resilience; participants recognized their future
care needs and preferences, and described an increased sense
of personal agency and greater acceptance about aging and
end-of-life. We discuss implications for more inclusive and
strengths-based practice, policy, and research with LGBTQ
elders.
COMMUNITY-BASED PARTICIPATORY METHODS
IDENTIFY NEEDS AND SOLUTIONS: LATINOS AND
ALZHEIMERS DISEASE
C.R.Gelman1, R.Glushefski2, 1. Silberman School of Social
Work at Hunter College, City University of New York, New
York, New York, 2. Brookdale Center for Healthy Aging,
New York, New York
In the U.S. there will be over 1 million Latinos with
Alzheimers disease and related dementias (ADRD) by 2050.
While Latinos are at greater risk for ADRD than non-His-
panic whites, they are less likely to access diagnostic and
intervention services. Through an academic-community
partnership, a needs assessment identified ADRD as a criti-
cal area of concern and an academic-community coalition
was formed to design, implement, and evaluate an interven-
tion that trains natural helpers (e.g., clerks, hair dressers)
to be able to detect symptoms of ADRD, provide culturally
competent information, and facilitate referral to a single
bilingual, bicultural community-based organization for fur-
ther intervention. Timely detection of ADRD can result in
slower progression of dementia and an improved quality of
life for persons with ADRD and their families. We describe
the collaborative process of this community-academic part-
nership and discuss implications internationally, drawing
comparisons with projects using natural helpers in various
Latin American countries.
USING NETWORK ANALYSIS TO EXAMINE
DEMENTIA CARE REFERRALS
C.Morano1, A.Savage1, C.Rees2, 1. Silberman School of
Social Work at Hunter College, City University of New
York, New York, New York, 2. State University of New
York Albany, Center for Human Services Research,
Albany, New York
Social network analysis (SNA) has been employed exten-
sively to understand the size, density, centralization, frag-
mentation of health care and social care. Network theory
and analysis has guided research in topics as diverse as
primary care practices, teamwork and inter-professional
practice, translational research, and to examine structural
relationships and influence in networks. This paper describes
a collaborative process with two universities and a commu-
nity-based provider in designing the PSS Network Analyses
IAGG 2017 World Congress
7
pilot study to examine the network structures used by
dementia care consultants in a community-based program.
Findings suggest a hierarchy of factors, including but not
limited to length of waiting lists, distance to the caregiver,
and race/ethnicity of the provider that influenced the selec-
tion of referrals to a variety of dementia related providers.
This session concludes with a discussion of potential uses of
SNA to support the concrete physical, emotional and finan-
cial needs of dementia caregivers.
INTERGENERATIONAL CULTURAL TRANSMISSION
AND COMMUNITY IDENTITY AMONG PACIFIC
ISLANDERS
H.Vakalahi2, N.M.Giunta1, 1. Silberman School of Social
Work at Hunter College, City University of New York, New
York, New York, 2. Morgan State University, Baltimore,
Maryland
Transmission of cultural values, beliefs, and traditions
from one generation to another rely on multiple mecha-
nisms within a variety of social and environmental contexts.
Intergenerational transmission of culture has been conceptu-
alized among Pacific Island communities as relationships and
connections across multiple systems from micro to macro
to metaphysical. This phenomenological study set in a small
community in Hawaii included in-depth individual inter-
views conducted with 36 Elders in their homes. Community
consultants collaborated with researchers throughout
the study to maintain trust and rapport with participants.
Qualitative analysis using principles of grounded theory
resulted in preliminary findings that suggest community
rituals serve as an important conduit for intergenerational
transmission of values, traditions, beliefs, and historical
knowledge. Culture is a primary underpinning of community
life; therefore, the community context is essential for under-
standing macro and micro social work practice, particularly
with indigenous communities. Implications for practice and
research will be discussed.
A NEW NEIGHBORHOOD EVERY FALL: AGING IN
PLACE IN ASMALL COLLEGE TOWN
K.H.Powell, Frostburg State University, Frostburg,
Maryland
Older adults who live in neighborhoods adjacent to aca-
demic institutions have unique experiences that make them
vulnerable to marginalization and displacement. As these
neighborhoods become increasingly dominated by students
and other university stakeholders, older adults find them-
selves in the minority in a neighborhood where they have
lived for many years. Often these neighborhoods are attrac-
tive to universities, city governments, and private companies
for their development potential, which can result in gentrifi-
cation. Results of a year-long ethnographic study of a neigh-
borhood adjacent to a medium-sized public university are
presented to shed light on relationships between members
of the following five stakeholder groups with vested inter-
ests in the neighborhood: older adult year-round residents,
students who live off-campus, property owners/managers
who serve as landlords, and public university or community
officials. The study highlights challenges and opportunities
for academic-community relations to support aging in place.
Implications for practice and research will be discussed.
8 Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 30 (PAPER)
NUTRITIONAL ISSUES IN OLDER ADULTS
FAT MASS PREDICTS SURVIVAL IN MEN BUT NOT
WOMEN IN THE BALTIMORE LONGITUDINAL
STUDY OF AGING
N.Chiles Shaffer, S.A.Studenski, National Institutes of
Health, Baltimore, Maryland
Age and body mass index (BMI) are known risk factors
for mortality. It is important to distinguish the makeup of
ones body composition, specifically the amount of lean and
fat mass, from BMI and understand the contribution of body
composition to mortality risk. We examined whether base-
line lean mass and fat mass predict survival in the Baltimore
Longitudinal Study of Aging, a study of normative aging.
Cox proportional hazards were modeled in 632 men and
684 women (ages 2095years old) with DXA data. In the
analytic sample, women were younger than men (mean age
59.8 vs. 63.7, p-value <0.001). Follow-up ranged from 2 to
25years (mean: 13years), and over the follow-up period 133
men and 91 women died. Baseline appendicular lean mass
(ALM) (kg) and fat mass (kg) were used to predict survival,
additionally adjusting for age and BMI (quadratic). In men,
greater fat mass reduces mortality after accounting for age,
ALM, and BMI. In women, neither fat mass nor lean mass
were associated with mortality risk. In women, body com-
position does not add to the survival effect of BMI, while in
men both lean and fat mass add to the survival effect of BMI.
Further research is needed to fully understand the impact of
lean and fat mass on survival in men and women, particu-
larly assessing change in body composition over time.
PLASMA KLOTHO, ADIPOSITY, AND INSULIN
RESISTANCE IN OLDER ADULTS: FINDINGS FROM
THE INCHIANTI STUDY
M.Shardell1, R.Kalyani2, R.D.Semba2, S.Bandinelli3, (13.4g/dL and 3.7g/dL) compared to survivors (14.3d/dL
R.Varadhan2, L.Ferrucci1, 1. National Institute on
Aging, Baltimore, Maryland, 2. Johns Hopkins Medical
Institutions, Baltimore, Maryland, 3. LHTC, Local Health
Unit Tuscany Centre, Firenze, Italy
Klotho is a recently discovered hormone with demonstrated
anti-aging properties in animal studies. In older humans, evi-
dence has linked plasma klotho with longevity. Insulin signaling
is associated with longevity in animals and in humans, medi-
ated in part by the accumulation of fat mass common in aging.
Whether klotho is part of this longevity pathway is unknown.
We hypothesize that plasma klotho is associated with insulin
resistance and this association depends on by obesity status.
Plasma klotho was measured in 832 participants aged
55years in InCHIANTI, a prospective cohort study comprising
Italian adults. Insulin resistance was operationalized using the
homeostasis model for insulin resistance (HOMA-IR). Body
size was categorized using World Health Organization body
mass index (BMI) categories (<25 [under- or normal weight;
n=303], 2529.9 [overweight; n=393], 30 [obese; n=136] kg/
m2). Stratified inverse probability weighted linear regression
modeled the association while handling missing data.
Mean (SD) klotho concentrations (pg/mL) were 718.9
(434.6) for under/normal weight, 687.8 (237.1) for
overweight, and 680.6 (210.6) for obese participants. After
adjustment for biomarkers, comorbidities, demographics,
and lifestyle; each logarithm higher klotho (pg/mL) was asso-
ciated with 0.69 higher units of HOMA-IR (95% confidence
interval[CI] 0.191.20; p-value=0.007) in overweight par-
ticipants. We found little evidence for association in partici-
pants with BMI<25kg/m2 (beta=0.20; 95%CI -0.200.61;
p-value=0.32) or obese participants (beta=-0.11; 95%CI
-1.16-0.94; p-value=0.84).
Plasma klotho was positively associated with insulin
resistance in overweight older adults, but not associated in
other BMI categories. Further studies are needed to explore
the relationship of these paradoxical findings to longevity.
NUTRITIONAL STATUS AND MORTALITY IN 5
YEARS IN BRAZILIAN ELDERLY: SURVIVAL ANALYSIS
L.P.Corona1, Y.Duarte2, M.Lebrao2, 1. Faculty of Applied
Scientes, University of Campinas, Limeira, Sao Paulo, Brazil,
2. University of So Paulo, Sao Paulo, Sao Paulo, Brazil
This study aimed to assess the impact of nutritional sta-
tus on survival time in Brazilian elderly living in five years
follow-up. Elderly (n=1,256) from the third wave of SABE
Study (Health, Well-being, and Aging) conducted in 2010,
were followed for 5years, when they were contacted for the
fourth wave. Survival functions were estimated according to
nutritional status in four groups: 1)without nutritional alter-
ation; 2) anemia only; 3) hypoalbuminemia only; 4) ane-
mia and hypoalbuminemia (Anemia= hemoglobin<12g/dL
for women and <13g/dL for men, and hypoalbuminemia=
serum albumin<3,5g/dL). Body Mass Index (BMI) was also
included. Hazard ratios (HR) were calculated, following the
Cox proportional hazards model, controlling for baseline
covariates. All analyses considered sample weights and were
performed using the Stata14. After the 5-year period, 12.3%
of the elderly died and 8.2% were lost to follow-up. Those
who died had lower hemoglobin and albumin concentrations
and 3.9g/dL;p<0.001). Crude death rate was 27.6/1000per-
son-years for elderly in group 1, 124.3 in group 2, 116.0
in group 3 and 222.8 in group 4 (p<0.001). In final mod-
els, group 2 and 3 showed similar effect (HR=2.53,p=0.002;
2.32,p=0.001; respectively) and group 4 had a twofold risk
(HR=4.48; p<0.001). BMI did not alter results, and lost sig-
nificance when in the same model as biomarkers. Thus, ane-
mia and hypoalbuminemia have additive effect on mortality
risk in 5 years, independently from BMI. Because they are
common and cost-effective biomarkers, they should be part
of the geriatric evaluation in clinical practice.
PROTEIN INTAKE AND INCIDENT SARCOPENIA IN
OLDER ADULTS: THE HEALTH ABC STUDY
D.K.Houston1, J.A.Tooze1, M.Visser2, F.A.Tylavsky3,
S.Rubin4, A.Newman5, T.B.Harris6, S.B.Kritchevsky1, 1.
Wake Forest School of Medicine, Winston Salem, North
Carolina, 2. Vrije Universiteit, Amsterdam, Netherlands, 3.
University of Tennessee Health Science Center, Memphis,
Tennessee, 4. University of California, San Francisco,
California, 5. University of Pittsburgh, Pittsburgh,
Pennsylvania, 6. National Institute on Aging, Bethesda,
Maryland
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Low protein intake has been hypothesized to contribute
to sarcopenia, the age-related loss of muscle mass, strength,
and performance. We examined the association between pro-
tein intake and incident sarcopenia in community-dwelling,
older adults in the Health ABC study (n=2,101; mean age
74.5 yrs, 53% female, 37% black). Protein intake was calcu-
lated using an interviewer-administered food frequency ques-
tionnaire and categorized into tertiles (<0.7, 0.7-<1.0, and
1.0g protein/kg actual body weight and <0.76, 0.76-<1.06,
and 1.06g protein/kg adjusted body weight). Sarcopenia
was defined as low appendicular lean mass adjusted for BMI
(<0.789 in men, <0.512 in women) and low grip strength
(<30kg in men, <20kg in women) or slow gait speed (<1.0
m/sec). The association between protein intake and incident
sarcopenia over 4years of follow-up was examined using pro-
portional hazard regression models adjusted for demograph-
ics, behavioral characteristics, height, total energy intake,
and chronic conditions. Mean (SD) protein intake was 0.90
(0.36) g/kg actual body weight. The cumulative incidence of
sarcopenia over 4years of follow-up was 18.5%. Individuals
in the lower two protein tertiles based on actual body weight
were at greater risk of sarcopenia over 4 years of follow-
up (HR (95% CI): 3.25 (2.045.18) and 1.78 (1.222.60),
respectively) compared to those in the upper protein tertile.
When adjusted body weight was used, only those in the low-
est protein tertile were at greater risk of sarcopenia (HR
(95% CI): 1.62 (1.022.57) and 1.17 (0.801.70)). Dietary
protein should be studied further as a modifiable risk factor
for sarcopenia.
DEVELOPING ACLINICAL DIAGNOSTIC TOOL FOR
THE IDENTIFICATION OF OLDER ADULTS WITH
HYPOVITAMINOSIS D
C.Annweiler1, G.Duval1, A.Brangier1, P.Par1, munication with physicians, enhanced access to non-medical
O.Beauchet2, A.Kabeshova1, B.Fantino1, 1. Geriatric
Medicine, Angers University Hospital, Angers, France, 2.
McGill University, Montreal, Quebec, Canada
Background: Hypovitaminosis D is highly prevalent
among older adults and associated with adverse health
events. To rationalize vitamin D assays and save health costs,
our objectives were to develop and test a clinical diagnostic
tool for the identification of older community-dwellers with
hypovitaminosis D.
Methods: 1924 community-dwelling volunteers65years
without vitamin D supplements were recruited in this cross-
sectional study. Aset of clinical variables (age, gender, living
alone, individual deprivation, body mass index, undernutri-
tion, polymorbidity, number of drugs used daily, psychoac-
tive drugs, biphosphonates, strontium, calcium supplements,
falls, fear of falling, vertebral fractures, Timed Up&Go test,
walking aids, lower-limb proprioception, handgrip strength,
visual acuity, wearing glasses, cognitive disorders, sad mood)
was recorded from standardized questionnaires and medi-
cal examination at the time of serum 25-hydroxyvitamin
D(25OHD) measurement. Hypovitaminosis D was defined
as serum 25OHD75nmol/L, 50nmol/L or 25nmol/L. The
whole sample was separated into training and testing subsets
to design, validate and test an artificial neural network (mul-
tilayer perceptron, MLP).
Results: 1729 participants (89.9%) had 25OHD75nmol/L,
1288(66.9%) had 25OHD50nmol/L, and 525(27.2%) had
IAGG 2017 World Congress
9
25OHD25nmol/L. MLP using 16 clinical variables was
able to diagnose hypovitaminosis D75nmol/L with accu-
racy=96.3%, area under curve(AUC)=0.938, and =79.3
indicating almost perfect agreement. It was also able to
diagnose hypovitaminosis D50nmol/L with accuracy=81.5,
AUC=0.867 and =57.8 (moderate agreement); and hypovi-
taminosis D25nmol/L with accuracy=82.5, AUC=0.835 and
=55.0 (moderate agreement).
Conclusions: We developed an algorithm able to iden-
tify, from 16 clinical variables, older community-dwellers
with hypovitaminosis D.Such inexpensive tool should help
clinicians in decisions to supplement their patients without
resorting to blood tests.
SESSION 35 (SYMPOSIUM)
INNOVATION IN HEALTH CARE DELIVERY FOR
ADULTS AGING WITH DISABILITIES
Chair: J.Caldwell, National Council on Aging
Co-Chair: M.Campbell, Grapeview, Washington
The Center for Medicare and Medicaid Services (CMS)
Innovation Center (CMMI) has contracted with NORC
at the University of Chicago to evaluate 23 Health Care
Innovation Award (HCIA) programs, using a multi-year
mixed-methods evaluation comprising several domains:
Medicare and Medicaid claims experience, multiple site
visits, focus groups, and in-depth interviews with patients,
physicians, program staff, and front line workers. After
the second year of the evaluation, we observe evidence of
reduced health care utilization and improved quality of life
for one-fourth of the programs, with supportive qualitative
information seen in focus groups, such as improved com-
services, and the establishment of a single point of contact,
thereby reducing the need for acute services. This symposium
summarizes key evaluation findings on five topics central to
health care delivery: expanded medical homes for individuals
with intellectual or developmental disabilities, care coordina-
tion for Medicaid beneficiaries, chronic disease self-manage-
ment for individuals aging with disability, end-of-life care,
and training for direct care workers. The panel suggests that
policy makers hoping to implement innovative care coordi-
nation services for high-risk populations should consider the
upfront investment necessary to establish a medical home,
careful retraining of clinicians, and the return-on-investment
that may be possible through reductions in hospitalizations
and emergency department use.
AGING WITH APHYSICAL DISABILITY IN MEDICAID
MANAGED CARE
T.Heller, R.Owen, A.Bowers, H.Gibbons, Department of
Disability and Human Development, University of Illinois
at Chicago, Chicago, Illinois
Medicaid expansion brings the opportunity to serve new
patients through innovation programs. Using data from
a mixed-methods CMMI evaluation, we explore cost and
quality of care outcomes for five programs. Several awardees
achieved statistically significant reductions in total cost of
care and significant reductions in hospitalizations, relative
to respective comparison groups. In addition, three of these
10
awardees delivered targeted services to Medicaid beneficiar-
ies at the highest risk, while improving quality on indicators
such as primary care use and potentially avoidable hospi-
talizations. Innovation programs achieved these outcomes by
helping patients who use unnecessary emergency department
visits establish relationships with primary care practitioners,
investing substantially in building patient trust through com-
munity outreach, peer support, home visits, and providing
social service support for housing, food, and transportation.
INNOVATION FOR INDIVIDUALS AGING WITH
LIFELONG DISABILITY
S.A.Ruiz1, M.M.Putnam2, J.Caldwell3, 1. Health Care, by drugs and their life span has been extended. Some drugs
NORC at the University of Chicago, Bethesda, Maryland,
2. Simmons College, Boston, Massachusetts, 3. National
Council on Aging, Arlington, Virginia
Medical advancements have extended the life of individu-
als with long-term disability into later life, also known as
aging with disability. The paucity of evidence-based programs
demonstrating effectiveness represents a gap for this unique
group. This study analyzes quasi-experimental mixed-meth-
ods evaluation data on two programs in California (N=211)
and Minnesota (N=124) funded under CMMIs Health Care
Innovation Award (HCIA) program, including Medicare and
Medicaid claims data on over 800 patients, administrative
comparison groups, survey data, site visits, and focus groups
with patients and caregivers. All programs show evidence of
improved quality of care and some support for reduced utili-
zation. In addition to self-management education and moti-
vational interviewing, mechanisms driving these favorable
findings include enhanced access, supportive care, and avoid-
ance of acute exacerbations of chronic conditions. Individuals
aging with disability are not traditional consumers and often
require careful tailoring and adaptations of existing programs.
INNOVATION IN CARE COORDINATION FOR
INTELLECTUAL OR DEVELOPMENTAL DISABILITIES
S.A.Ruiz1, J.Caldwell2, 1. Health Care, NORC at the
University of Chicago, Bethesda, Maryland, 2. National
Council on Aging, Arlington, Virginia
A significant gap remains between existing evidence-
based care coordination techniques in medical homes for
the general population and those that have been successfully
translated for people with intellectual and developmental
disabilities (ID/DD). Two programs funded by CMMI have
dedicated resources to the translation of existing evidence-
based practices for the ID/DD population in community or
clinical settings. Across New York, New Jersey, and Rhode
Island, these programs have served over 2,200 individuals
and demonstrated improved quality of care and limited evi-
dence of reduced health care claims utilization. A greater-
than-expected investment was needed to retrain clinicians
and other staff to understand the unique needs of people
with ID/DD and cater approaches based on person-centered
planning. Establishing a medical home faced several barri-
ers, such as administrative delays due to changes in State
Medicaid offices and issues regarding health plan reim-
bursement. Additionally, community-based organizations
often encountered difficulties in targeting their services to a
population with the appropriate risk level for a successful
intervention.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 40 (SYMPOSIUM)
LONG-LIVED ANIMAL MODELS AND HEALTH-SPAN
EXTENSION IN STUDIES OF AGING
Chair: N.R.Barzilai, Albert Einstein College of Medicine,
New York
Co-Chair: V.Gorbunova, Rochester University, Rochester,
New York
Discussant: D.Sinclair, Harvard Medical School, Boston,
Massachusetts
A dramatic advance in the filed of aging occurred when
animal models where targeted by genetic, environmental or
are approved for use in human conditions but not for aging.
The NIA has created an intervention testing program (ITP)
where drugs that may target specific mechanism for aging
can used and life span is determined in 3 centers for both
sexes. The challenge that has not been addressed adequately
before, is how we make sure that life span extension is cou-
pled with health-span. A longer or even similar period of
diseases is not really a good alternative for targeting aging.
For example, while different species of nematodes may have
extended life- but not health-span several human centenar-
ians group have extended health-span coupled with contrac-
tion of morbidities. In this symposium we would like leading
gerontologists in the biology of aging to discuss their experi-
ence and address the following points:
Is longevity in long-lived sub-species in nature live also
healthier?
How do we study health-span in pre clinical setting of
animal models?
Is there health-span exchange i.e. protection from one dis-
ease but propensity for another (rapamycin and diabetes as
an example)?
Which other animal models can be useful to confirm
effects that are relevant to humans.
Animals in nature (Gorbunova, V), genetic manipulations
(Cohen, H), testing drugs in rodents (Sinclair, D and Strong
R; including rapamycin, acarbose, metformin, resveratrol
and supplement of NAD) will be subject for discussion.
THE NIA INTERVENTIONS TESTING PROGRAM: AN
UPDATE
R.Strong1, D.Harrison2, N.Nadon3, R.A.Miller4, 1. Texas
Health Sciences Center, San Antonio, Texas, 2. Jackson Lab,
Bar harbor, Maine, 3. NIH/NIA, Bethesda, Maryland, 4.
University of Michigen, Detroit, Michigan
The NIA Interventions Testing Program is a preclinical,
multi-site translational research program to evaluate agents
hypothesized to extend mouse lifespan by retarding aging or
postponing late life diseases. Interventions proposed by sci-
entists from the research community are initially tested, in
parallel, at three sites (Jackson Laboratories, University of
Michigan and the University of Texas Health Science Center
at San Antonio) in male and female genetically heterogene-
ous UM-HET3 mice using identical, standardized protocols.
The use of genetically heterogeneous mice greatly reduces the
possibility that the results are only valid for a single strain.
Fifty-three lifespan experiments, involving 30 test agents,
were initiated in the first 11 years of the ITP. Significant
effects on longevity, in one or both sexes, have been published
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
for 6 of the tested agents. These agents are proving useful as
new tools to probe the aging process and for identifying new
therapeutic targets for clinical intervention.
LONGEVITY MECHANISMS IN LONG-LIVED
MAMMALS
V.Gorbunova, A.Seluanov, University of Rochester,
Rochester, New York
Animals have evolved a dramatic diversity of aging rates.
Even within mammals, lifespans differ over 50-fold from
four years in a mouse to 211 years in a bowhead whale.
This natural diversity of lifespan can be exploited to under-
stand the mechanisms of longevity. With modern technologi-
cal advances now available, it became possible to undertake
comparative study of aging at molecular level. Our goal
is to identify mechanisms that allow such exceptionally
long-lived animals to live long and healthy lives and then
use these mechanisms to benefit human health. I will dis-
cuss our recent progress in the studies of tumor suppressor
mechanisms, and DNA repair in short and long-lived rodent
species.
IMPROVING HEALTHSPAN BY MANIPULATING
SIRT6 LEVELS: HOW DOES IT WORK?
H.Cohen, Bar-Ilan University, Tel Aviv, Israel
Mice over expressing the NAD+ dependent deacylases
SIRT6 (MOSES mice) have extended lifespan along with
significant improvement of their healthspan. In compari-
son to their wild-type (WT) littermates, old MOSES mice
showed amelioration of a variety of age-related disorders,
including: improved glucose tolerance, younger hormo-
nal profile, reduced age-related adipose inflammation and
increased physical activity. To explore the mechanisms
underlying SIRT6 positive effects, series of complementary
metabolomics, transcriptomics and proteomics analyses
were performed. Together, these analyses demonstrate that
SIRT6 overexpression mimics key features of the meta-
bolic profile of dietary restriction (DR) a well-known treat-
ment that extends healthy lifespan in multiple organisms.
Like DR, SIRT6 overexpression reduces IGF-1 levels and
signaling and induces liver and muscle AMPK activity. In
addition, it reprograms liver metabolism, particularly, the
induction of fatty acid beta-oxidation, thus providing the
required energy when nutrients are limited. These findings
will promote the development of drugs against age related
diseases.
NAD PRECURSORS AS INTERVENTIONS FOR AGE-
RELATED DISEASES AND EXTENDING HUMAN
HEALTHSPAN
D.Sinclair, 1. Harvard Medical School, Boston,
Massachusetts, 2. Harvard Glenn Center, Boston,
Massachusetts
From yeast to mammals, nicotinamide adenine dinucle-
otide (NAD+) is a critical cofactor for redox reactions and
for the activity of sirtuins. Levels of NAD+ decline with age.
Interventions that boost NAD+ levels increase C. elegans
lifespan and restore mitochondrial function in aging mice,
in each case is dependent upon the sirtuins. Interventions
that increase NAD+ availability, such as NAD+ precursors
IAGG 2017 World Congress
11
and CD38 inhibitors induce profound changes in aging
mice including reversal of aspects of aging. Thus agents that
restore youthful NAD+ levels may be next generation inter-
ventions to improve human healthspan.
SESSION 45 (SYMPOSIUM)
BIOLOGICAL MARKERS IN FAMILY RESEARCH
Chair: L.Bangerter, Mayo Clinic, Pennsylvania
Co-Chair: S.Zarit, Penn State University
This symposium will examine the use of biological mark-
ers as an important component of family research. The
papers presented in this symposium highlight the utility of
biological markers as a mechanism by which to enhance our
understanding of a variety of family experiences and rela-
tional ties including family stressors, parent-child interac-
tions, everyday family support, and family caregiving. Cichy
will discuss the association between daily family stressors
and naturally occurring cortisol levels; this discussion will
emphasize racial differences in these associations. Birditt
will examine daily interactions that middle-aged adults have
with their aging parents and adult children. This presenta-
tion will focus on how daily interactions with generations
above and below have implications for daily negative affect
and cortisol. Bangerter will focus specifically on the relation-
ships between middle-aged children and aging parents and
discuss the biopsychosocial implications of giving support to
parents with health problems and limitation in activities of
daily living. Liu will conclude with a discussion of biological
implications of family caregiving through an examination of
three biomarkers: salivary cortisol, Dehydroepiandrosterone
Sulfate, and alpha amylase. Each presentation applies bio-
logical markers to understand distinctive family experiences
and ties which are fundamental to individual and family
functioning.
RACIAL DIFFERENCES IN ASSOCIATIONS BETWEEN
FAMILY NETWORK STRESSORS AND SALIVARY
CORTISOL
K.E.Cichy1, R.S.Stawski2, 1. Human Development and
Family Studies, Kent State University, Kent, Ohio, 2.
Oregon State University, Corvalis, Oregon
Research reveals emotional costs of African Americans
family ties, however, few studies consider the physiological
toll of stressors involving family. We address this gap by exam-
ining racial differences in associations between daily family
stressors and naturally occurring cortisol levels. During daily
diary interviews, African American and European American
respondents from the National Study of Daily Experiences
(NSDE II, N=1, 931)reported on daily network stressors
(i.e., other family members stressors) and provided salivary
cortisol samples four times throughout the day on 4 of the
8 interview days. The interaction between individual differ-
ences in network stressor frequency and race significantly
predicted cortisol area under the curve (AUC; p < .01). Even
after covarying for negative affect, symptoms, and family
support provision, African Americans who report more net-
work stressors exhibited a lower AUC (i.e., less cortisol out-
put), whereas European Americans exhibited no association.
Implications for health disparities will be discussed.
12
DAILY INTERACTIONS WITH AGING PARENTS AND
ADULT CHILDREN: IMPLICATIONS FOR WELL-
BEING AND CORTISOL
K.Birditt1, J.Manalel1, K.Kim2, S.Zarit3, K.L.Fingerman4,
1. Institute for Social Research, University of Michigan, Ann
Arbor, Michigan, 2. University of Massachusetts Boston,
Boston, Massachusetts, 3. Pennsylvania State University,
State College, Pennsylvania, 4. University of Texas at
Austin, Austin, Texas
Midlife individuals report greater investment in their
children than in their parents. Little is known about daily
experiences in these ties, and the psychological and biologi-
cal systems that may underlie these associations. The present
study examined daily experiences with aging parents and
adult children and implications of those experiences for daily
negative affect and cortisol. Participants were middle-aged
adults (N = 156; 56% women) from the Family Exchange
Study Wave 2 who completed a 7-day daily diary study and
4 days of saliva collection which was assayed for cortisol.
Individuals reported more contact but fewer negative experi-
ences with adult children than with parents. Nevertheless,
contact and negative experiences with adult children were
more consistently associated with negative affect and daily
cortisol patterns than interactions with parents. Findings are
consistent with the intra-individual stake hypothesis which
suggests that individuals are more invested in relationships
with their children than their parents.
SUPPORT TO AGING PARENTS: IMPLICATIONS FOR
MIDDLE-AGED CHILDRENS DIURNAL CORTISOL
AND DAILY MOOD
L.Bangerter1, Y.Liu2, S.Zarit2, K.Birditt3, K.L.Fingerman4,
1. Mayo Clinic Robert D.and Patricia E.Kern Center for
the Science of Health Care Delivery, Rochester, Minnesota,
2. Penn State University, State College, Pennsylvania, 3.
University of Michigan, Ann Arbor, Michigan, 4. The
University of Texas at Austin, Austin, Texas
This study examines whether giving support to parents
has implications for middle-aged childrens diurnal cortisol
and daily mood. During 4 consecutive days, 148 middle-aged
adults (mean age=55) reported support they gave to their
parents and provided saliva 4 times a day. Multilevel models
estimated within-person differences in positive and negative
affect (PA/NA), cortisol awakening response (CAR) and area
under the curve (AUC-G) as a function of giving same-day
and previous-day support. We examined whether these asso-
ciations are exacerbated when a parent has health problems
or activities of daily living (ADL) needs. When participants
gave support to parents with ADL needs, they had higher
next-day AUC-G, higher same-day PA and lower next-day
NA. Giving support to parents with health problems was
associated with higher next-day NA. A biopsychosocial
approach shows that giving support to aging parents is an
ambiguous experience with differential implications for bio-
logical stress and daily mood.
LINKING DAILY HPA AND SNS ACTIVITY TO FAMILY
CAREGIVERS FUNCTIONAL HEALTH OVER TIME
Y.Liu1, S.Zarit1, M.Rovine2, D.Almeida1, 1. Center for
Healthy Aging, The Pennsylvania State University, State
Innovation in Aging, 2017, Vol. 1, No. S1
College, Pennsylvania, 2. University of Pennsylvania,
Philadelphia, Pennsylvania
The study examined the extent of association between
stress biomarkers among 153 family caregivers of individu-
als with dementia (IWDs) and caregivers changes in func-
tional health over time. Caregivers who initially participated
in a study of the effects of ADS services on three biomarkers,
salivary cortisol, DHEA-S and alpha amylase (sAA), were
followed for a one-year period. Two factors, caregiving tran-
sitions and ADS use, which might moderate the effects of
biomarkers on functional health were considered. Among
caregivers who experienced a transition, and who used less
than average ADS days per week, lower daily cortisol and
sAA total outputs were associated with increasing functional
limitations. Caregivers who experienced a transition but
used greater than average ADS days per week did not show
such patterns of association. This study is among the first
to explore associations between daily biomarkers and long-
term health among family caregivers of IWDs.
SESSION 50 (SYMPOSIUM)
CHALLENGING ATTITUDES TO AGEING AND
AGEISM
Chair: A.Kydd, Edinburgh Napier University, Edinburgh,
Lothian, United Kingdom
Discussant: L.Ayalon, Bar Ilan University, Ramat Gan,
Israel
The developed world has an increasing number of peo-
ple who are classed as the old, with the largest increase
being those aged over eighty-five years. Population age-
ing is a worldwide phenomenon. The oldest old (people
aged 85 or older) constitutes eight per cent of the worlds
65-and-over population. On a global level, the 85-and-over
population is projected to more than triple between 2010
and 2050 (National Institutes of Health, 2011:8). In many
countries, the oldest old are the fastest growing age group
in the total population (United Nations, 2014; National
Institutes of Health, 2011). These people are more likely to
have multimorbidities and have less functional capacity to
compensate physically for an acute episode of injury or ill
health. Projections indicate that there will be considerable
differences in the age composition of the EU-27 population
during the period 2015 to 2050 (Eurostat, 2015). The most
pronounced changes being the share of working-age and old-
age groups in the population (Sobczak, 2014:18), meaning
that there are a growing number of potentially dependent
people coupled with a shrinking working-age population
(Eurostat, 2015). It is imperative for all societies to address
negative attitudes towards older people as there remains a
high prevalence of ageism in societies globally. The detrimen-
tal effects of negative attitudes and ageism are substantial. In
this symposium negative attitudes and ageism are discussed
at discourse level; amongst older people; with caregivers;
amongst professionals and with housing providers covering
work from Ireland, Scotland, America, Malta and Spain.
AGEISM IN THE THIRD AGE
A.Kydd1, A.Fleming2, 1. School of Nursing Midwifery
and Social Care, Edinburgh Napier University, Edinburgh,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Lothian, United Kingdom, 2. Independent Researcher,
Hamilton, Lanarkshire, United Kingdom
The global increase in the numbers of older people show
a dramatic increase in the numbers of people over 85years.
This means that the definition of older people spans sixty
years. The advent of the third and fourth age has served to understand the concept of professional ageism as identified
provide a distinction between the old and the oldest-old. This
paper presents a literature review exploring ageism by those
in their third age not wanting to be seen as a member of the
fourth age. This is a form of ageism -it involves stereotypical
perceptions of the oldest old. Such attitudes disenfranchise
the oldest old and can prove detrimental to those transition-
ing into the fourth age. They may choose to refuse assistance
that might put them into the fourth age category, but might
help them maintain their engagement and independence into
their older age. After attending this session, participants will
gain understanding of ageism amongst the old.
ATTITUDES TOWARD AGING AMONG THE
GERIATRIC HEALTH CARE TEAM: DONT FORGET
THE CAREGIVER
M.F.Wyman1,2, S.Shiovitz-Ezra3, O.Parag3, 1. Psychiatry,
University of Wisconsin, Madison, Wisconsin, 2. WS
Middleton Memorial VA Hospital, Madison, Wisconsin, 3.
Hebrew University, Jerusalem, Israel
Previous research examining attitudes toward the elderly
among healthcare providers has established that negative
stereotypes and negative views of older adults are common.
However, few studies have assessed attitudes in an essential
member of the geriatric health care team, the family car-
egiver. We present an overview of past research examining
attitudes toward aging in health care, and discuss original
findings from a sample of caregivers of White and African-
American older women living in the community. Using the
AGED Inventory (Knox etal., 1995), we examined predic-
tors of negative or positive evaluations of the typical older
woman. Associations with both caregiver and care recipient
characteristics were observed. More negative ratings were
related to increased caregiver burden and more care recipi-
ent depression, though care recipient medical burden was
not related to caregiver attitudes. African-American caregiv-
ers rated older women more positively on some dimensions.
Implications for addressing ageism in the healthcare team
and for caregiver education are discussed.
PROFESSIONAL AGEISMDOES IT EXIST?
S.C.Buttigieg, 1. University of Malta, Msida, Malta, 2.
University of Birmingham, Birmingham, United Kingdom,
3. Aston University, Birmingham, United Kingdom
Ageism has complex social roots and broad consequences.
It includes a span of intolerant knowledge, values, attitudes
and behaviours towards older adults. Two contexts that are
intensely accessed by older people are healthcare and long-
term care. Nevertheless, there is scant literature on the older
peoples real needs for care, seemingly a reflection of actual
practice and ageist attitudes. One questions whether or not
these contexts, as well as the transition between them, are
serving the older people well. Indeed, professional ageism
is the label used to describe the service providers attitudes
towards older adults, namely specific patient management
IAGG 2017 World Congress
13
biases that are often based on negative misconceptions. This
paper presents the findings of a narrative literature review
that explores professional ageism in healthcare and long-
term care, emerging from medical, geriatrics and gerontol-
ogy journals. After attending this session, participants will
in the literature.
AGEISM IN HOUSING: CHALLENGES FOR AGEING
IN PLACE. THE CASE OF THE CITY OF TARRAGONA
(SPAIN)
B.Deusdad, Rovira i Virgili University, Tarragona, Spain
Ageism as a practice associated with housing has not
been analysed either by ageism analyses or housing studies,
even though it is one of the causes, which prevents ageing-
in-place. At the same time, most of the studies agree that
older adults prefer to remain at home as long as they can.
However, accessibility in dwellings and neighbourhoods is
lacking in Western societies, not to mention in developing
countries. Moreover, there is not enough housing supply cur-
rently to provide the possibility of moving in adapted apart-
ments at an old age. This is clearly also the situation with
those users of little or no resources.
Even though an Integral Urban Plan was implemented
in Tarragona, most buildings still have accessibility difficul-
ties for older people (no lifts, barriers outside and inside the
dwellings), which has consequences for older people trying
to maintain an active social life which in turn reinforces
an attitude of ageism (forced isolation and loneliness). The
city fails to provide care-adapted housing to those in need.
Needless to say, there are long waiting lists so as to have
access to public care-homes. A false deinstitutionalization
based on family care and support is taking place with far
more severe consequences for older peoples ageing-in-place
in the future.
DOES DISCOURSE MATTER IN AGEISM?
A.Phelan, School of Nursing, Midwifery & Health System,
University College Dublin, Dublin, Dublin, Ireland
This presentation examines how ageism is explicitly
and implicitly expressed in common discursive activities
in everyday life. Using two methods of discourse analysis,
Foucauldian discourse analysis and discursive psychol-
ogy, the paper demonstrates how ageism is produced and
reproduced through prevailing macro and micro discourses.
Findings indicate that ageism is tacitly interwoven within
commonplace narratives through domains such as cognitive,
functional and financial dependency and such narratives
serve to perpetuate and consolidate both a professional and
social marginalization of older people. The paper concludes
with the observation that discourse does indeed matter in the
context of how we discursively construct older people, which
inevitably impacts on how we relate to them and deliver ser-
vices to them. After attending this session, participants will
be able to understand the ways ageism is interwoven in com-
monplace, taken for granted narratives. In addition, partici-
pants will identify how ageist discourse impacts on practice
in everyday life.
14
SESSION 55 (SYMPOSIUM)
DESIGN OF TECHNOLOGIES TO SUPPORT
SUCCESSFUL AGING WITH DISABILITY
Chair: W.A.Rogers, Georgia Institute of Technology
Millions of people, worldwide, are aging with long-term
impairments such as mobility, vision, and hearing impair-
ments. They may have lifelong experience dealing with these
limitations but the normative aging process brings addi-
tional motor, sensory, and cognitive changes that may lead
to disabling conditions. Technology has great potential to
support the needs of these individuals but we need targeted
design solutions and a multi-pronged approach: (1) Success
will depend on understanding user needs for everyday task
challenges, in general, as well as for specific tasks such as
medication adherence. These are the research topics of the
presentations by Gonzalez etal. and Fain etal. (2) We need
to test potential design solutions. Sanford et al. will detail
a mobile application to support outdoor route planning by
people aging with ambulatory disabilities who have comorbid
vision loss. Gandy etal. will describe a cognitive game that
overcomes barriers of access and provides compelling experi-
ences that motivate and engage older players. (3) Long-term
success will come from ensuring that designers consider the
unique needs of older adults aging with impairments. Rebola
etal. will describe a unique design competition targeted to
students, worldwide, intended to inspire talented designers to
develop innovative technology-enabled design solutions for
the aging population, especially considering the varied abili-
ties and limitations of older adults. These projects are part
of the RERC on Technologies to Support Successful Aging
with Disability (www.techsage.gatech.edu). This symposium
links well with the meeting theme of global aging and health:
bridging science, policy, and practice.
AGING CONCERNS, CHALLENGES, AND EVERYDAY
SOLUTION STRATEGIES (ACCESS) OF INDIVIDUALS
WITH IMPAIRMENTS
E.T.Gonzalez1, T.L.Mitzner1, J.L.Singleton1, W.A.Rogers2, usability and utility testing with a beta version that limited
1. Georgia Institute of Technology, Atlanta, Georgia, 2.
University of Illinois at Urbana-Champaign, Champaign,
Illinois
Many individuals with long-term impairments use assis-
tive technologies to enable them to participate in everyday
activities. As their capabilities change with age, it is cru-
cial to determine if their support needs are still being met,
and if not, how to adapt or integrate technology supports.
The Aging Concerns, Challenges, and Everyday Solution
Strategies (ACCESS) Study provides a comprehensive user
needs assessment for older adults with long-term vision, hear-
ing, and mobility impairments. ACCESS is a two-part study
comprised of questionnaires (e.g., demographics, health,
functional limitations) and an in-depth interview assess-
ing challenges with a range of daily activities and current
strategies for overcoming them. Participants are between the
ages of 6079 in each target population (blind/low vision,
Deaf/hard of hearing, mobility impaired). Data will provide
insights into unmet needs among older adults with long-term
sensory and mobility impairments and will provide guidance
for the design of supportive technologies for this understud-
ied population.
Innovation in Aging, 2017, Vol. 1, No. S1
MEDICATION ADHERENCE FACILITATORS AND
BARRIERS FOR OLDER ADULTS WITH DISABILITIES
W.B.Fain, S.Farmer, S.Owens, C.Fausset, A.Foster,
Georgia Tech Research Institute, Georgia Institute of
Technology, Waco, Georgia
Medication regimens for older adults with chronic ill-
nesses can be complex and difficult to manage. Approximately
50% of the general population does not adhere to prescribed
medication schedules (Lee & Taylor, 2006). Various factors,
including medication regimen complexity, cost, and poor
patient health literacy interact in complex ways to produce
barriers to adherence. Little is known about the medica-
tion adherence strategies of people with disabilities aging
into secondary disabilities. This study uses an ethnographic
approach to identifying facilitators and barriers to medica-
tion adherence in a population of 26 older participants with
primary visual, hearing, or mobility disabilities. Many tech-
nologies designed to facilitate adherence are not viable for
this population as they face a set of unique challenges com-
pared to non-impaired older adults. By understanding how
and why some patients are successful in managing their own
medications, interventions can be developed to support those
who are not.
APPLICATION FOR LOCATIONAL INTELLIGENCE
AND GEOSPATIAL NAVIGATION (ALIGN)
J.A.Sanford, S.Guhathakurta, S.Melgen, G.Zhang,
S.Mahajan, Georgia Tech, Atlanta, Georgia
For people aging with long term ambulatory disabili-
ties, the onset of age-related comorbid functional losses can
severely restrict community mobility. The purpose of this
project is to develop and evaluate the feasibility of a mobile
application (ALIGN) based on static (e.g., sidewalk condi-
tion, street networks, land uses) and dynamic (e.g., traffic
volumes, weather, and light quality) environmental factors to
inform outdoor route planning by people aging with ambu-
latory disabilities who have comorbid vision loss. Twenty
individuals with mobility and vision loss completed initial
the number of factors. Based on feedback from the labora-
tory usability testing, the user interface was refined, including
increasing font size, adding a voice command button and a
tutorial. Although real world testing demonstrated the utility
of the application, results suggested that effectiveness could
be increased with more precise and consistent verbal direc-
tions and real time information.
DESIGNING SERIOUS GAMES FOR OLDER
ADULTS: ACOGNITIVE TRAINING CASE STUDY
M.Gandy, L.M.Levy, R.Solomon, A.Lambeth, D.Byrd,
Interactive Media Technology Center, Georgia Tech,
Atlanta, Georgia
The rising ubiquity of technology in peoples homes and
across the world allows researchers to carefully craft game-
based interventions for older adults that address serious
needs such as physical rehabilitation, social connectedness,
and education/training. Cognitive games, and other benefi-
cial interventions, can be pushed, updated, and delivered
to existing technology (computers, phones, tablets, smart
TVs) overcoming barriers of access and providing compel-
ling experiences that motivate and engage the older players.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
However, these interventions must be built upon a foun-
dation of scientific understanding regarding what types of
activities will yield the desired serious outcomes. While
game theming and interfaces must be designed to be acces-
sible, approachable, and compelling for the target audience.
Lastly validation of these interventions must be demon-
strated via formal user studies. In this paper we present a
case study of a multi-year project focused on designing,
implementing, deploying, and testing a universally designed
cognitive training game.
DEVELOPING ACOMPETITION TO ADVANCE
TECHNOLOGY DESIGN FOR THE AGING WITH
DISABILITY POPULATION
C.B.Rebola, Rhode Island School of Design, Providence,
Rhode Island
Design and technology can have a significant impact
on the aging with disability population, empowering these
individuals to sustain independence, maintain health,
engage safely in basic activities at home/community, and
fully participate in society. Yet, there is a need to increase
knowledge, practice about, and availability of effective
universally-designed technologies. A competition can be
an effective way to tap into a rich, diverse and collective
design intelligence to address these issues. The TechSAge
Design Competition 2016 was launched to inspire talented
designers to develop innovative technology-enabled design
solutions. As part of the competition, judging criteria were
framed to guide contestants in the design of technologies.
The judging was based on the criteria of promoting inde-
pendence, integration, implementation, inspiration, and
progression, as part of a framework through universal
design. This presentation discusses results from the compe-
tition by analyzing the entries and judging towards present-
ing refined criteria for future competitions.
SESSION 60 (SYMPOSIUM)
THE HEALTHY AGING PROGRAM AT THE U.S. CDC:
PROMISE AND PROGRESS IN PUBLIC HEALTH
Chair: L.C.McGuire, Centers for Disease Control and
Prevention, Georgia
Co-Chair: V.J.Edwards, Centers for Disease Control and
Prevention
With the graying of the U.S. population, there has
been an increased recognition in public health to promote
healthy aging and address major problems afflicting older
Americans. The Centers for Disease Control and Prevention
(CDC) has established the Healthy Aging Program (HAP)
to serve as the focal point for cross-cutting public health
action. Housed in the CDCs National Center for Chronic
Disease Prevention and Health Promotion (NCCDPHP),
Program staff work with a variety of partners to increase
the reach of their programs and broaden dissemination of
their efforts.
For over 10 years the HAP has used the Healthy Brain
Initiative as its guide for prioritizing activities. Based upon
the public health model, this document enumerates a variety
of activities designed to increase awareness of and support
for cognitive health. Although this is a new area for public
IAGG 2017 World Congress
15
health, great strides have been made in infusing cognitive
health into public health programs.
This symposium will report on the activities of CDCs
HAP. Dr. McGuire will give an introduction to the Healthy
Brain Initiative and explain how it serves as a guide for the
CDC and state public health agencies. Dr. Taylor will dis-
cuss the new data portal for information about aging, and
its potential to become a resource for researchers and pol-
icy makers. Dr. Edwards will describe surveillance efforts
via modules administered via the Behavioral Risk Factor
Surveillance Survey (BRFSS). Finally, Ms. French of the
Alzheimers Association will present examples of CDCs
partnership activities and their impact on the community.
CDCS HEALTHY BRAIN INITIATIVE: COGNITIVE
AGING AND AD/RD FROM APUBLIC HEALTH
APPROACH
L.C.McGuire, Centers for Disease Control and Prevention,
Atlanta, Georgia
The Center for Disease Control and Preventions (CDC)
Healthy Aging Program leads the Healthy Brain Initiative
to broaden understanding of and support for healthy cog-
nitive aging as a central part of public health practice. The
Initiative creates and supports partnerships, collects and
reports data, increases awareness of cognitive aging, and pro-
motes adoption of 35 action items detailed in The Healthy
Brain Initiative: The Public Health Road Map for State
and National Partnerships, 20132018 (http://www.cdc.
gov/aging/pdf/2013-healthy-brain-initiative.pdf). Because
dementia, including Alzheimers disease, doesnt have a cure,
identifying and reducing modifiable risk factors is the best
approach. The public health community should embrace
cognitive aging as a priority, invest in its promotion, and
move scientific discoveries to public health practice. This
presentation will focus on public healths role with respect to
cognitive health through CDCs Healthy Brain Initiative and
current CDC activities.
AGING-RELATED SURVEILLANCE ACTIVITIES AT
THE CDC
V.J.Edwards, L.C.McGuire, C.A.Taylor, Centers for
Disease Control and Prevention, Atlanta, Georgia
One priority action in The Healthy Brain Initiative: The
Public Health Road Map for State and National Partnerships,
20132018 is surveillance of cognitive health issues. CDCs
Healthy Aging Program (HAP) has developed and promul-
gated the use of two modules, on subjective cognitive decline
and caregiving, in the Behavioral Risk Factor Surveillance
System (BRFSS). The BRFSS is the worlds largest ongoing
telephone health-related survey, collecting data in 50 states
and three U.S.territories. The HAP enlisted the help of sub-
ject matter experts and used cognitive testing to refine and
improve these modules.
State-level data from the modules have been used to
inform state Alzheimers plan development and implementa-
tion, and to create awareness and education about cognitive
decline and caregiving through webinars, proclamations, and
media events. These data can further the understanding of
the public health burden, inform public health policy and
strategies, and monitor quality of life for all Americans.
16
DATA AT YOUR FINGERTIPS: THE CDC HEALTHY
AGING DATA PORTAL
C.A.Taylor, L.C.McGuire, Centers for Disease Control and
Prevention, Atlanta, Georgia
Public health surveillance data are important as they can
inform policymakers and health professionals on the cur-
rent status of conditions, behaviors, and risk factors in a
population. The Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health
Promotion has developed the Healthy Aging Data Portal.
This free, publicly accessible online resource provides access
to a range of national, regional, and state data on the health
of older adults. Users can examine data on indicators such as
nutrition and physical activity, screenings and vaccinations,
tobacco and alcohol use, and mental and cognitive health.
Portal users may view data by geographic area or indi-
cator, stratify by demographic variables, export data tables,
print reports, and create customized maps and charts. The
Portal enables policymakers and public health professionals
to examine data on the health of older adults in order to
enhance awareness and action in public health programming.
COLLABORATION BETWEEN THE ALZHEIMERS
ASSOCIATION AND THE CDCS HEALTHY AGING
PROGRAM
M.E.French, Alzheimers Association, Washington, District
of Columbia
The Alzheimers Association has an ongoing, construc-
tive partnership with CDCs Healthy Aging Program. This
presentation highlights two products of this partnership --
state fact sheets and national reports based on the Subjective
Cognitive Decline and Caregiving BRFSS modules, and,
along with Emory University, the development of an under-
graduate curriculum to prepare a competent public health
workforce for the growing problem of Alzheimers disease
and other dementias.
BRFSS data can inform population-based responses to
dementia. Alzheimers Association state chapters dissemi-
nate state-specific data to local stakeholders and use BRFSS
data to promote policy development/change. However, train-
ing future health professionals to understand the impact of
this growing problem has not received a great deal of atten-
tion. To prepare a competent public health workforce, the
Alzheimers Association, CDC, and Emory University devel-
oped an undergraduate curriculum entitled, A Public Health
Approach to Alzheimers and Other Dementias. Results of
these joint efforts will be presented.
SESSION 65 (PAPER)
EDUCATION, RACE/ETHNICITY, AND COGNITION
COGNITIVE INEQUALITIES IN LATER LIFE: CROSS-
COUNTRY DIFFERENCES IN THE EDUCATION-
COGNITION GRADIENT
A.Leist, PEARL Institute for Research on Socio-Economic
Inequality, University of Luxembourg, Esch-sur-Alzette,
Luxembourg
Later-life cognitive function is intrinsically linked to
amount and quality of education received in childhood and
Innovation in Aging, 2017, Vol. 1, No. S1
adolescence, supposedly by education increasing cognitive
reserve. However early cognitive skills also determine how
much schooling is received. Current methods cannot dis-
entangle education and cognition. I propose a method to
standardize education and comparatively analyze the educa-
tion-cognition gradient in order to assess if cross-country dif-
ferences in later cognitive function reflect earlier educational
inequalities.
Methods: 16,941 respondents to the Survey of Health,
Ageing and Retirement in Europe providing at least two
measurements (waves 1 to 5)from 16 countries, aged 5059
were included. Cognitive function was an average of imme-
diate, delayed recall and executive function. Education was
standardized by logit-rank transformation, providing infor-
mation on educational rank. Mixed (random-effects) mod-
els were run with covariates and education as fixed effect,
random intercept and slope. Empirical Bayes predictors were
estimated to investigate the education-cognition gradient.
Results: Cognitive levels were above average in most
continental, northern European and some post-communist
countries (Slovenia, Estonia), and below average in southern
European, Poland, and Israel. Education-cognition gradients
were above average in France and post-communist countries
(Poland, Slovenia, Czechia), reflecting better average fit of
cognitive levels with amount of schooling received. In con-
trast, continental European countries showed below-average
gradients, i.e. higher cognitive inequalities.
Discussion: With this method, the link between education
and cognition can be examined more closely. Findings reflect
country differences in educational inequalities, i.e. accessibil-
ity to higher education independent of socioeconomic status,
at the time when this middle-aged cohort was schooled.
EDUCATIONAL DIFFERENTIALS ON LIFE
EXPECTANCY WITH AND WITHOUT COGNITIVE
IMPAIRMENT IN BRAZIL
F.Andrade1, M.Lebrao2, Y.Duarte2, 1. Kinesiology
and Community Health, University of Illinois--Urbana-
Champaign, Champaign, Illinois, 2. Universidade de Sao
Paulo, Sao Paulo, Brazil
Low educational levels have been linked to cognitive
impairment in late life, however the impact of education on
cognitive impairment free life expectancy (CIFLE) has not
been previously estimated in Brazil. The aim of the present
study is to investigate the differences in life expectancy with
and without cognitive impairment by educational levels and
gender in Brazil. The sample was drawn from the three waves
(2000, 2006 and 2010)Health, Well-Being, and Aging Study
(SABE) collected in Sao Paulo, Brazil. Participants for whom
the Mini-Mental State Examination was available were
included (n=2,101). Interpolation of Markov Chains method
was used to estimate CIFLE and years spent with cogni-
tive impairment (CILE) by education and gender. CIFLE at
age 60 was 12.7 years among men with no education and
16.0 among their educated counterparts. On the other hand,
CILE was higher among men with no education than those
with education (3.2 and 1.6 years, respectively). Among
60-year old women without education, CIFLE reached
16.0years, but it was considerably higher among educated
women (20.1years). CILE reached 4.4years among women
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
aged 60 with no education, versus 2.4 years women their
educated counterparts. Older adults with no education live
shorter lives and more years with cognitive impairment than
those with education. Older women in Sao Paulo live longer
lives, but they live a greater number of years with cognitive
impairment.
RACIAL AND ETHNIC DIFFERENCES IN COGNITIVE
IMPAIRMENT-FREE LIFE EXPECTANCY IN THE
UNITED STATES
M.A.Garcia1, B.Downer2, C.Chiu3, J.Saenz4, S.Rote5, variables at the person-level were conducted. A significant
R.Wong6, 1. University of Texas Medical Branch, Sealy
Center on Aging, Galveston, Texas, 2. Division of
Rehabilitation Sciences, University of Texas Medical Branch,
Galveston, Texas, 3. Institute of European and American
Studies, Academia Sinica, Nankang, Taiwan, 4. University
of Southern California, Davis School of Gerontology, Los
Angeles, California, 5. University of Louisville, Kent School
of Social Work, Louisville, Kentucky, 6. University of Texas
Medical Branch, Department of Preventive Medicine and
Community Health, Galveston, Texas
Background: Cognitive impairment and dementia are
major health issues confronting older adults. In 2002,
approximately 13.9% of people in the United States aged 71
and older had dementia, and 22.2% had cognitive impair-
ment without dementia. Previous research suggests that older
African Americans and Hispanics are more likely than older
whites to suffer from cognitive impairment and dementia.
Despite growing interests in racial/ethnic disparities in cog-
nitive health, less in known about racial/ethnic differences
in life expectancy with and without cognitive impairment/
dementia.
Methods: This study employs data from 8 waves of the
Health and Retirement Survey (19982012) to estimate
racial/ethnic differences in the transitional probabilities
among four states: cognitively normal, cognitively impaired/
no dementia, dementia, and death among 32 271 Non-
Hispanic Whites, African Americans, U.S.-Hispanics, and
Foreign-born Hispanics adults 50years and older. Sullivan-
based multistate life tables are used to estimate life expectan-
cies with and without cognitive impairment and dementia in
later life.
Results: Results show that older African Americans and
Hispanics spend a larger fraction of their remaining years
with cognitive impairment and dementia relative to older
whites regardless of gender. Foreign-born Hispanic women
and African American males are particularly disadvantaged
in the proportion of years spent after age 50 with cognitive
impairment and/or dementia.
Conclusions: This issue merits special attention in the
development of community-based long-term care programs
to appropriately target the specific needs of different minor-
ity and immigrant elderly who are entering into their last
decades of life.
EXAMINING CHANGES IN COGNITIVE
IMPAIRMENT SYMPTOMS AMONG OLDER U.S.
BLACK AND WHITE ADULTS
D.Byrd, Community Health Sciences, UCLA Fielding
School of Public Health, Los Angeles, California
IAGG 2017 World Congress
17
Individuals with increasing cognitive impairment are at
risk of developing Alzheimers or other dementias. Blacks
are approximately 23 times more likely than whites to
have cognitive impairment and these disparities worsen
over time. This study examines black-white disparities in
cognitive impairment scores among aging adults enrolled
in all 5 waves of the Americans Changing Lives Study (N
=3,617). Cognitive impairment was assessed at each wave
using a 5-item Short Portable Mental Status Questionnaire.
Multilevel analyses with age as the level-1 variable and other
interaction between age-squared and race was found (chi-
squared = 6.19, p = .045), indicating that blacks cognitive
impairment scores at each wave was significantly higher than
whites in the presence of model covariates. Study findings
demonstrate clear racial differences in the trajectory of cog-
nitive impairment symptoms over time; whereby, cognitive
impairment is more prevalent in later life among blacks.
EXERCISE AND COGNITIVE FUNCTION IN OLDER
HISPANIC/LATINO ADULTS: RESULTS FROM THE
CAMINEMOS! STUDY
L.Piedra1, F.Andrade1, R.Hernandez1, S.Boughton1,
L.Trejo3, C.A.Sarkisian2, 1. Social Work, University
of Illinois at Urbana-Champaign, Urbana, Illinois, 2.
David Geffen School of Medicine at UCLA, Los Angeles,
California, 3. City of Los Angeles Department of Aging,
Los Angeles, California
For this study, we examined the prospective effect of
an evidenced-based exercise intervention (Caminemos!)
on cognitive function among older Hispanic/Latino adults
and the potential synergistic effects (if any) of an attribu-
tion retraining intervention given to a random sample to
counter negative ascriptions of the aging process. We used
baseline and follow-up (1- and 2- year) data collected from
Hispanics/Latinos 60 years (N=571) who participated in
Caminemos! across 27 senior centers. All participants were
randomly assigned to either: a) treatment group a 1-hour
attribution retraining session + 1-hour exercise class, or b)
control group health education + 1-hour exercise class.
Mixed-effects linear regression was used to determine the
effects of the exercise class and the attribution retraining
component on longitudinal changes in cognitive function-
ing, as measured by the Modified Mini-Mental State (3MS)
Examination. After we adjusted our model for age, sex,
education, income and medical comorbidities, participants
in both intervention arms displayed higher cognitive func-
tioning scores at the 1-year (b=1.76, p=0.001) and 2-year
(b=1.37, p=0.013) follow-up when compared to original
baseline scores. However, we found no significant differ-
ence in cognitive function between the treatment versus
control conditions (b=0.41, p=0.582), nor were any differ-
ences found across groups over time. The results indicate
that the exercise intervention improved cognitive function in
older Hispanics/Latinos, regardless of the supplemental age-
related attribution retraining. These findings suggest that
limited access to exercise programs may present a greater
obstacle in forestalling cognitive decline in older Hispanics/
Latinos than the negative beliefs they might hold about the
aging process.
18
SESSION 70 (SYMPOSIUM)
HEALTH AND MENTAL HEALTH ISSUES OF OLDER
ADULTHOOD: EVIDENCE BASED TREATMENTS
Chair: N.Kropf, Georgia State University, Atlanta, Georgia
Co-Chair: S.Cummings, University of Tennessee
Although the population of older adults is experienc-
ing higher levels of health and well-being than previously,
there is also the probability that health and social changes
will accompany advancing years. Treatment approaches that
effectively address health and mental health issues are neces-
sary with the aging of the Baby Boomer generation. Increased
aging is not limited to the U.S.; it is a global issue that is
reshaping family life and social policy throughout the world.
This symposium will present three evidence based treat-
ment approaches that are effective in addressing challenges
of aging. Psychoeducational and support interventions are
used to help older adults with adjustments to new conditions,
create and enhance network bonds, and provide information
for skill development. Problem solving therapy is a psycho-
logical intervention that teaches people to cope with stress
of here-and-now problems to reduce negative health and
mental health outcomes. Effective problem solving skills are
thought to mitigate the probability of experiencing negative
health and mental health outcomes when confronted with
difficult and challenging events. Motivational Interviewing
is an approach to counseling that focuses on helping clients
resolve ambivalence in an effort to work toward and effect
behavioral change. This approach is frequently used to help
overcome addictions and develop new ways to function,
as in situations where health challenges require different
behaviors. For each approach, theories of change, treatment
approaches, and application to a case will be presented.
PROBLEM-SOLVING THERAPY FOR OLDER ADULTS
S.Cummings, University of Tennessee, Knoxville, Tennessee
Problem solving therapy (PST) is an effective interven-
tion for treating older adults who struggle with stress related
health and mental health issues (DZurilla & Nezu, 1999;
Nezu, Nezu & DZurilla 2013). Clients are trained to
overcome major obstacles that inhibit effective coping and
heighten stress by means of problem identification, genera-
tion of solutions, solution implementation, and post-imple-
mentation evaluation. Effective problem solving involves the
ability to adaptively develop and match helpful solutions to
life problems while taking into account internal and exter-
nal factors that impact the problem (Nezu, 2013). Research
documents the effectiveness of PST for use with older adults
experiencing a variety of issues ranging depression, anxi-
ety and mild cognitive impairment to cancer, arthritis and
post-stoke functioning (Kirkham, Seitz, & Choi, 2015). PST
treatment principles and strategies will be presented and the
research base reviewed. Acase study will highlight the PST
treatment approach with older adults.
MOTIVATIONAL INTERVIEWING: AN EVIDENCE-
BASED TREATMENT FOR OLDER ADULTS
L.Cooper, Meharry Medical College, Nashville, Tennessee
Motivational Interviewing (MI) is a brief client-centered
intervention focused on the resolution of ambivalence to
Innovation in Aging, 2017, Vol. 1, No. S1
enable patient behavior change. Changes in health behaviors
such as drinking, smoking, exercise and diet are often pre-
scribed by physicians for older adults to help improve physi-
cal health, combat medical conditions and foster enhanced
mood (Rollnick, Miller & Butler, 2008). Lack of compliance,
however, is common due to a conflict within the patient
regarding the pros and cons of change (Cooper, 2012). MI
focuses on helping patients explore and resolve ambivalence
by drawing out their intrinsic motivation to and capacity
for change (Rosengren, 2009). Agrowing body of research
indicates the efficacy of MI for improving health behaviors
and decreasing depression and anxiety among older adults.
The research based will be reviewed. MI principles, skills and
techniques will be discussed and demonstrated via a case
study.
PSYCHOEDUCATIONAL AND SOCIAL SUPPORT
INTERVENTIONS WITH OLDER ADULTS
N.Kropf, Georgia State University, Atlanta, Georgia
During later life, a number of changes occur that impact
health and well-being. Regardless of the reason or whether
they are normative or non-normative, the older adult
experiencing these changes often needs to modify behav-
iors, learn new skills, or deal with the psychosocial conse-
quences. Additionally, family members and care providers
are also impacted by these changing conditions, which have
significance for their own functioning. Two approaches
that are used in these circumstances are psychoeducation
and social support interventions. While differences and in
structure and context exist, the underlying theoretical per-
spectives of these approaches are comparable with goals
and outcomes of enhanced coping, increased competence,
and decreased stress. These two treatment approaches will
be overviewed, including the methods of practice. Case
content of an older woman who is newly diagnosed with a
chronic illness will be presented to highlight application of
practice principles.
SESSION 75 (SYMPOSIUM)
DEALING WITH TRUNCATION BY DEATH IN
LONGITUDINAL ANALYSES OF GERONTOLOGIC
OUTCOMES
Chair: T.E.Murphy, Yale University School of Medicine,
Hamden, Connecticut
Co-Chair: L.C.Barry, University of Connecticut Center on
Aging, Farmington, Connecticut
Discussant: P.H.Van Ness, Yale University
In longitudinal studies of older persons, mortality among
participants is common and may bias the associations of pri-
mary interest between explanatory variables and non-death
outcomes. Appropriate handling of truncation by death in
applied gerontologic research depends on factors that include
the study objective and the richness of the data resources. We
first present simple scenarios illustrating the effect of differ-
ing imputational assumptions on associations with several
post-discharge functional outcomes from older persons sur-
viving the ICU. This first presentation also emphasizes the
need to creatively choose ways of clearly demonstrating how
the death of participants influences associations. We proceed
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
to examine two cases wherein the associations between an
explanatory variable and longitudinal outcome are evaluated
with both joint and separate modeling. The first examines
the association between diagnosis of dementia and count of
medications and the second that between the causal effect
of vitamin D on count of depressive symptoms. The second
example of joint modeling posits the use of g-computation
of model parameters to obtain causal effects. Lastly we dis-
cuss two-stage multiple imputation and demonstrate some
approaches for dealing with the incomplete data, from both
attrition and mortality, in longitudinal studies of cognitive
outcomes.
ASSOCIATIONS WITH POST-DISCHARGE FUNCTION
OF OLDER ICU SURVIVORS: SENSITIVITY TO DEATH
T.E.Murphy1,2, M.Pisani1,2, L.Ferrante1,2, T.M.Gill1,2, 1. enrolled in the InCHIANTI study. Among 1,203 partici-
Yale School of Medicine, New Haven, Connecticut, 2. Yale
Program on Aging, New Haven, Connecticut
In the Precipitating Events Project, 754 initially non-dis-
abled persons of age 70years and above have been followed
on a monthly basis for over 15 years. Monthly telephone
interviews solicit self-reported dependence in ADLs, IADLS,
and certain mobility measures. Having recorded all deaths
among participants, it allows a very focused examination of
the interplay between monthly function and the occurrence
of death. Supposing that decedents continued providing data
after death, we illustrate how their deaths affect the primary
associations of interest between explanatory variables and
non-death outcomes over a range of imputational assump-
tions. We include the following examples on the monthly
post-discharge function of survivors of an ICU admission:
association between risk factors and time to functional
recovery, association between pre-admission frailty and total
count of disability among ADLs, IADLs, and mobility, and
association between pre-admission frailty and incident dis-
charge to a skilled nursing facility.
ASSOCIATIONS BETWEEN DEMENTIA STATUS AND
POLYPHARMACY JOINTLY ACCOUNTING FOR
DROPOUT AND DEATH
G.Agogo1, D.Gnjidic2, D.Moga3, H.Allore1, 1. Yale School
of Medicine, New Haven, Connecticut, 2. University of
Sydney, Sydney, New South Wales, Australia, 3. University
of Kentucky, Lexington, Kentucky
Dropout and deaths may bias associations between expo-
sures and outcomes in longitudinal studies of older patients
and may be accounted for by jointly modeling longitudinal
outcome and death or dropout. As more seriously ill persons
have both a higher likelihood of taking more medications and
dying, we present methods to study the association between
dementia diagnosis and change in the number of medica-
tion. Data from the US National Alzheimer Coordinating
Center was used to match participants on year, sex, and age
(n=5048; 2524 develop dementia, 2524 controls) who were
60years and observed annually for 3years (pre-diagnosis, Canada
diagnosis and post-diagnosis). One year post-diagnosis, 1532
(30%) participants had dropped out and 710 had died. We
compare adjusted results from the joint model with separate
models. We will demonstrate whether accounting for drop-
out and deaths alters the association between dementia and
medication use.
IAGG 2017 World Congress
19
COMBINING SHARED PARAMETER MODELS WITH
STRUCTURAL MODELS TO OVERCOME DEATH BIAS
IN AGING RESEARCH
M.Shardell, National Institute on Aging, Baltimore,
Maryland
Bias from death is common in longitudinal studies
of older adults. The problem is even more complex when
researchers aim to estimate causal effects when time-depend-
ent confounding is present. To address this problem, we pro-
pose fitting shared-parameter models for the study outcome
and mortality. To obtain causal effects, we perform g-com-
putation on model parameters. SAS PROC NLMIXED code
enhances the methods usability. We illustrate the approach
to study 25-hydroxyvitamin D [25(OH)D] and affect in
observations occurring every three years from participants
pants aged >= 60years; 143, 298, and 435 participants died
prior to first, second, and third follow-up visits, respectively.
25(OH)D<20ng/mL at all visits was associated with 2.61
worse mean affect, measured by Center for Epidemiologic
Studies Depression Scale (95% Confidence Interval[CI]
0.974.26). In contrast, conventional linear mixed effects
models with g-computation estimated a larger effect (2.94;
95%CI 1.344.54).
ANALYSIS OF LONGITUDINAL DATA OF OLDER
ADULTS WITH ATTRITION AND MORTALITY
O.Harel, University of Connecticut, Storrs, Connecticut
Participant attrition and differential mortality within
longitudinal studies pose serious problems for obtaining
inferences about a population of aging individuals. Attrition
and mortality are often highly related to aging-related out-
comes. Inferences regarding aging-related changes are better
defined as conditional on the probability of surviving and/or
remaining in the study. Current state-of-the-art approaches
rely on statistical assumptions of missing at random (MAR)
where the probability of missing information is related to
covariates and/or previously measured outcomes. However,
death causes an individual to leave the population of interest
whereas attrition from a study does not (though these are
not unrelated processes). Recent statistical methods focus on
deriving estimates of aging-related changes that are condi-
tional on the mortality and attrition-related processes. We
use two-stage multiple imputation and demonstrate some
approaches for dealing with the incomplete data, attrition
and mortality on cognitive outcomes in longitudinal studies
of aging.
SESSION 80 (SYMPOSIUM)
GAIT REHABILITATION PROGRAMS AND AGING:
NEW ADVANCES FROM THE CANADIAN GAIT
CONSORTIUM
Chair: O.Beauchet, McGill University, Montreal, Quebec,
Co-Chair: L.Bherer, University of Montreal, Montral,
Quebec, Canada
Discussant: J.Barden, University of Regina, Regina,
Saskatchewan, Canada
This symposium will present recent advances in gait reha-
bilitation (GR) programs in older adults. Gait is the medical
20
term use to describe human bipedal locomotion. Gait impair-
ment leads to unsafe gait and several adverse consequences
such as falls.
GR is the act of restoring safe gait. It is a key compo-
nent of preventive, symptomatic and curative interventions
of gait impairment. Physical activity and exercises are the
main component of GR. Several trials have suggested that
physical exercises also protect against cognitive decline. But
the question of the best outcome to determine the GR effects
remains to determine.
Recent advances in the understanding of mechanisms of
age-related gait impairment, like interaction between gait
and cognition or the key role of vitamin D deficiency, raise
the development of innovative and creative GR programs
not only based on physical activity. An improvement of phys-
ical performance and fall reduction have been reported with
vitamin D supplementation. It has also been reported that
motor imagery, defined as mentally simulating a given action
without actual execution, combined with physical exercises
resulted in a more significant improvement of motor per-
formance than physical exercises alone. New GR programs
based on merging mental tasks, physical exercises and vita-
min D supplementation are developed. In addition, new tech-
nology like software on electronic devices playing the role
of virtual coach or corresponding to interactive video games
has now been used to promote physical activity and change
exercise behavior.
OUTCOME FOR GAIT REHABILITATION PROGRAM:
BIDIRECTIONAL ASSOCIATION BETWEEN GAIT
SPEED AND COGNITION
J.Best, University of British Columbia, Vancouver, British
Columbia, Canada
Few cohort studies examined longitudinal associations
between age-related changes in cognition and physical per-
formance. Over 9-year period 2876 participants, who were
initially well-functioning community-dwelling older adults
(aged 7079years at baseline; 52% female; 39% black), were
followed. Usual gait speed, Digit Symbol Substitution Test
(DSST) and Mini-Modified Mental State examination (3MS)
scores were assessed years 0, 4, and 9.Early decline between
years 04 in gait speed predicted later decline between years
49 in performance on the 3MS (P=.004) and on the DSST
(P<.001). The associations between early decline in cognition
and later decline in gait speed were weaker and were non-
significant after correcting for multiple comparisons (P=.019
for 3MS and P=.051 for DSST). The results indicate declin-
ing gait speed as a precursor to declining cognitive function-
ing, and suggest a weaker reciprocal process among older
adults confirming that improvement of gait speed if a good
outcome for gait rehabilitation program.
HYPOVITAMINOSIS D, VITAMIN D
SUPPLEMENTATION, AND CHANGES IN GAIT:
WHAT HAVE WE LEARNED?
O.Beauchet, Medicine, McGill University, Montreal,
Quebec, Canada
Gait disorders are caused by physiological system impair-
ments that depend in part on vitamin D-related metabolic
processes. The association between hypovitaminosis D and
gait instability may be explained by adverse effects on the
Innovation in Aging, 2017, Vol. 1, No. S1
neuromuscular system as well as on central nervous sys-
tems, and in particular by impairment of the highest levels
of gait control. However, the association between hypovita-
minosis D and gait instability still needs to be investigated.
Indeed, observational studies show mixed results, as some
studies reported a significant association between low serum
25OHD concentration and poor muscle performance, while
other not. Like observation studies, intervention studies
have demonstrated discordant results. Some clinical trials
found a significant vitamin D-related improvement in physi-
cal performance, while others failed to show any effect of
supplementation. The results suggest that vitamin D sup-
plementation alone is not sufficient to improve gait per-
formance, and thus should be combined with physical or
mental exercises.
DUAL-TASK TRAINING PROGRAM FOR OLDER
ADULTS: BLENDING GAIT, VISUOMOTOR AND
COGNITIVE TRAINING
T.Szturm, University of Manitoba, Winipeg, Manitoba,
Canada
Gait and cognitive impairments, which are common
with ageing often coexist, causing a reduction in the levels
of physical and mental activity and are prognostic of future
adverse health events and falls. Multi-task training that
simultaneously addresses both mobility and cognition ben-
efit healthy ageing are important to consider in gait reha-
bilitation. An exploratory Randomized Control Trial was
conducted to describe the feasibility and acceptability of a
dual-task treadmill walking programs delivered in the com-
munity, and to obtain preliminary data on the effectiveness
of the Multi-task training intervention. Twenty-four commu-
nity-dwelling older participants aged 7085 and with history
of falls were recruited. Outcome included measures of gait
under single and dual task conditions. Dual task conditions
included computerized visuomotor and visuospatial cogni-
tive activities. Results demonstrated the feasibility of the
dual-task treadmill training programs in the community, and
the systems ability to improve dual task gait and visuospatial
cognitive functions.
SMARTPHONE ACCELEROMETRY FOR GAIT
VARIABILITY ASSESSMENT AND REHABILITATION
IN OLDER ADULTS
J.Barden, University of Regina, Regina, Saskatchewan,
Canada
This session will focus on the use of body-fixed sensors
(particularly accelerometers) to assess gait variability in
older adults. An overview of different gait variability meas-
ures and processing methods will be provided (e.g., gait
symmetry, stride regularity, fractal structure) including infor-
mation on the relationship of these measures to diminished
gait capacity and fall risk in older adults with and without
physical impairments. This session will also present informa-
tion on the advantages to be gained from using Smartphone
technology for the purpose of gait variability assessment and
monitoring in and out of the clinic. The potential application
of using Smartphone technology as a clinical tool to assess
various aspects of gait control and stability for the purpose
of evaluating physical activity intervention (i.e., gait rehabili-
tation programs) will also be discussed.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
COGNITIVE TRAINING, PHYSICAL EXERCISE, AND
COMBINED INTERVENTION TO IMPROVE GAIT IN
OLDER ADULTS
L.Bherer, Concordia University, Montreal, Quebec, Canada
A great amount of research in the past decades was ori-
ented towards finding effective ways to enhance cognitive
functioning and mobility in older adults. Physical exercise
and cognitive training have shown great benefits for cogni-
tive functioning, gait and posture in the older adults pop-
ulation. More recently researchers have investigated the
potential synergetic effect of more than one approach for
preventing cognitive decline. This talk will present recent
findings from cognitive training and exercise intervention
on cognitive and gait outcomes. Results from a combined
intervention trial will also be presented and discussed in the
context of expected synergetic effect of exercise and cogni-
tive intervention to improve gait in older adults.
SESSION 85 (SYMPOSIUM)
PAIN AND RELATED SITUATIONS SURROUNDING
OLDER ADULTS: AN INTERNATIONAL PERSPECTIVE
Chair: M.Tse, The Hong Kong Polytechnic University,
Hong Kong
Co-Chair: A.Budnick, Charit - Universittsmedizin Berlin,
Berlin, Berlin, Germany
Discussant: B.S.Huseb, University of Bergen, Bergen,
Hordaland, Norway
Chronic pain is common among ageing population. Fifty
per cent of older people in the community and up to 80%
of nursing home residents experience chronic pain. Chronic
pain significantly impairs both physical and psychological
well-being. Pain has never been adequately managed. Due
to concerns about the side-effects of continuous analgesic
use, only 20% of older adults take pain-relief medications.
Individuals who suffer from pain is more likely to develop
a sense of loneliness, fear, anger, depression and anxiety,
which may lead to more severe mental health problems, if
not addressed properly and in time. Indeed, unrelieved pain
impact on individual and the society, which further increase
the burden of medical and social services.
The Gate Control Theory describes pain in sensory, affec-
tive and cognitive dimensions; of which pain modulation
can be achieved according to these dimensions. Brain region
involved in pain perception, the anterior cingulated cortex, is
less activated with social attachment, which in turn is asso-
ciated with more pain, and vice versa. Therefore, creative,
innovative and the use of social capital are important fea-
tures in pain management.
The symposium will present innovative approaches
in managing pain among older adults in China, Germany,
Norway and Japan, including the use of peer volunteers to
lead pain management program for older adults; the use of
play activities in managing pain for dementia older adults,
and an interdisciplinary approach aiming to reduce pain
among nursing home residents.
THE USE OF PEERS IN LEADING PAIN
MANAGEMENT PROGRAM FOR NURSING HOME
RESIDENTS WITH CHRONIC PAIN
M.Tse, School of Nursing, The Hong Kong Polytechnic
University, Hong Kong
IAGG 2017 World Congress
21
To examine the feasibility of a peer-led pain management
program among nursing home residents. A quasi-experi-
mental study in two nursing homes (with 50 nursing home
residents) joined the study. Experimental group (n=32) was
given a 12-week group-based peer-led pain management
program. Education in pain and demonstrations of non-
pharmacological pain management strategies were provided
led by twelve trained peers. Control group (n=18) received
pain management program each week over 12 weeks from
the research team.
A significant reduction in pain intensity, activities of daily
living, increased in happiness level for the experimental
group (p<0.001), while loneliness level dropped significantly
for experimental group (p<0.001) and not the control group.
Peer volunteers showed a significant increase in self-rated
pain management knowledge and self-efficacy in volunteer-
ing. Peer-led pain management program was feasible and
has potential at relieving the chronic pain and enhancing the
physical and psychological health of nursing home residents.
INTERDISCIPLINARY PAIN MANAGEMENT IN
GERMAN NURSING HOMESFINDINGS FROM
ACRCT
A.Budnick1, R.Kreutz2, D.Draeger1, 1. Charit -
Universittsmedizin Berlin, Institute of Medical Sociology
and Rehabilitation Science, Berlin, Germany, 2. Charit
- Universittsmedizin Berlin, Institute of Clinical
Pharmacology and Toxicology, Berlin, Germany
Pain management for nursing home residents (NHR) is
important and needs more than a mono-disciplinary perspec-
tive. At least one in two German NHR suffer from pain. The
extent of non-pharmacological therapies (NPT) used for pain
management in NHR is rather low. Moreover, pharmacolog-
ical pain management is often inappropriate. Scientists from
six disciplines developed an intervention aiming to improve
pain management skills in nursing staff and physicians. We
performed a cluster-randomized controlled trial in twelve
nursing homes. Pain management was analyzed before (T0,
n=239) and after the intervention (T1, n=206; T2, n=177)
in NHR aged 65years. At baseline, 82.6% of NHR (mean
age 82.98.1 years) were affected by pain. At follow-up,
the intervention resulted in an increase in prescribed NPT
and a decrease (p=0.03) in the proportion of NHR without
pain medication. The observed benefits of and methodologi-
cal challenges in this interdisciplinary trial will be critically
discussed.
THE RESPONSE OF AGITATED BEHAVIOR TO PAIN
MANAGEMENT IN PERSONS WITH DEMENTIA. RCT
TRIAL
B.S.Huseb1, C.Ballard2, J.Cohen-Mansfield3,
D.Aarsland2, 1. Global Public Health and Primary Care,
University of Bergen, Bergen, Hordaland, Norway, 2. Kings
College, London, United Kingdom, 3. University of Tel-
Aviv, Tel-Aviv, Israel
Behavioral disturbances and pain are common in nursing
home (NH) patients with dementia. Reduction of agitation
by pain treatment was demonstrated. It is, however, unclear
which specific agitated behaviors respond to analgesics.
352 patients with advanced dementia and behavioral dis-
turbances were included from 60 clusters of 18 Norwegian
NHs. According to a pre-defined scheme for 8 weeks,
22
intervention groups received individual pain treatment with
acetaminophen, morphine, buprenorphine patch, and/or pre-
gabaline. Control groups received usual care. We used linear
random intercept mixed model in two-way repeated measure
with adjustment for heteroscedasticity. Assessed by Cohen-
Mansfield Agitation Inventory (CMAI), verbally agitated
behaviors (factor 3), such as complaining, negativism, and/
or cursing or verbal aggression, showed largest significant
difference (p<0.001), followed by physically non-aggressive
behaviors (Factor 2) (p=0.008), and aggressive behaviour
(Factor 1) (p=0.037) after 8 weeks. Especially, restlessness
and pacing were sensible to analgesics, and should lead to
assessment and treatment of pain.
IMPROVING FUTURE INTERDISCIPLINARY PAIN
MANAGEMENT FOR OLDER ADULTS FROM
STUDENTS PERSPECTIVE
Y.Kodama1,4, H.Fukahori1, N.Yamamoto-Mitani2,
A.Ishii3, M.Tse3, 1. Graduate School of Health Care
Science,Tokyo Medical and Dental University, Tokyo,
Japan, 2. School of Integrated Health Sciences, Faculty of
Medicine, Tokyo University, Tokyo, Japan, 3. School of
Nursing,The Hong Kong Polytechnic University, Kowloon,
Hong Kong, 4. School of Nursing and Rehabilitation
Sciences, Showa University, Yokohama, Japan
Pain management for older adults should be provided
through both pharmacological and non-pharmacological
interdisciplinary methods. Healthcare students perspectives
regarding pain management might influence the quality of
future care they provide to older adults. This study explored
pain management strategies, knowledge, and education by
surveying Japanese university students specializing in the
healthcare sciences. We obtained 661 (44.4%) responses. The
preferable strategy was a combination of pharmacological
and non-pharmacological care (38.7%), particularly among
nursing students (51.5%). Atotal of 563 (87.7%) students
had not received pain management education during the past
two years, and 404 (63.7%) desired more education. Pain
medication knowledge was low to moderate; it was higher
among medical students (p < 0.05). Poor pain management
knowledge may affect the quality of care students provide
to older adults after graduation. Support for older adults
should be improved by further developing pain management
education by considering the differences among disciplines.
EFFICACY OF PLAY ACTIVITY PROGRAM TO
ALLEVIATE CHRONIC PAIN IN OLDER ADULTS
WITH DEMENTIA
J.L.Lau, M.Tse, The Hong Kong Polytechnic University,
Kowloon, Hong Kong
Dementia is known to be one of the leading causes of
diminished quality of life in older adults. Pain is the lead-
ing contributor to disability in older adults with dementia.
However, attention given to non pharmacological pain man-
agement of older adults with dementia is limited.
This study aims to investigate the efficacy of play activity
program to relieve chronic pain among the older adults with
dementia.
It is a pre and post interventional study. A total of 10
clients, included 5 males and 5 female joined the study. Their
mean age was 79.1 and diagnosed mild (MMSE mean score
Innovation in Aging, 2017, Vol. 1, No. S1
22.1) to moderate dementia (MMSE mean score 17). Mean
pain score was 8.3 (moderate pain) as measured by Abbey
pain scale. Aplay activity program was given 2 sessions per
week for 3 weeks. Each session includes 25 minutes of physi-
cal exercises, 15 minutes of artworks and 5 minutes wrap up
activities.
At the post-intervention assessment, the mean pain score
of the dementia clients was decreased from 8.3 to 7.6. An
improvement on the behavior, an increased socialization and
eye contact between the dementia clients were observed. The
program has promoted better health outcomes for dementia
clients which will be discussed critically.
SESSION 90 (PAPER)
DETECTING AND MEASURING FRAILTY II
SIMPLE RESPIRATORY MEASUREMENTS FOR THE
SCREENING OF FRAILTY IN LOWMIDDLE INCOME
COUNTRIES
E.O.Hoogendijk3, T.Flores Ruano4, P.Kowal2, U.Perez-
Zepeda5, E.Dent1, 1. School of Medicine, The University
of Queensland, Woolloongabba, Queensland, Australia, 2.
World Health Organisation, Geneva, Switzerland, 3. VU
University Medical Center, Amsterdam, Netherlands, 4.
Department of Geriatrics, Albacete University Hospital,
Albacete, Spain, 5. Geriatric Epidemiology Research
Department, Instituto Nacional de Geriatra, Mexico City,
Mexico
Frailty in older adults is characterised by a reduced capac-
ity to cope with external stressors across multiple physiologi-
cal systems. The respiratory system is particularly vulnerable
to external stressors (respiratory infections, allergies, and
smoking) and in turn, an individuals respiratory capacity
may provide a simple means for the identification of frailty.
This study assessed the ability of spirometry measurements to
screen for frailty in the World Health Organisation (WHO)s
global Study of AGEing (SAGE). The SAGE database pro-
vided data on 42,487 people aged over 50years across six
low-middle income countries: China, Ghana, South Africa,
India, Russia and Mexico (Wave 1: 2013 2015). Frailty
was classified using Frieds frailty criteria. Spirometry meas-
urements included Forced Expiratory Volume in 1 second
(FEV1), Forced Vital Capacity (FVC), and FEV1/FVC. The
ability of spirometry measurements to accurately identify
frailty was determined by several efficacy measurements:
area under receiver operator characteristic (ROC) curves
(auROC), sensitivity and specificity, positive and negative
predictive values (PPV and NPVs), and Youden Index (YI)
score. We found that FEV1, FVC and an FEV1/FVC ratio
< 80% all showed high discriminatory ability in accurately
identifying frailty, independent of chronic respiratory condi-
tions. Results from this study indicate that spirometry meas-
urements can be used to screen for frailty in older adults
residing in the community.
EVIDENCE FOR THE LATENT FACTOR STRUCTURE
OF FRAILTY
L.Young, D.Sheets, B.Gali, S.W.MacDonald, Nursing,
University of Victoria, Victoria, British Columbia, Canada
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Despite increasing demand to support aging in commu-
nity for frail seniors, there is no gold standard frailty measure
to guide frailty assessments by health professionals. Current
frailty measures are not sensitive enough to support effec-
tive screening and thus negatively impact health professional
decision-making during their care of seniors living in the
community. The aim of this study is to investigate the latent
structure of frailty to inform refinement of existing frailty
measures for seniors living in the community to develop a
robust measurement tool. Using data from Canadians 65
who were participants in the national Canadian Longitudinal
Study on Aging (CLSA) (20122015), we assessed factors for
the latent structure of three frailty scales (Rockwoods Frailty
Index, Frieds Frailty Criteria and the Edmonton Frailty
Scale). Using structural equation modelling we explored the
relationship between frailty and factors across physical, psy-
chological, social, and clinical domains. Structural equation
models were developed to identify factors for the latent struc-
ture of frailty. Our models (n=30,111) highlight several key
factors common among the three frailty scales including: age,
sex, dementia, Activities of Daily Living (ADL), Instrumental
ADLs (IADL), and cognition. Robust frailty assessments are
key to effective health professional decision-making in sup-
port of aging in community initiatives.
FRAILTY AND THE BLOOD PRESSURE RESPONSE TO
THE STRESSOR OF HEMODIALYSIS AMONG OLDER
PATIENTS
M.McAdams De Marco1, H.Ying2, I.Olorundare2,
A.Gross1, Q.Xue1, J.D.Walston2, K.J.Bandeen-Roche1,
D.Segev2, 1. Johns Hopkins University School of Public
Health, Baltimore, Maryland, 2. Johns Hopkins School of
Medicine, Baltimore, Maryland
Frailty is a multi-system dysregulation resulting in a vul-
nerability to stressors; yet evidence for this hypothesis is
lacking. Hemodialysis represents a great stressor for older
adults with ESRD. Sympathetic nervous system (SNS) acti-
vation is an essential compensatory mechanism for intra-
dialytic blood pressure (iSBP/iDBP) maintenance. Frailty
was measured on 163 older hemodialysis patients and
pre- and post-dialysis BP measures were collected. We used
adjusted linear and logistic regression to test for a differ-
ence in the pre- and post- dialysis change in SBP and DBP
by frailty status. In a separate cohort, frailty was measured
on 15 hemodialysis older patients who had 10 intradialytic
BP measures and we used an adjusted linear growth curve
model to test the association between frailty and iSBP as well
as iDBP. Frail dialysis patients had a greater change in their
SBP (-4mmHg; p=0.24) and DBP (-7mmHg; p=0.001) while
on dialysis. In adjusted analyses, those who were frail had
a 1.95-fold (95%CI:1.013.76; p=0.047) increased odds
of a 15mmHg decline in SBP and 3.7-fold (95%CI:1.89
7.33; p<0.001) increased odds of a 5mmHG decline in
DBP while on dialysis. For those who were frail, the rate
of iSBP change was -2.93mmHG/30minutes (p=0.05) com-
pared to -1.23mmHG/30minutes (p=0.22) for those who
were nonfrail. Similar results were observed for iDBP (frail:-
2.15mmHG/30minutes [p=0.01] vs. -0.68mmHG/30minutes
[p=0.21]). Frailty represents a state of SNS dysregulation for
patients in which adults undergoing the stressor of hemo-
dialysis have a poor SBP and DBP response. This is the first
IAGG 2017 World Congress
23
evidence of SNS dysregulation among frail patients with
ESRD.
CIRCULATING BIOMARKERS PREDICT INCIDENT
FRAILTY: THE IRISH LONGITUDINAL STUDY ON
AGEING (TILDA)
A.M.OHalloran1, E.A.Laird1, M.Healy2, R.Moran3,
J.Nolan3, S.Beatty3, A.Molloy1, R.Kenny1,2, 1. Trinity
College Dublin, Dublin, Ireland, 2. St. Jamess Hospital,
Dublin, Ireland, 3. Waterford Institute of Technology,
Waterford, Ireland
Blood biomarkers have been linked to phenotype frailty
in several cross-sectional and fewer longitudinal studies. We
examined whether blood biomarkers were associated with
incident frailty at two years using three frailty instruments.
Secondary data analyses were performed in adults aged 50+
years (n=3,379) from the Irish Longitudinal Study on Ageing
(TILDA). Biomarkers of micronutrient status (vitamin B12,
vitamin D, lutein and zeaxanthin), inflammatory stress
(CRP), metabolic function (HbA1c, Total, HDL and LDL
cholesterol) and renal function (creatinine and cystatin c)
were measured at baseline. Pre-frailty and frailty were meas-
ured at baseline and two year follow-up using the Phenotype
Frailty, Frailty Index and FRAIL Scale instruments. Logistic
regressions computed associations between baseline bio-
markers and combined incident prefrailty/frailty using the
three frailty instruments at follow-up. Incident prefrailty/
frailty was 21.1%, 15.6% and 13.8% for the Phenotype,
Frailty Index and FRAIL Scale respectively. Lower vitamin D
at baseline correlated with incident prefrailty/frailty for the
phenotype (OR:0.99, p<0.05) and FRAIL Scale (OR:0.99,
p<0.05) instruments. Higher CRP at baseline correlated
with incident prefrailty/frailty for the phenotype (OR:1.01,
p<0.01) and FRAIL Scale (OR:1.01, p<0.05) instruments. All
analyses were adjusted for age, age2, sex, education, smoking
status, BMI, and the number of medications and supplements
taken regularly. Only vitamin D and CRP were significantly
associated with increased risk of transitioning into prefrailty/
frailty over two years, for more than one frailty instrument.
This highlights the importance of vitamin D sufficiency in
this at risk group, and the importance of how we chose to
measure frailty in older adults.
VALIDITY OF FRAILTY PHENOTYPE CRITERIA
USING QUADRICEPS STRENGTH TO REPRESENT
MUSCLE POWER
P.Assantachai, S.Intalapaporn, W.Muangpaisan,
D.Pisarnsalakit, S.Udompunturak, Preventive & Social
Medicine, Faculty of Medicine Siriraj Hospital, Bangkok,
Thailand
Frailty detection among older people is needed to prevent
subsequent disability or premature death. Although hand-
grip strength is used in frailty phenotype criteria, some older
people cannot perform the measurement. Since quadriceps
strength has been proposed as an alternative indicator to
represent muscle power in sarcopenia diagnosis. So, we have
investigated the validity of frailty phenotype criteria using
quadriceps strength.
During the first year of study, a total of 3,122 subjects
aged 50years old or more were recruited. The mean age was
64.8 8.2years. By using the modified criteria, 1490 cases
24
(47.7%), 1448 (46.4%) and 184 (5.9%) were robust group,
pre-frail group and frail group, respectively. Among the frail
group, 19.6% and 80.4% were men and women, respec-
tively. With multiple logistic regression analysis, deformity
(OR 1.96, 95%CI: 1.283.01), diabetes mellitus (OR 1.88,
95%CI:1.192.97), increasing age (OR 1.09, 95%CI:1.06
1.12), decreasing body weight (OR 0.94, 95%CI:0.910.97),
increasing hip circumference (OR 1.05, 95%CI: 1.011.09),
lower bone stiffness (OR 0.98, 95%CI:0.960.998), lower
albumin (OR 0.46, 95%CI:0.220.95), longer 5-chair
stand test (OR 1.05, 95%CI:1.021.07), poor ADL(OR
1.11, 95%CI:1.081.14) and poor quality of life (OR 0.93,
95%CI:0.910.95) were independent factors that determined
frailty. When we measured the outcomes and characteristics
of the frail group on the second year of follow-up, various
adverse indicators and outcomes including death were found
more frequent within frail group with statistical significance.
In conclusion, the frailty phenotype criteria using quadri-
ceps strength was also an effective tool to identify those who
were frail and not able to do handgrip strength measurement.
SESSION 95 (PAPER)
INTERNATIONAL PERSPECTIVES IN HOME CARE
HOSPITAL-AT-HOME INTEGRATED CARE
PROGRAMME FOR DISABLING HEALTH CRISES IN
CATALAN OLDER ADULTS
M..Mas1,2, M.Inzitari1,3, S.Sabat4, R.Miralles1,5, p<.001), yet with a slope of .002 (95% CI of .001 to .002).
S.J.Santaeugnia2, 1. Universitat Autnoma Barcelona,
Barcelona, Catalonia, Spain, 2. Badalona Serveis
Assistencials, Badalona, Catalonia, Spain, 3. Parc Sanitari
Pere Virgili, Barcelona, Catalonia, Spain, 4. Fundaci
Puigvert, Barcelona, Catalonia, Spain, 5. Parc de Salut Mar,
Barcelona, Catalonia, Spain
In older patients with health crises, complex interventions
are needed not only to provide acute treatments but also for
post-acute care. In vulnerable patients, usual care includes
acute hospitalisation and admission to geriatric rehabilita-
tion units. Evidence supports hospital-at-home acute care
but little is known about its use on acute disability. Based on
a review of international experiences, we created a commu-
nity resource as alternative to acute and post-acute inpatient
care, for older patients living in the urban area of Barcelona.
We present data of a cohort of 244 hospital-at-home
patients, comparing it with 605 matched inpatient care
patients of a post-acute care unit. Clinical characteristics were
similar between groups (home vs. inpatient, mean [95% IC]
or %) including: age (83.8 [82.984.6] vs. 83 [82.483.6],
p=0.160), Barthel Index at admission (41.5 [38.444.6] vs.
42.6 [40.744.5], p=0.527), delirium (16.8% vs. 13.4%,
p=0.197), with differences in length of acute stay (6.1 [5.3
6.9] vs. 11.2 [10.511.9] days, p <0.001). Main outcomes
included: a. Health Crisis Resolution (patient at home at
the end of intervention); b.Functional Resolution: Relative
Functional Gain (functional gain/functional loss) 35%;
c. Health Crisis Resolution with Functional Resolution. In
the matched analysis, there were non significant differences
in Health Crisis Resolution (home vs. inpatient) groups, OR
[95% IC] 1.159, [0.7771.729]. Hospital-at-home obtained
Innovation in Aging, 2017, Vol. 1, No. S1
significant better outcomes on Functional Resolution (1.586
[1.0672.358]) and Health Crisis Resolution with Functional
Resolution (1.486 [1.0292.147]), with shorter length of
intervention (mean difference [95% IC], days) -5.813 [-9
849 to -1.778]. In conclusion, the new model obtained more
efficient clinical outcomes.
DERIVATION OF FRAILTY INDEX FROM THE RAI
HOME CARE ADAPTED FOR SWITZERLAND
C.Ludwig1, C.Busnel2, 1. School of Health Sciences
- Geneva, Geneva, Geneva, Switzerland, 2. Genevese
Institution for Homecare (imad), Carouge, Switzerland
Since 2006, Swiss home care services have been advised to
use RAI-HC adapted for Switzerland for defining individual-
ized care plans. This instrument surveys a wide array of health
domains that can be considered for the derivation an index
of frailty (IF) according to the accumulation of deficit per-
spective. The data were collected in Geneva, Switzerland by
the Genevese institution for homecare (imad) during the year
2015. Over this period, 3839 individuals aged 65 years
received the RAI-HC at admission. Among them 97.3% had
no missing data and were considered for the analysis. The
sample consisted in 3736 individuals (67.8% females) aged
82.7 ( 7.7) years. The IF was derived from a set of 52 vari-
ables for which deficits were scored and computed according
to the published guidelines (Searle etal. 2008). Results show
that the IF is distributed normally, with a mean of .24 ( .13),
an interquartile range of .16 and values of .04 at percentile 1
and .63 at percentile 99. Age effect was significant (R2=0.12,
The result supports the feasibility of deriving a frailty index
from data collected with the Swiss RAI-HC and replicate
previous findings using inter-RAI Home Care (Armstrong
et al. 2010) and Acute Care (Hubbard et al. 2015) instru-
ments. This procedure allows implementing a frailty estima-
tion directly from the patients assessment done in clinical
routine, thus offering a frailty estimate without additional
time of assessment.
THERAPEUTIC SELF-CARE IS AN ENABLING FACTOR
THAT PROMOTES THE SAFETY OF OLDER ADULTS
IN HOME CARE
W.Sun1,2, 1. Nursing, University of Toronto, Lindsay,
Ontario, Canada, 2. University of Ontario Institute of
Technology, Oshawa, Ontario, Canada
The purpose of this mixed methods study was to examine
the concept of therapeutic self-care in the context of home
care safety, as well as its influence on the safety of older
adults and their informal caregivers in home care.
The quantitative approach used a retrospective cohort
design and utilized secondary databases for Ontario home
care clients from the years 2012 to 2014. Logistic regres-
sion was used to examine the association between thera-
peutic self-care and adverse events. Qualitative interviews
were conducted with the clients and their informal caregiv-
ers to generate themes about their perspectives of home
care safety in relation to therapeutic self-care and informal
caregiving.
Quantitative findings indicated that low therapeutic self-
care ability was associated with an increase in the odds of
clients experiencing: (1) unplanned hospital visits; (2) decline
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in activities of daily living; (3) falls; (4) unintended weight
loss, and (5) non-compliance with medication. Qualitative
interviews revealed four over-arching themes: (1) Struggling
through multiple aspects of safety challenges; (2) Managing
therapeutic self-care by developing knowledge, competency
and self-confidence; (3) Coping with informal caregiving
through problem-solving, stress management and caregiver
relief; (4) Seeking education, support and collaboration from
home care.
This mixed methods study points to the importance of
therapeutic self-care ability as an enabling factor in promot-
ing the safety of older adults in home care. This knowledge
is vital to the quality improvement in home care services
that focuses on the enablement of therapeutic self-care to
reduce the safety related risks and burden for home care
recipients.
TEAM-MANAGED HOME-BASED PRIMARY CARE IN
SINGAPORE: ACASE SERIES THAT DEMONSTRATES
COST SAVING
W.Ng, K.Yea, F.Mok, Z.Z.Lim, Tsao Foundation, FUNCTIONAL AND INTELLECTUAL DISABILITIES IN
Singapore, Singapore
Home-based care is commonly perceived as costly and
limited in reach. This paper investigates cost savings (or the
lack of it) generated from a Singapore-based medical home-
care called Hua Mei Mobile Clinic (HMMC), which has
been in operation since 1993. HMMC is an initiative from
Tsao Foundation, an non-governmental organization that
has a vision for assisting the elders to be a master of ones
destiny and to have meaning in life even when one is near
the end of it. Elders recruited to HMMC are generally of
advanced age, having multiple comorbidities and needing
intensive health and social interventions. The core features of
HMMC are: Primary Care Approach; Comprehensive Needs
Assessment; Interdisciplinary Team care processes; Regular
Team Communication; and 24/7 Access. Method: Pre- and
post-HMMC enrolment health utilization data were studied
for elders who fulfilled the following the criteria: 1)enrolled
to HMMC from 1st January 2013 to 31st December 2015 for
six months or more; 2) health utilization data were acces-
sible from HMMC electronic medical records. Pre- and post-
enrolment data were then compared. Results: 62 elders were
included in the study. There was a reduction in Emergency
Department attendance by 62%; reduction in acute hospital
admissions by 54%; as well as reduction in length of hospital
stay 83%. Conclusion: HMMC had demonstrated cost sav-
ings in terms of the reduction in the use of tertiary heath care
resources. This study would be developed into a cost-benefit
analysis to compare such cost saving with the cost of operat-
ing HMMC.
24-HOUR CARE: WORK AND SLEEP CONDITIONS
AMONG FILIPINO LIVE-IN CAREGIVERS IN LOS
ANGELES
J.Nazareno1, K.Riley2, S.Malish1, 1. Center for
Gerontology, Brown University, Providence, Rhode Island,
2. University of California, Los Angeles, Los Angeles,
California
Live-in formal caregivers spend consecutive days in
patients homes, raising questions about their ability to secure
adequate sleep while on duty. Few studies have examined
IAGG 2017 World Congress
25
sleeping conditions and outcomes for this growing work-
force. We collected weeklong sleep logs and interview data
from 32 Filipino caregivers in Los Angeles who provide live-
in services at least three consecutive days per week. We also
utilized the Upworth Sleepiness Scale (ESS). Respondents
recorded an average of 6.4 hours of sleep during workdays
divided over 2.5 sleep periods. Caregivers reported signifi-
cantly lower quality sleep while at work; more than 40%
indicated excessive daytime sleepiness based on ESS scores.
Female caregivers reported worse sleep outcomes than their
male counterparts; some variations in sleep outcomes were
also found by employment arrangements. Live-in caregivers
experience frequent sleep interruptions at all hours of the day
and night to attend to patients needs. The resulting impacts
on sleep quality pose risks for both work-related injury and
errors in patient care.
SESSION 100 (PAPER)
OLDER ADULTS
COHORT EFFECTS IN DISABILITY: IMPLICATIONS
FOR MORE DISABILITY IN OLD AGE AND IN
RECENT GENERATIONS?
E.Badley1,2, M.Canizares2, A.Perruccio1,2, S.Hogg-
Johnson1,3, M.Gignac1,3, 1. University of Toronto - Dalla
Lana School of Public Health, Toronto, Ontario, Canada,
2. Krembil Research Institute, Toronto, Ontario, Canada, 3.
Institute for Work & Health, Toronto, Ontario, Canada
The goal of this study was to determine a) if the age-tra-
jectory (life course) of disability differs by birth cohort and
b) whether any cohort differences are explained by changes
in socio-economic status (SES), lifestyle factors, and the pres-
ence of chronic conditions. We used biannually collected
data from the 19942010 Canadian Longitudinal National
Population Health Survey: 10,330 participants born from
1925 to 1974 grouped in five 10-year birth cohorts. The out-
come was reported disability (needing help with daily living
activities or reporting long-term disability). We used multi-
level logistic growth models to examine cohort effects in the
age-trajectory of disability adjusting for sex, SES (education,
income), lifestyle factors (BMI, physical activity, sedentary
behavior, smoking status) and multimorbidity (2+ conditions
up to 17). We found significant cohort differences in the age-
trajectory of disability (p<0.0001): when compared at the
same age, each succeeding recent cohort had higher odds of
disability than those in the earlier cohort. The age-trajecto-
ries were similar for men and women, although women had
higher prevalence of disability. Low SES (education and/or
income), being smoker, obesity, and multimorbidity were
associated with increased odds of having disability. Though
attenuated, cohort differences remained significant after
accounting for differences in SES, lifestyle factors, and mul-
timorbidity. The results suggest that more recent cohorts of
Canadian adults are more likely to have disability and that
they report disability earlier than previous generations. This
finding has important implications for the organization and
planning of healthcare and social services for the disabled
population.
26
A CROSS-SECTIONAL STUDY EXAMINING IMPACT
FACTORS OF DISABILITY AMONG THE ELDERLY IN
DIFFERENT AREA
L.Luo, M.Yang, B.Dong, Center of Gerontology and
Geriatrics, West China hospital, Chengdu, Sichuan, China
Introduction: Elderly with disability need more care due
to the decline in physical function. As the most populous
country of disability, the pressure what China faces is far
greater than any country in the world. There are lack of the
evidence of the impact factors of disability among the elderly
and no guidebook help doctors how to prevent and intervene
it. In this study, we aim to examine the difference of impact
factors of disability among the Chinese elderly in rural and
urban area.
Methods: Cross-sectional study. Establishing the data-
base of disability among the elderly in rural and urban area.
Analyze the difference of impact factors of disability among
the elderly in rural and urban area.
Results: 1387 elderly were included, 751 were from rural
area and the rest were from urban area. The impact factors
disability among the elderly in rural area were: age, sexual-
ity, scores of GDS, quality of sleep, chronic diseases, height,
weight, smoking, educational level; The impact factors dis-
ability among the elderly in urban area were: age, scores of
GDS, quality of sleep, physical exercise.
Conclusion: the impact factors of disability among the
Chinese elderly in rural and urban area are very different.
The doctors should use different methods to prevent and
intervene it.
OLDER PEOPLE WITH INTELLECTUAL DISABILITY:
AN 11-YEAR REGISTER STUDY OF HEALTHCARE
USE PATTERNS
M.Sandberg, G.Ahlstrm, A.Axmon, J.Kristensson, evaluative criterion and symptom attribution differ across
Department of Health Sciences, Lund University, Lund,
Sweden
The population of older people with intellectual disabili-
ties (ID) is growing. People with ID are known to have more
diseases and are believed to start aging earlier than the gen-
eral population, but knowledge about their healthcare use
is limited. This study aimed to explore somatic healthcare
utilization patterns among people with ID in Sweden, com-
pared to the general population 20022012. The sample con-
sisted of people with ID, aged 55 years and older in 2012
(n=7936), and an equal-sized birth- and sex matched general
population sample (n=7936). The sample was divided into
5-year intervals age groups. In- and outpatient data were col-
lected from the Swedish National Patient Register. The result
revealed that in younger age groups, the ID group had higher
utilization compared with the general population sample,
with higher risks for planned and unplanned in- and outpa-
tient care, particularly for unplanned inpatient registrations.
Decreasing patterns were seen with age; with lower risks in
the ID group for the oldest age groups. This was most evi-
dent in planned in- and outpatient care. In those with at least
one registration the ID group had, compared with the gen-
eral population sample, fewer planned outpatient visits, and
in the younger age groups longer unplanned length of stay.
In conclusion this study shows that in younger people with
ID utilize more healthcare than the general population, that
utilization decreases with age and fewer people with ID use
Innovation in Aging, 2017, Vol. 1, No. S1
healthcare in old age. The barriers for older people with ID
to accessing planned healthcare need more investigation.
SESSION 105 (SYMPOSIUM)
BIOPSYCHOSOCIAL APPROACH TO INTERVENTION
FOR COGNITIVE IMPAIRMENT IN WESTERNIZED
CHINESE CULTURES
Chair: T.Liu, The University of Hong Kong, Hong Kong
Co-Chair: G.Wong, The University of Hong Kong, Hong
Kong, Hong Kong
The effectiveness of biopsychosocial approach to demen-
tia care and intervention is culturally sensitive. The bulk
of these models have been developed in Western cultures;
when applied to Asian countries, issues such as psychologi-
cal processes, moral standards, and services delivery often
determine their applicability. In this symposium, four papers
are presented about applications of Western dementia care
concepts in Hong Kong and Guangzhou, two Chinese cit-
ies sharing the same dialect with slightly different degrees of
Westernization. Wong etal present a formative research on
the cultural adaptation of cognitive stimulation therapy, an
evidence-based non-pharmacological intervention originated
from the UK, in the Hong Kong context. Issues such as more
reserved and collective personality, attitudes towards author-
ities, and family roles are found to be important considera-
tions in intervention design. Wang etal find different roles of
self-efficacy in caregiver burden among Chinese adult chil-
dren and spouses of people with dementia in Guangzhou and
Hong Kong. The results are discussed in the context of fam-
ily role and filial piety. While subjective memory complaint
and depression are related to development of dementia, self-
culture and introduces variability in these parameters. Liu
et al follow up 2,081 community-dwelling elders in Hong
Kong, and find that depression but not subjective cognitive
complaints predicted changes in cognition. The model of
memory clinics has been adopted in Hong Kong, and Chan
elaborated on the development and preliminary findings of
a collaborative service among memory clinics, community-
based dementia care services, and families.
CULTURAL ADAPTATION OF COGNITIVE
STIMULATION THERAPY IN ACHINESE
POPULATION: AFORMATIVE RESEARCH
G.Wong1,2,3, O.Yek2, A.Zhang1, T.Lum1,2, 1. Department
of Social Work and Social Administration, The University of
Hong Kong, Hong Kong, Hong Kong, 2. Sau Po Centre on
Ageing, The University of Hong Kong, Hong Kong, Hong
Kong, 3. Department of Psychiatry, The University of Hong
Kong, Hong Kong, Hong Kong
Cognitive stimulation therapy (CST) has been recom-
mended as an effective intervention for improving cognitive
symptoms and quality of life in people with mild-to-mod-
erate dementia. Evidence-based protocols originally devel-
oped in Western countries may not be directly applicable in
Chinese population due to different cultural and societal fac-
tors. Following the formative method for adapting psycho-
therapy guidelines, we investigated the feasibility of applying
CST in Hong Kong Chinese, and consolidated opinions of
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
stakeholders on necessary modifications for local adaptation.
Focus groups and individual interviews were conducted in
day care centres and nursing homes with CST group facilita-
tors, CST group participants, family caregivers and formal
caregivers before and after the intervention. Some key areas
for modifications are related to the reserved personality,
which require alternating the content of some activities (e.g.,
public expression of personal opinion), and possible role
conflicts for family caregivers to continue delivering CST at
home, which require alternating delivery format.
DIFFERENT ROLE OF SELF-EFFICACY IN THE
EXPERIENCE OF BURDEN BETWEEN DIFFERENT
CAREGIVERS
J.Wang1,2, G.Wong2,3, T.Lum2,3, 1. School of Nursing, The
Chinese University of Hong Kong, Hong Kong, Hong Kong,
Hong Kong, 2. Department of Social Work and Social
Administration, The University of Hong Kong, Hong Kong,
Hong Kong, Hong Kong, 3. Sau Po Centre on Ageing, The
University of Hong Kong, Hong Kong, Hong Kong, Hong
Kong
Self-efficacy is an individuals assessment of his/her abil-
ity to successfully master a specific task. This study inves-
tigated the different mediating effect of three domains of
self-efficacy between stressors and caregiving burden among
adult child and spousal dementia caregivers. We interviewed
195 caregivers of people with dementia (123 adult children,
and 72 spouses) recruited from memory clinics, community
primary care and day care centers in two cities, mainland
China. Series of multiple regressions were conducted to test
the mediating effect. The results showed self-efficacy for con-
trolling upsetting thoughts greatly mediate the effect of the
stressors on caregivers burden for both groups. Self-efficacy
for responding to disruptive behaviors functioned as a medi-
ator for adult children; whereas self-efficacy for obtaining
respite functioned as a mediator for spouses. These results
provided insight of mediating role of self-efficacy to inform
different effective intervene methods for the two caregiver
groups.
RELATIONSHIP BETWEEN SUBJECTIVE MEMORY
COMPLAINT, DEPRESSION, AND COGNITION IN
HONG KONG CHINESE
T.Liu1, J.Xu1, G.Wong1,2, J.Tang1, T.Lum1,2, 1. Sau Po vation that aging is a major risk factor for development
Centre on Ageing, The University of Hong Kong, Hong
Kong, Hong Kong, Hong Kong, 2. Department of Social
Work and Social Administration, The University of Hong
Kong, Hong Kong, Hong Kong, Hong Kong
Subjective memory complaint (SMC) is common in
older people and has been found to associate with depres-
sive symptoms and future cognitive decline. However, the
relationship between them is complex and still inconclusive.
Understanding the respective extent SMC and depression
explain and predict changes in cognitive function may pro-
vide insight. Our study followed 2,081 community-dwell-
ing older persons aged 65 or above in Hong Kong for one
year, and measured their SMC with a dichotomous ques-
tion, depression with Geriatric Depression Scale (GDS), and
cognition with Cantonese Montreal Cognitive Assessment
(MoCA). Baseline SMC and GDS scores were moderately
correlated (r=.42, p < .001), and they were associated with
IAGG 2017 World Congress
27
poorer cognition after controlling for age, gender and educa-
tion at baseline (R2 change=.03, p < .001), and at follow-up
(R2 change=.03, p < .001). However, only depression was
predictive of changes in cognition, not age, gender, educa-
tion, or SMC.
TRIPARTITE COLLABORATION ON DEMENTIA
CARE BETWEEN HOSPITAL, COMMUNITY, AND
FAMILY
H.Chan1,2, 1. University Department of Medicine, The
University of Hong Kong, Hong Kong, Hong Kong, Hong
Kong, 2. Sau Po Centre on Ageing, The University of Hong
Kong, Hong Kong, Hong Kong, Hong Kong
Living with dementia is a great challenge to both
patients and their caregivers due to the debilitating condi-
tions that affect them progressively. In line with the Hong
Kong Governments strategic direction on elderly services,
an exploratory study was carried out to examine a tripartite
collaboration model on dementia care among hospital-based
memory clinic, community-based non-governmental organi-
zations (NGOs), and families affected by dementia. Patients
diagnosed with mild to moderate dementia and their car-
egivers were identified in memory clinics and referred to an
empowerment program consisting of educational talks and
workshops. They were later triaged to appropriate NGOs
for cognitive training and social care. A designated Linked
Person was responsible for care coordination. A feedback
and support system was in place between the clinical teams
and community partners. Attendance in the empowerment
program and community care services was the main outcome
measurement. Implications and findings of the care model
will be discussed.
SESSION 110 (SYMPOSIUM)
BIOMARKERS OF HUMAN AGING
Chair: R.A.Kohanski, National Institute on Aging, Division
of Aging Bio, Bethesda, Maryland
The Geroscience hypothesis states that slowing the rate
of aging will delay the onset and/or reduce severity of aging-
related diseases without necessarily altering life span, thus
improving health at older ages. This is based on the obser-
of chronic diseases and degenerative conditions. The rate
of aging can be understood as the losses of function cou-
pled with the advent of chronic diseases with the passage
of time. It is often represented as physiological or biologi-
cal age versus chronological age or years. From this simple
picture three questions emerge: What are the metrics used to
measure physiological aging? Do these metrics or biomark-
ers of aging explain the risk factor aspect of aging that
underlies the geroscience hypothesis? Do these biomarkers of
aging account for the variation in health for each age group
in a population?
QUANTIFICATION OF BIOLOGICAL AGING FOR
TESTING GEROPROTECTIVE INTERVENTIONS
D.Belsky1,2, 1. Duke University School of Medicine,
Durham, North Carolina, 2. Social Science Research
Institute, Duke University, Durham, North Carolina
28
Quantification of biological aging is contentious. Many
methods are being put forward, but these have not been
compared to one another in the same humans. We conducted
comparative analysis of 7 measures of biological aging
based on telomere length, epigenetic marks, and clinical bio-
marker algorithms in a 19723 birth cohort (N=1,037) fol-
lowed prospectively through midlife, the Dunedin Study. We
focused on a midlife cohort because this life course stage is
little-studied in geroscience even though geroprotective inter-
ventions may be most effective if administered early, before
disease processes become established. We evaluated correla-
tions among biological ages estimated via different methods,
tested within-person change over time, and compared pre-
dictions of healthspan-related characteristics (physical func-
tioning, cognitive decline, subjective signs of aging). Results
shed light on different strategies for uncovering markers of
biological aging and highlight the utility of comparatively
young cohorts for advancing geroscience research.
AGING AND HEALTH BIOMARKER DISCOVERY
TRANSLATIONAL INSIGHTS FROM NONHUMAN
PRIMATES
R.Anderson1,2, 1. William S.Middleton Memorial Veterans
Hospital, Madison, Wisconsin, 2. University of Washington
School of Medicine and Public Health, Madison, Wisconsin
An emerging paradigm in aging research identifies meta-
bolic dysfunction as a root cause in the age-related increase
in disease vulnerability. Several diseases of aging, including
diabetes, cancer, and neurodegeneration, have an established
metabolic component. Our studies in nonhuman primates
have focused on links between metabolic status and disease
vulnerability. Caloric restriction (CR) delays aging and the
onset of age related disease in diverse species, including non-
human primates. Our work demonstrates that CR animals
are metabolically distinct from their control counterparts.
Molecular profiling identifies CR responsive elements in the
transcriptome, proteome, and metabolome that are highly
enriched for metabolic pathways and in particular mitochon-
drial processes. These data show that improvements in health
and survival are associated with changes in energy metabo-
lism in nonhuman primates, a highly translational model for
human aging. Metabolic biomarkers identified in these stud-
ies may be clinically relevant for the early identification of
elevated disease risk in humans.
GROWTH DIFFERENTIATION FACTORS AND
SENESCENCE-RELATED PROTEINS AS MODIFIERS OF
AGING
N.LeBrasseur, Mayo Clinic, Rochester, Minnesota
Advances in geroscience include the identification of pro-
teins that both accelerate and delay the emergence of aging-
related phenotypes, at least in preclinical models. Translation
of this work to humans is critical to determine whether
these potential modifiers of aging associate with or predict
important clinical outcomes and, ultimately, represent tar-
gets for novel and transformative therapeutic interventions
to improve health among older people. Our laboratory has
been particularly interested in 1)members of the transform-
ing growth factor- superfamily; growth differentiation
factor 8 (GDF8, or myostatin), and GDF11, and 2)factors
produced and secreted by senescent cells, collectively referred
Innovation in Aging, 2017, Vol. 1, No. S1
to as the senescence-associated secretory phenotype (SASP).
The objectives of this lecture are to provide the rationale for
the selection of GDF8, GDF11, and SASP proteins as ger-
onic factors, and to share findings from our recent studies
that have examined their associations with aging-associated
diseases and conditions.
GENERIC BIOMARKERS IN AGEING: TOOLS TO
STUDY METABOLIC HEALTH AND RESPONSE TO
INTERVENTIONS
E.Slagboom, Leiden University Medical Centre, Leiden,
Netherlands
There is enormous diversity in health span with age, rang-
ing from unhealthy 60- to vital 90-year-olds. This diversity is
poorly understood and obscures the effect of interventions
(rarely tested in elderly subjects). Underlying this diversity
may be energy metabolism and immunity understood as
drivers of health in ageing. Biomarkers based on this knowl-
edge could improve evidence-based medicine among the
elderly, but will require coordinated efforts in longitudinal
and intervention studies. Ageing-related changes in omics
may have greater predictive power than traditional metrics
of metabolic health (e.g. metabolites, glycosylations, tran-
scripts, epigenetics and gut microbiome versus serum insulin,
lipids, BP and BMI), especially in the fastest growing popula-
tion of elderly humans. In our ongoing research on omics as
biomarker in ageing, we witness signatures of early develop-
ment in addition to age-related dys-differentiation, revealing
both generic and disease-specific signatures. We will discuss
the insights obtained from linking intervention and epide-
miological studies.
SESSION 115 (SYMPOSIUM)
DYADIC ASSOCIATIONS IN LATER LIFE: EXPLORING
THE INTERDEPENDENT NATURE OF HEALTH AND
MARRIAGE
Chair: J.B.Yorgason, Brigham Young University, Provo,
Utah
Discussant: C.A.Berg, University of Utah
Age-related changes in health often necessitate spousal
caregiving among older married couples. Such caregiving can
impact relationship functioning and satisfaction. Likewise,
positive and negative marital interactions may also be linked
with mental and physical health. Indeed, marriage provides
the context for illness management and caregiving for health
problems among later life couples. Although published lit-
erature points to these associations generally, advances in
dyadic research continues to elaborate and provide nuanced
details of how and when health and marriage are linked. This
symposium advances understanding of interdependent asso-
ciations between health and marriage, with five presentations
using dyadic data. The first and second papers address links
between illness and relationship satisfaction, with the first
paper examining ADLs and IADLs among caregivers, and the
latter addressing specific severe illnesses among a large Korean
sample. The third and fourth papers explore spousal support
during and in relation to diabetes treatment, using quantitative
and qualitative approaches, respectively. The fifth paper uses
a daily diary design to explore actor and partner reciprocal
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Innovation in Aging, 2017, Vol. 1, No. S1
lagged associations between health and marital interactions.
The session discussant, Cyndi Berg, has expert knowledge of
theory and research linking health and marriage in later life
and during spousal caregiving. Together, the papers of this
symposium present a unique dyadic examination of ways that
health and marriage intersect for many older couples.
PHYSICAL AND COGNITIVE HEALTH RELATED TO
MARITAL INTERACTIONS: ADAILY DIARY CROSS-
LAG EXAMINATION
J.B.Yorgason1, H.Choi2, 1. School of Family Life,
Brigham Young University, Provo, Utah, 2. Sungkyunkwan
University, Seoul, Korea (the Republic of)
Marital processes have been linked with physical health.
Physical health challenges, sometimes due to aging, have also
been associated with marital outcomes. Literature has estab-
lished interrelations between health and marriage, and that
connections vary for husbands and wives. Studies examining
reciprocal pathways between health and marriage have used
panel data across years. The current study examined such
pathways within a daily dairy framework among couples
across 14 days. Multivariate multilevel models were used
to model cross-lag, actor/partner associations between daily
physical and cognitive health and daily positive and negative
marital events for 191 older couples. Findings suggest that
daily health limitations are predictive of next-day higher pos-
itive marital events for husbands and fewer negative marital
events for wives. Daily cognitive challenges in husbands were
linked to fewer next-day negative marital events for wives.
Also, daily negative marital events were linked to greater
next-day cognitive challenges for both husbands and wives.
SPOUSES HEALTH AND RELATIONSHIP
SATISFACTION IN THE CAREGIVER HEALTH
EFFECTS STUDY
J.Monin, Yale University, New Haven, Connecticut
Within spousal caregiving dyads, both partners health
and relationship satisfaction are inextricably linked. Drawing
from interdependence theory, we tested the hypothesis that
each spouses health relates to their own and their partners
relationship satisfaction. Two hundred thirty three spousal
dyads in the Caregiver Health Effects Study (CHES), ancillary
to the Cardiovascular Health Study (CHS), reported relation-
ship satisfaction at CHES baseline. Depressive symptoms,
activities of daily living (ADLs), instrumental ADLs (IADLs),
and self-reported health were obtained at the corresponding
CHS wave. Using the Actor-Partner Interdependence Model
we found that for both partners, greater depressive symptoms
and lower self-reported health related to lower relationship
satisfaction (actor effects). Caregivers greater IADL needs
were associated with lower relationship satisfaction (actor
effect). When care recipients depressive symptoms were
high, caregivers had lower relationship satisfaction (partner
effect). For both partners, having a spouse with greater ADL
needs was associated with lower relationship satisfaction.
FOLLOWING YOUR LEAD: PATIENTS DIET
ADHERENCE, SPOUSE AWARENESS AND
INVOLVEMENT IN MANAGING DIABETES
K.J.August1, M.M.Franks2, K.V.Westley1, K.S.Rook3, recorded conversations between diabetes patients, their
M.Stephens4, 1. Department of Psychology, Rutgers
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29
University, Camden, New Jersey, 2. Purdue University,
West Lafayette, Indiana, 3. University of California, Irvine,
Irvine, California, 4. Kent State University, Kent, Ohio
Spouses often are involved in the day-to-day manage-
ment of chronic illnesses by supporting their partners
adherence to treatment recommendations (health-related
social support), or regulating their partners behaviors when
adherence is irregular or absent (health-related social con-
trol). Although support and control have implications for
both partners, little is known about what prompts spouses
daily involvement. Using daily diary data from 129 patients
with type 2 diabetes, we found that on days when patients
reported higher adherence to their diabetic diet, spouses were
more aware of their partners being on track with their diet,
which in turn, was related to more spousal support. On days
when patients reported lower adherence, spouses were more
aware of their partners being off track with their diet, which
in turn, was related to more spousal control (both persuasion
and pressure). Findings suggest that spouses may be appro-
priately calibrating their involvement in response to patients
adherence.
THE IMPACTS OF SPOUSES HEALTH CONDITIONS
ON DEPRESSIVE SYMPTOMS
J.Min1, J.B.Yorgason2, J.Fast1, N.C.Keating3, 1. University
of Alberta, Edmonton, Alberta, Canada, 2. Brigham Young
University, Provo, Utah, 3. Swansea University, Swansea,
Wales, United Kingdom
Spousal health decline can negatively affect ones mental
health outcomes; however, less is known about how the qual-
ity of marital relationships and spousal caregiving moderates
this association and how this association may be sensitive
to the different chronic health conditions considered in this
study. To addressed our research questions, we conducted
multilevel analyses using 3487 couples age 45 + at baseline
from the 4 waves of the Korean Longitudinal Study on Aging
(KLoSA; 2006 -2012).
Results indicated that the husbands cancer and stroke
were related to increased depressive symptoms among wives
while these associations were not found among husbands.
We also found a significant moderating effect of marital
satisfaction and caregiving status. The findings suggest that
considering gender, relationship quality and caregiving con-
text within couples are important. Health care providers are
encouraged to be aware of the possibility that couples are
connected in both physical health and mental health.
HE SAID, SHE SAID: SUPPORTIVE INTERACTIONS
AMONG MARRIED COUPLES DURING DIABETES
APPOINTMENTS
A.Seidel2, M.Marshall1, M.M.Franks1, S.Oates3, 1.
Human Development & Family Studies, Purdue University,
West Lafayette, Indiana, 2. Pennsylvania State University,
York, Pennsylvania, 3. IU Health, Indianapolis, Indiana
Given that patients with diabetes who have support-
ive spouses follow treatment regimens better than patients
who do not, we explored indications of spousal support, or
lack thereof, during diabetes medical appointments. Data
were collected from questionnaires and unscripted, audio-
spouses, and their physicians. We found a positive relation
30
between feelings of support and adhering to diabetes-related
health behaviors (e.g. meal plans, testing blood sugars).
Additionally, content analysis of conversations compared
couples in which the patients reported high versus low lev-
els of support. Healthcare conversations differed between
the low support and high support couples in four key areas:
spouse involvement in diet-related activities, spouse compli-
ments or criticisms of patients diet-related behaviors, direct
discussion about support, and frequency of spouse commu-
nication during the medical appointment. Implications may
include training physicians to recognize spousal support that
is available to patients with diabetes.
SESSION 120 (SYMPOSIUM)
HOW OLD DO YOU FEEL?: CURRENT DIRECTIONS
IN SUBJECTIVE AGE RESEARCH
Chair: Y.Stephan, University of Montpellier, Montpellier,
France
Co-Chair: A.Terracciano, Florida State University,
Tallahassee, Florida
Discussant: T.M.Hess, North Carolina State University,
Raleigh, North Carolina
Subjective age, i.e. how old or young individuals feel, is a
growing area of research in Gerontology because of its links
with important outcomes among older adults. Indeed, cross-
sectional and longitudinal research has shown that, independ-
ent of chronological age, a younger subjective age is related to
health-promoting behaviors, better physical and mental health,
and better cognitive performance and slower cognitive decline
over time. In addition, recent studies focusing on the determi-
nants of subjective age revealed that the age individuals feel
integrates a range of cues about aging, spanning from biologi-
cal to social. This symposium brings together researchers from
Europe and the United States to present new research on the
determinants and implications of subjective age. First, David
Weiss and Anna Reitz will examine whether variability in indi-
viduals subjective age can be explained by essentialist beliefs
about aging. Second, Matthew Hughes and Margie Lachman
will test whether functional health and memory predict dif-
ferential changes in subjective age. Third, Jennifer Bellingtier
and Shevaun Neupert will report on the link between daily
fluctuations in subjective age, affect, and daily Awareness of
Age-Related Change. Fourth, Amit Shrira and colleagues will
examine whether subjective age and nearness to death moder-
ate emotional complexity among individuals with varying lev-
els of posttraumatic symptoms. Finally, Yannick Stephan and
colleagues will present new data on the association between
subjective age and longevity from large national longitudi-
nal cohorts followed for almost twenty years. As discussant,
Thomas Hess will tie the relevance of these findings to theories
of subjective aging.
IS AGE MORE THAN ANUMBER? ESSENTIALIST
BELIEFS ABOUT AGING PREDICT HOW YOUNG OR
OLD PEOPLE FEEL
D.Weiss1, A.Reitz2, 1. Columbia University, New York,
New York, 2. New York University, New York, New York
Although aging comes with seemingly inevitable changes,
there is a great variability in how young or old people feel.
Innovation in Aging, 2017, Vol. 1, No. S1
However, little is known about the social-cognitive deter-
minants of this subjective age bias, that is, the discrepancy
between chronological age and felt age. Thus, we exam-
ined whether variability in individuals subjective age can
be explained by essentialist beliefs about aging. Specifically,
we predicted that people who believe that aging is a fixed
process, compared to those who think of it as malleable,
should report a reduced subjective age bias. In line with
predictions, findings demonstrate that people who endorse
essentialist beliefs about aging perceived their age as static
and unchangeable and reported a significantly smaller sub-
jective age bias. This effect appeared to be even stronger with
advancing age. The discussion focuses on social-cognitive
and motivational mechanisms of subjective conceptions of
aging and older adults responses to aging-related challenges.
GETTING OLDER FASTER? CHANGES IN
SUBJECTIVE AGE ARE TIED TO FUNCTIONAL
HEALTH AND MEMORY
M.Hughes, M.E.Lachman, Brandeis University, Waltham,
Massachusetts
There is interest in understanding what factors contribute
to changes in subjective age. With longitudinal data collected
in the Midlife in the United States (MIDUS) study, we exam-
ined changes in subjective age over 18 years. We assessed
whether two domains that typically show aging-related
declines, functional health and memory, would predict dif-
ferential changes in subjective age, controlling for age, sex,
and education. Whereas an average of 18years had passed
between the first and third waves, participants on average
felt only 14.76years older, although some felt they had aged
more. Worse functioning with regard to health and memory
predicted greater increases in subjective age. Additionally,
those who reported that their health and memory, relative
to their peers, had decreased also demonstrated greater
increases in subjective age. This suggests that although most
people feel that they are aging slower than they actually are,
aging-related declines contribute to faster subjective aging.
DAILY AWARENESS OF AGE-RELATED CHANGE AND
WELL-BEING IN OLDER ADULTS
J.A.Bellingtier, S.D.Neupert, North Carolina State
University, Raleigh, North Carolina
Awareness of Age-Related Change (AARC) has emerged
as a new dimension of subjective age associated with impor-
tant well-being outcomes between-people (Brothers et al.,
2015). Awareness of aging gains and losses may shift based
on a days experiences, but the implications of daily fluctua-
tions have yet to be investigated. We measured AARC daily
over 8days in a sample of 116 adults ranging in age from
60 to 90. Findings indicate significant within-person vari-
ability in AARC. Controlling for age, gender, education, and
between-person AARC, daily negative affect was significantly
higher on days with a greater perception of AARC losses,
whereas daily positive affect was higher on days with greater
perceptions of AARC gains. Furthermore, daily AARC gains
predicted younger daily felt ages and between-person dif-
ferences in AARC losses predicted younger daily ideal ages.
Findings suggest daily AARC plays an important role in the
daily affect and subjective ages of older adults.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SUBJECTIVE AGING AND EMOTIONAL
COMPLEXITY OF TRAUMATIZED OLDER ADULTS
A.Shrira1, E.Bodner1, Y.Hoffman1, Y.Palgi2, 1. Bar-Ilan
University, Ramat Gan, Israel, 2. University of Haifa, Haifa,
Israel
Subjective aging refers amongst other aspects to percep-
tions of ones age and nearness to death, and appears to
be related to resilience. Subjective aging may be especially
relevant for older adults coping with traumatic events. The
present study examined whether subjective age and nearness
to death moderate emotional complexity among individuals
with varying levels of posttraumatic symptoms. We used data
from two 14-day diary study samples (Sample 1: N=188, M
age=57.8; Sample 2: N=140, M age=67.8). Subjective aging
was measured at the between- and within-subject level in
Sample 1 and 2, respectively. Emotional complexity was
assessed by intraindividual correlations of positive affect
and negative affect. In both samples, three-way interactions
showed that feeling younger or further away from death was
related to increased emotional complexity, especially among
those high in posttraumatic symptoms. Findings suggest that
favorable perceptions of aging are most relevant to regulat-
ing emotional experience of traumatized older adults.
SUBJECTIVE AGE AND LONGEVITY: EVIDENCE
FROM THREE LONGITUDINAL SAMPLES
Y.Stephan1, A.Sutin2, A.Terracciano2, 1. UFRSTAPS,
University of Montpellier, Montpellier, France, 2. Florida
State University, Tallahassee, Florida
The age individuals feel is related to health and well-being.
In this study we examined the association between subjec-
tive age and mortality using three large longitudinal samples
from the United States, the Health and Retirement Study, the
National Health and Aging Trends Study and the Midlife in
the United States Study (total N= 13455). Controlling for
demographic factors, an older subjective age was predic-
tive of higher mortality risk across the three samples, over
a follow-up of four to almost twenty years. Individuals who
felt older had about twofold higher risk compared to those
with a younger subjective age. The inclusion of depressive
symptoms and disease burden partially accounted for these
relationships. These findings provide further support to sub-
jective age as a crucial biopsychosocial marker of aging.
SESSION 125 (SYMPOSIUM)
TIME USE AMONG OLDER ADULTS: DIFFERENTIALS
AND IMPLICATIONS FOR WELL-BEING
Chair: D.Carr, Rutgers University, New Brunswick, New
Jersey
Discussant: K.Latham-Mintus, Indiana University-Purdue
University--Indianapolis, Indianapolis, Indiana
How do older adults spend their time, and what are the
implications of daily time use for health and well-being?
Drawing on daily diary data from the American Time Use
Survey (ATUS) and Supplements on Disability and Use of
Time to the Panel Study of Income Dynamics (PSID), these
five papers document the correlates and consequences of
older adults time use, with particular attention to the ways
that health, caregiving responsibilities and family relation-
ships shape time use. Dukhovnov, Zagheni and Ryan explore
IAGG 2017 World Congress
31
racial and ethnic differences in informal care transfers and
the implications for older adults emotional well-being.
Kalenkoski examines how the unpaid caregiving responsi-
bilities of older adults affect their well-being, paying particu-
lar attention to gender differences. Lam and Garcia assess
whether elder caregivers report time constraints, and com-
pare whether caregivers and non-caregivers vary in the time
spent in personal care, social activities and sports, house-
work and employment. Shandra examines how the presence
of a sensory, cognitive, physical, or multiple disability is asso-
ciated with the likelihood and intensity of participation in six
types of leisure activities (passive, exercise, organizational,
hobbies, arts, and social), with particular attention to age
variation therein. Flood and Genadek investigate the rela-
tionship between marital quality and duration and couples
shared time during later adulthood, with particular attention
to active versus passive time use. The authors discuss the
methodological and theoretical implications of their work,
and show how daily diary data provides a unique window
on older adults daily lives and well-being.
ELDERCARE AND TIME CONSTRAINTS: DOES
ACCESS OR UTILIZATION OF WORKPLACE LEAVE
MATTER?
J.Lam1, J.Garcia-Roman2, 1. University of Queensland,
Indooroopilly, Queensland, Australia, 2. Minnesota
Population Center, Minneapolis, Minnesota
Population aging is requiring a re-examination of the role
of eldercare. According to the U.S. Census Bureau, nearly
one in five U.S. residents will be age 65 or older in 2030.
Unpaid caregivers often experience what is called caregiver
strain, defined as psychological, emotional, and/or physical
strain through the act of caregiving. This paper will draw
on data from the 2011 American Time Use Survey (ATUS),
to examine whether elder caregivers may report time con-
straints, as the act of providing care may take time away
from other activities. It will compare whether caregivers
and non-caregivers may vary in the amounts of time spent
in personal care, social activities and sports, housework and
employment. Further, it will investigate whether access and/
or utilization of unpaid eldercare leave may modify this rela-
tionship, as it may allow worker-caregivers to engage, or per-
ceive the possibility of engaging in various work and family
responsibilities.
HOW DO THE ADULT CARE RESPONSIBILITIES OF
OLDER AMERICANS AFFECT THEIR WELL-BEING?
C.Kalenkoski, Texas Tech University, Lubbock, Texas
This paper will use time-use and well-being data from the
2013 Disability and Use of Time Supplement to the Panel
Study of Income Dynamics (DUST) to examine how the
unpaid caregiving responsibilities of older adults affect their
well-being, paying particular attention to gender differences.
Early results using the 2009 DUST show that, controlling
for pre-existing levels of reported life satisfaction, provid-
ing unpaid physical and medical care for others is associ-
ated with reduced levels of tiredness and pain compared to
other activities by husbands. Wives do not experience any
difference in tiredness or pain while engaging in this type
of caregiving compared to other activities. In addition, these
caregiving activities are not found to elicit any greater or
32
lesser amounts of calm, happiness, frustration, worry, or sad-
ness than other activities by either husbands or wives. Other
types of caregiving activities (by type of activity and type of
recipient) will be examined.
MARITAL CHARACTERISTICS AND COUPLES
SHARED TIME DURING ADULTHOOD
S.Flood, K.Genadek, Minnesota Population Center,
Minneapolis, Minnesota
This paper leverages unique data from the 2009 and 2013
Supplements on Disability and Use of Time to the Panel
Study of Income Dynamics (PSID) to investigate the rela-
tionship between marital characteristics and couples shared
time during later adulthood. Previous research indicates that
spousal interaction is a key dimension of marital quality. We
extend previous research that has been primarily focused on
time spent with a spouse for working-age adults and parents
by considering couples shared time during the stage of life
after the career- and family-building years, specifically ages
50 and 79. By using the PSID, we make two key contribu-
tions to the literature. First, we analyze the quality of time
with a spouse by differentiating between active and passive
shared time. Second, we examine how marital quality and
marital duration are associated with time with a spouse,
which has been a major limitation of previous research in
this area. Results show that the nature of time with a spouse
active versus passive varies by levels of marital support
and marital strain and that in the cross section, marital dura-
tion shows a u-shaped relationship with active shared time.
DISABILITY AND PATTERNS OF LEISURE
PARTICIPATION ACROSS THE LIFE COURSE
C.Shandra, State University of New York at Stony Brook,
Stony Brook, New York
I use nationally representative data from the Well-Being
Module of the American Time Use Survey (N=38,547) to
examine: (1) how the presence of a sensory, cognitive, physi-
cal, or multiple disability associates with the likelihood and
intensity of participation in six types of leisure activities
(passive, exercise, organizational, hobbies, arts, and social),
and (2) if these patterns vary by age. Overall, people with
all types of disability are more likely to engage in passive
formsand less likely to engage in active formsof leisure
activity; however, many of these differences are mediated by
health status. These associations persist, net of sociodemo-
graphic and health controls, for people with physical or mul-
tiple disabilities. Furthermore, greater differences in leisure
time by disability status are observed with increasing age.
Older adults with disabilities are more susceptible to disen-
gaged leisure time, compared both to those without disability
and to younger adults with disability.
SESSION 130 (SYMPOSIUM)
FACILITATING PURPOSE IN LATER LIFE
Chair: J.Nakamura, Claremont Graduate University,
Claremont, California
Discussant: L.L.Carstensen, Stanford University
Across the life course, dedication to a social purpose is
associated with both individual and collective well-being.
Increasingly, later life is being recognized as a period when
Innovation in Aging, 2017, Vol. 1, No. S1
adults may form a purpose goal meaningful to themselves
and useful to others and dedicate their energies to pursuing
it, for example, by leveraging accrued experience to create
new ways of addressing social problems. Three papers will
share empirical reports addressing how older adults in the
U.S. form and pursue social purpose and the psychosocial
and institutional means by which this can be facilitated, sum-
marizing lessons learned from three mixed-methods research
projects. A leader in the psychology of aging will provide
a discussion. Anne Colby will present results of a study of
purpose beyond-the-self and its correlates in adults over
50, based on a survey of a nationally representative sam-
ple (n=1,200) and over 100 interviews on the topic. Jeanne
Nakamura will present a paper based on 50 in-depth inter-
views with individuals over 60 who have been honored for
successful social innovation, charting the diverse pathways
those individuals took to realize their purpose goals. Jim
Emerman will discuss results of a survey of organizations
helping older individuals find ways to live out their purpose
goals, mapping programmatic resources available to this
population and analyzing opportunities and gaps in services.
Then, Laura Carstensen will provide an integrative discus-
sion of the papers, informed by her extensive body of work.
The session will conclude with discussion by the panel and
audience of issues that have been raised.
NATIONAL STUDY OF PURPOSE BEYOND THE SELF
IN OLDER ADULTS
A.Colby1, M.Bundick2, K.Remington1, 1. Stanford
University, Palo Alto, California, 2. Duquesne University,
Pittsburgh, Pennsylvania
This paper reports on the findings of a study of purpose
beyond-the-self (bts) in U.S. adults aged 5090. Purpose
beyond-the-self is defined as active engagement toward goals
that are meaningful to the self and contribute to the world
beyond the self. The study includes a nationally representa-
tive survey of 1,200 respondents, with in-depth interviews
of 107. Analyses to date indicate that about 30% of older
adults exhibit purpose bts; that purpose is approximately
equally prevalent across age, gender, education, income, and
health status; and that people of color are more likely to be
purposeful than are white respondents. Further analyses will
report the significant positive relationships between pur-
pose and other indicators of positive adaptation, including
gratitude, prosocialness, generativity, and personal growth
initiative. The nature, significance, and dynamics of purpose
in later life will be explicated through interview-based case
examples, describing highly purposeful individuals from a
wide range of life situations.
PATHWAYS TO SOCIAL PURPOSE AND INNOVATION
AFTER SIXTY
J.Nakamura, L.Graham, T.Chan, K.Procter, Psychology,
Claremont Graduate University, Claremont, California
Much attention has been devoted to traditional forms
of social contribution in later life such as volunteering. In
contrast, little is known about social innovation the crea-
tion of new ways to address persistent social problems. In
particular, the pathways leading to social innovation in later
life are largely uncharted. In an ongoing mixed-methods
research project, we are examining the nature, antecedents,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and correlates of this form of social contribution in later life
by studying nominees for the Purpose Prize, a U.S. award
that recognizes successful social innovation by individuals
over sixty. This presentation will draw on semi-structured
interviews conducted with 50 Purpose Prize honorees. Based
on systematic coding and analysis, we present the key build-
ing blocks of older adults pathways to social innovation,
and distill the features of the most common pathways while
documenting the diversity of pathways taken. Implications
for facilitating later-life expression of creative prosocial ener-
gies are discussed.
MAPPING RESOURCES FOR OLDER ADULTS
SEEKING PURPOSE BEYOND THE SELF
J.Emerman, Encore.org, San Francisco, California
This paper will present findings from a survey of organi-
zations serving the needs of individuals aged 50+ who iden-
tify one or more expressions of purpose beyond-the-self as a
major life goal. We will discuss the types of services these pro-
grams offer, the range of populations and geographies served
and some of the major opportunities and challenges these
organizations face. Additionally, we will analyze where there
are needs that the current configuration of organizations is
not meeting and populations that are currently underserved.
Finally, we will discuss opportunities for professionals and
institutional sectors not currently engaged in this work to fill
these unmet needs.
SESSION 135 (PAPER)
DEPRESSION: CORRELATES AND CONSEQUENCES
GAIT SPEED PREDICTS ENGAGEMENT IN PROBLEM
SOLVING THERAPY IN OLDER ADULTS WITH
DEPRESSION
S.T.Stahl, S.M.Albert, M.Dew, S.Anderson, M.Butters, cognitive performance, physical activity, previous falls, num-
A.Gildengers, J.Karp, C.Reynolds, Psychiatry, University
of Pittsburgh, Pittsburgh
To determine the acceptability of clinical interventions
for depression prevention, identifying clinical characteristics
associated with its engagement is needed. The purpose of
this study is to describe baseline correlates of engagement in
Problem Solving Therapy (PST) in adults 60 and older who
reported subthreshold depression and high disability bur-
den. PST involved 68 sessions in which participants learn
skills to solve self-selected problems that are contributing to
stress and reduced quality of life. During PST, intervention-
ists completed 3 rating scales that asked about patients level
of participation in problem solving activities, understand-
ing of the process, and session homework effort in order to
measure patients engagement with PST. Using multivariate
regression, we tested associations among demographics (age,
sex, race, education), mental health (depression), physical
health (medical illness, gait speed), and cognitive function
as correlates of engagement in the PST intervention of our
depression prevention trial (n=50). Faster gait speed was sig-
nificantly associated with more effort and motivation during
intervention sessions and greater understanding of PST con-
cepts. Faster gait speed was also significantly associated with
more effort in completing homework material, as rated by
IAGG 2017 World Congress
33
interventionists. These findings suggest that healthier older
adults may be more likely to engage in PST. These findings
raise questions about whether therapists should consider gait
speed when deciding to offer therapy like PST. Discussion
will focus on the role of reporting intervention engage-
ment in the clinical trial literature and whether an indicator
of intervention engagement should serve a moderator or a
mediator in trial outcome analyses.
THINKING, FEELING AND MOVING IN AGING:
THE ROLE OF COGNITION AND DEPRESSION IN
BALANCE CONTROL
F.Faria1,2,3, S.Muir-Hunter1, M.MonteroOdasso1,2,3, 1.
Medicine, University of Western Ontario, London, Ontario,
Canada, 2. Parkwood Institute, London, Ontario, Canada,
3. Lawson Health Research Institute, London, Ontario,
Canada
Emerging evidence shows that motor and balance control
in older people is affected by cognitive status and by depres-
sive symptoms. However, how static balance is affected by
the presence of both, cognitive and depressive symptoms
together, in the same individual is unknown. We hypoth-
esize that balance control will differ in older individuals
based on their cognitive status (MCI), presence of depres-
sive symptoms, or both factors combined. Ninety six older
participants (mean age =756) were stratified by cognitive
and depressive status as follows: No cognitive or depressive
symptoms(Controls, n=25; 71 years old), Cognitive but no
depressive symptoms (MCI; n=36; 75years old); Cognitive
and with depressive symptoms (MCI_ds; n=19; 76 years
old); and Cognitive with major depression (MCI_D; n=16;
74 years old). Balance (area of body sway) was assessed
while standing during eyes open and eyes closed conditions
using an electronic rigid platform (Bertec Inc.). Balance
under eyes open condition did not significantly differ across
groups (Mixed RM-ANCOVA) after controlling for age, sex,
ber of medications and antidepressants. Interestingly, partici-
pants having cognitive and depressive deficits (MCI_ds and
MCI_D) showed a lack of physiological increase in balance
sway in the challenging condition of eyes closed (p=0.003).
Our findings suggest that combination of depressive and cog-
nitive symptoms may reduce flexibility of balance control in
older adults, placing them at higher risk of falls. Potential
mechanism of these associations including the hyper cau-
tious control through cognitive resources will be discussed.
URBANICITY OF RESIDENCE AND DEPRESSION
AMONG OLDER ADULTS IN GHANA AND SOUTH
AFRICA
D.Adjaye-Gbewonyo, G.Rebok, J.J.Gallo, A.Gross,
S.Ahmed, C.Underwood, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland
As the primary cause of disability worldwide, depression
is a significant contributor to global morbidity and mortal-
ity and often disproportionately affects older adults. Several
studies have demonstrated a link between urban residence
and depression, but few studies have examined this associa-
tion among older adult populations, and even fewer have
studied it within an African context. Given that African
societies are aging and urbanizing at rapid rates, this study
34
aimed to assess the relationship between urbanicity and
depression using the Ghana and South Africa samples of the
World Health Organization Study on Global AGEing and
Adult Health (SAGE) wave 1 (20072008). Depression over
the past 12months was measured using self-reported treat-
ment and depressive symptoms based on ICD-10 criteria
in 4209 Ghanaian and 3149 South African adults 50years
and older residing in their current location for over one year.
The 12-month prevalence of depression was 7.5% and 4.0%
in Ghana and South Africa, respectively; and 41.1% and
65.5%, respectively, lived in urban areas. Comparing urban
to rural residents, the unadjusted odds ratio (OR) for depres-
sion in South Africa was 1.46 (95% CI: 0.942.29), with an
adjusted OR of 1.08 (95% CI: 0.661.76) in multivariable
analysis. The unadjusted and adjusted ORs for Ghana were
0.92 (95% CI: 0.611.39) and 0.94 (95% CI: 0.601.47),
respectively. Although these results do not support a signifi-
cant difference in 12-month depression likelihood between
urban and rural SAGE participants in Ghana or South Africa,
they suggest that the direction of effects may differ in each
setting.
DEPRESSION, CHRONIC DISEASE AND FUNCTIONAL
LIMITS: ACOMPARISON BETWEEN THE UNITED
STATES AND INDIA
D.Eynon Black, J.Parajuli, J.Brown, Miami University, ing at individual change over time, DRS scores remained the
Oxford, Ohio
Depression is a substantial global health problem with
implications for public health policy, planning of social pro-
grams and medical spending. Empirical evidence shows that
chronic disease and functional limitation lead to depression
among older adults. Few studies have attempted to under-
stand the impact of functional limitations on the association
between chronic disease and depression in low-income coun-
tries. Our study begins this investigation with a comparison
study between India and the US. This study examines the
effects of chronic disease conditions and functional limita-
tions on depressive symptoms controlling for other measures
including age, race, education and marital status. These asso-
ciations are investigated with data from the 2012 wave of
the Health and Retirement Study for the United States (HRS)
and 2010 Longitudinal Aging Studies of India (LASI), har-
monized for comparability. Preliminary findings suggest the
association between chronic disease and depression is par-
tially mediated by functional limitations in the United States.
However, different results are present within the LASI dataset.
The presence of chronic disease conditions does not predict
depression, whereas there is a positive association between
functional limitations and depressive symptoms (p<.0001)
that does not alter the relationship between chronic condi-
tions and depressive symptoms. We discuss the cultural and
policy differences that are likely behind this observed differ-
ence and further discuss the implications of our findings for
future research.
WHOS SINGING THE BLUES? DEPRESSIVE
SYMPTOMS AMONG OLDER ADULTS ACROSS THE
CONTINUUM OF CARE
E.Neufeld1, S.Freeman2, L.Spirgiene4, U.Horwath3, 1. EP-CP involvement in the early stages of an illness, cre-
Centre for Rural and Northern Health Research, Laurentian
University, Sudbury, Ontario, Canada, 2. University
Innovation in Aging, 2017, Vol. 1, No. S1
of Northern British Columbia, Prince George, British
Columbia, Canada, 3. Hospital of Bonifratres, Cracow,
Poland, 4. Lithuanian University of Health Sciences,
Kaunas, Lithuania
Late-life depression is a common mental health issue
with a significant burden of illness on a global scale. This
study investigated depressive symptoms among older adults
across three health sectors in Ontario, Canada to inform a
systems-level approach to late-life depression across the care
continuum.
interRAI assessment data from the home care (HC), the
palliative home care (PHC), and long term care (LTC) sectors
were examined (20112014). Assessments on older adults
aged 60 years+ in HC (N=116,533), PHC (N=19,678),
and LTC (N=125,496) were examined. Depression symp-
toms were measured within each sector using the interRAI
Depression Rating Scale (DRS) with a threshold of DRS>3
indicating probable depression. Change in depressive symp-
toms over time was examined, including predictors of the
development of depression.
At baseline, DRS>3 scores were observed in 190.7
cases/1000 HC clients, 118.1 cases/1000 PHC clients, and
242.3 cases/1000 LTC residents. This increased to 206.4
cases/1000 HC clients, 133.2 cases/1000 PHC clients, and
286.5 cases/1000 LTC residents at follow-up. When look-
same for the majority of older adults across sectors. However,
the proportion of individuals with a worsening of depression
symptoms was highest in the LTC sector.
Changes in depressive symptoms are discussed by health
sector in relation to demographic and clinical variables,
including differences in the main drivers of depression symp-
toms. Results show that symptoms of depression are sig-
nificant among older adults and require a multidisciplinary
approach to assessment and care.
SESSION 140 (SYMPOSIUM)
ADAPTING ACARE VALUES/PREFERENCES
INTERVENTION FOR PEOPLE WITH CHRONIC
ILLNESS AND THEIR CARE PARTNER
Chair: D.W.Coon, Arizona State University, Phoenix,
Arizona
Discussant: K.Maslow, Gerontological Society of America,
Washington, District of Columbia
This symposium focuses on adapting SHARE (Support,
Health, Activities, Resources & Education) into new for-
mats and populations. Grounded in care values clari-
fication/care preferences identification, SHARE is an
individualized in-home intervention for people in the early-
stage of Alzheimers disease (AD) and their care partners,
and has demonstrated feasibility, acceptability, and impact
on key outcomes. Emphasis on early detection and treat-
ment of life-limiting illnesses is growing, but without a
corresponding emphasis on interventions that address the
mental health/well-being of early-stage people (EPs) and
their family care partners (CPs). SHARE, by identifying
and intervening with a chronic life-limiting illness through
ates advantages beyond early medical intervention alone.
For example, EPs and CPs can be educated on the potential
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
impacts of the illness before crises occur and caregiver bur-
den advances; EPs can be active decision-makers in their
care by voicing their care values/preferences directly to CPs;
and thus, EP-CP dyads can be coached on how to develop
a plan that addresses the care, security, quality of life, and
well-being of the EP while supporting the CP. The papers in
this symposium provide an overview of SHARE with pri-
marily non-Hispanic white dyads and its adaptation from
a focus on AD to other chronic illnesses; a translation of
SHARE into EPIC (Early-stage Partners in Care), a group-
based format for AD dyads embedded into Alzheimers
Association Chapters; and additional insights into tailoring
EPIC to meet the needs of Spanish-speaking Latinos in the
US Southwest.
THE SHARE PROGRAM: FROM DEMENTIA CARE TO
BROADER CHRONIC ILLNESS CARE
C.J.Whitlatch, S.Orsulic-Jeras, Benjamin Rose Institute on
Aging, Cleveland, Ohio
Alzheimers disease and other dementias are being diag-
nosed earlier in the disease progression thanks to advances
in medical procedures and technologies. For the person
receiving the diagnosis and their family carer, few programs
exist which help care dyads plan for the future and discuss
preferences for care. Likewise, for cognitively intact persons
with chronic conditions, few programs exist which provide
support as the care dyad works to create a manageable plan
of care that addresses each persons concerns and fears. The
SHARE Intervention, originally developed for early-stage
dementia families, has shown positive outcomes for both
members of the care dyad. This presentation first describes
the development of the six-session SHARE intervention and
its use in community settings. Next, discussion will focus on
current efforts to adapt SHARE for dementia for use with
families facing the challenges of chronic illnesses. Discussion
will highlight revisions to program procedures, materials,
recruitment, and evaluation.
EPIC (EARLY-STAGE PARTNERS IN CARE):
TRANSLATING SHARE INTO AGROUP-BASED
INTERVENTION
D.W.Coon, M.Todd, D.Kapp, Arizona State University,
Phoenix, Arizona
This presentation focuses on the translation of SHARE
into a group- and coach-call based intervention for peo-
ple with early-stage dementia (EPs) and their care part-
ners (CPs) that was delivered by Alzheimers Association
Chapter staff in urban and rural settings across Arizona.
Sessions included activities for the entire group together,
separate EP or CP groups, and one individualized session.
EPIC provides skills-training, and care values clarification,
planning, and support that honors the EPs care values and
future care preferences. EPIC participants reported signifi-
cant changes in mood (e.g., depression and other negative
affect) and quality of life indicators (e.g., quality of life,
self-efficacy, care preparedness), as well as high levels of
overall benefit; increased understanding of memory loss
and its effects; increased confidence in dealing with memory
problems, and that EPIC made their lives easier. One hun-
dred percent (100%) of dyads reported that EPIC enhanced
their ability to care for one another.
IAGG 2017 World Congress
35
TAILORING EPIC, AGROUP-BASED SHARE
INTERVENTION, TO MEET THE NEEDS OF SPANISH
SPEAKERS
B.V.Carbajal, V.Rosas, D.W.Coon, College of Nursing
& Health Innovation, Arizona State University, Phoenix,
Arizona
This presentation provides insights on tailoring EPICs
outreach, assessment, and intervention activities for Spanish
Speaking Latinos. EPIC (a group-based intervention proto-
col derived from SHARE) is designed to reduce stress and
enhance well-being of people with early-stage dementia and
their care partners. Steps in tailoring included: ongoing com-
munity advisory board feedback; conceptual translation of
all project material; and incorporation of suggestions from
six focus groups with 51 Latino family caregivers, profession-
als, and direct care staff. Participants regarded the projects
revised care values and preferences as critically important for
Latino families (excellent visual aids; concepts are simple
to understand and manage; very useful, these activities
would help to have a conversation and come to agreement).
Feedback also helped to expand Latino outreach efforts by
choosing less threatening language to describe dementia,
speaking at existing community health classes, conducting
Concerned about Changes in Your Memory? forums, and
using social media across the generations.
SESSION 145 (SYMPOSIUM)
MODELING THE OUTCOME AND COST IMPACTS OF
INTERVENTIONS FOR DEMENTIA (MODEM)
Chair: M.Knapp, London School of Economics and
Political Science, London, United Kingdom
Dementia has enormous impacts on health and quality of
life for people with the illness, their families and other peo-
ple who care for them. With population ageing the number
of people with dementia will increase considerably over the
coming decades, despite recent evidence that the prevalence
and incidence of dementia has reduced in the last 20years.
Abig challenge facing countries is how to provide high qual-
ity treatment and support to individuals with dementia in
ways that are acceptable to them and at a cost considered by
society to be affordable.
In this session we present results from the MODEM pro-
ject which aims to generate new evidence and feed it into pol-
icy and practice to improve the lives of people with dementia
and their carers. After an overview of MODEM describing
the different components and scientific methods (Presentation
1), we describe the Dementia Evidence Toolkit developed
from a systematic mapping of the literature on effective and
(potentially) cost-effective interventions in dementia care
(Presentation 2). MODEM will use both microsimulation and
macrosimulation methods and in Presentation 3 we describe
results from the microsimulation model MicSIMPOP on the
amount of care estimated to be required over the period to
2040 conditional on socioeconomic factors, health behav-
iours, cognitive impairment and other comorbidities. The
macrosimulation model (Presentation 4) integrates results
from MicSIMPOP and the Dementia Evidence Toolkit over-
all to produce projections of future numbers of people with
dementia and the cost impacts of making the evidence-based
interventions more widely available.
36
THE MODEM PROJECT
M.Knapp1, A.Comas-Herrera1, R.Wittenberg1, C.Jagger2,
MODEMTeam1, 1. London School of Economics and
Political Science, London, United Kingdom, 2. Newcastle
University Institute for Ageing, Newcastle upon Tyne,
United Kingdom
MODEM is an ambitious project that is projecting how
future costs, health and quality of life of people living with
dementia and their family and other caregivers (carers) could
be improved by wider availability of evidence-based inter-
ventions. It projects numbers, needs, costs and outcomes for
people with dementia and carers over the period to 2040
under current care and support arrangements in England, and
then projects what would happen if better treatments, better
care services and better support for carers were made avail-
able to everyone who could benefit from them. Projections
build on both microsimulation (individual-level) and macro-
simulation (aggregate) models, a comprehensive review and
synthesis of available evidence (as described in other pres-
entations in this session) and the experiences of people with
dementia and carers. Projections will feed into discussions of
future policy, purchasing and provision. MODEM runs from
2014 to 2018.
MODEM DEMENTIA EVIDENCE TOOLKIT:
WEB-BASED RESOURCE OF DEMENTIA CARE,
TREATMENT, AND SUPPORT EVIDENCE
A.Comas-Herrera, D.McDaid, A.Park, B.Adelaja,
D.Lombard, M.Knapp, MODEMTeam, London School of
Economics and Political Science, London, United Kingdom
The MODEM Dementia Evidence Toolkit is a public
resource that gives access, via a website, to scientific evidence
gathered as part of a systematic mapping of the literature
on evaluations of interventions for treatment, care and sup-
port of people with dementia and carers. The Toolkit has
two components: a bibliographic database and plain English
evidence summaries on what works in dementia care. The
bibliographic database: The searchable database comprises
over 3,000 empirical journal articles and 700 systematic
reviews, obtained by searching key bibliographic databases
(Medline, Psychinfo, CINAHL, Social Care Online and IBSS)
for articles published from 2009 to June 2015. The articles
were screened and coded according to type of dementia, care
setting, type of outcomes, type of intervention and country.
Evidence summaries: The evidence summaries are produced
using systematic methods. They aim to offer rigorous, yet
accessible, digests of the evidence on effectiveness and cost-
effectiveness of key dementia interventions.
MICSIMPOP: MODELING HOW LIFESTYLE FACTORS
AND CHRONIC DISEASES AFFECT CARE NEEDS
WITH DEMENTIA
C.Jagger1, A.Kingston1, H.Booth2, MODEMTeam3,
1. Institute of Health and Society, Newcastle University,
Newcastle upon Tyne, United Kingdom, 2. Australian
National University, Canberra, Australian Capital Territory,
Australia, 3. London School of Economics and Political
Science, London, United Kingdom
MicSIMPOP is a microsimulation model aiming to model
the health and associated care needs of the English popula-
tion to 2040 and the impact of interventions for risk factor
reduction, disease prevention and treatment. Modelled on a
Innovation in Aging, 2017, Vol. 1, No. S1
previous Australian microsimulation model DYNOPTASim,
MicSIMPOP uses a discrete time approach with baseline
data (and monthly transition probabilities) from three UK
longitudinal studies: Understanding Society (ages 35+); the
English Longitudinal Study of Ageing (ages 50+); and the
Cognitive Function and Ageing Study II (ages 65+). Baseline
characteristics generated on individuals include sociode-
mographic factors, lifestyle behaviours, a range of diseases
including cognitive impairment, CHD, stroke, diabetes, and
dependency/care needs measured by a time-based measure.
This presentation will describe projections of dependency
levels for people with different levels of cognitive impairment
over the next 25years as well as numbers with other comor-
bidity of importance for appropriateness and effectiveness
of interventions.
MACROSIMULATION MODEL: PROJECTIONS OF
NUMBERS OF OLDER PEOPLE WITH DEMENTIA
AND ASSOCIATED COSTS
R.Wittenberg, B.Hu, A.Comas-Herrera, MODEMTeam,
London School of Economics and Political Science, London,
United Kingdom
The macrosimulation model will produce projections to
2040 of the future numbers of older people with dementia
in England, associated expenditures on care and outcomes
in terms of quality of life for them and their family or other
unpaid carers. It will take as inputs the outputs of the micro-
simulation model and modelling of the impact of specific
interventions. A key feature is that this model will differ-
entiate between groups of people with dementia by sever-
ity of cognitive impairment and physical disability, and it
will assign packages of care to people with dementia based
on their needs related characteristics. It will use data from
the MRC Cognitive Function and Ageing Study (CFAS), the
English Longitudinal Study of Ageing (ELSA), official data
from the Health and Social Care Information Centre, base-
line data from various trials of interventions for people with
dementia and new data collected as part of the MODEM
study.
SESSION 150 (PAPER)
AGING-IN-PLACE/TRANSPORTATION
ID RATHER STAY: DOCUMENTARY VIDEO AS
AKNOWLEDGE MOBILIZATION TOOL FOR AGE-
SUPPORTIVE NEIGHBORHOODS
C.Ottoni, J.Sims-Gould, H.A.McKay, University of British
Columbia, Vancouver, British Columbia, Canada
We created Id Rather Stay, a 19-minute, evidence-
informed documentary video, to engage community and
government stakeholders around barriers and facilitators
for agesupportive neighborhoods. We used the interaction
model of knowledge translation to critically assess two dis-
semination stages; phase one (societal level): 14 forums with
government, policy makers, and older adults, and 7 inter-
national film festivals with the general public (N= est. 800);
phase two (individual level): screening and focus groups with
1015 older adults in 6 different geographic locations (average
age= 73). During phase one we analyzed video Director and
researcher field notes, and post-screening discussion content.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
In phase two we analyzed field notes, focus group transcrip-
tions, and post-screening and 6-month follow-up surveys. In
both phases, we found that documentary video effectively
educated viewers and initiated discussion. Further, results
from our extended data collection and analysis in phase two
suggests that individuals were impacted along a scale: educa-
tion, knowledge diffusion (sharing), and/or action to improve
circumstances. We also offer insight on strategies to move
research-evidence from discussion to implementation.
EVERYTHING IN MODERATION: INTERACTION
EFFECTS AMONG GENDER, RACE, AND DRIVING
REDUCTION/CESSATION
J.Vivoda1, C.M.Connell2, A.Schulz2, J.Grengs2, that it increased their needs for neighbourhood characteris-
S.Heeringa2, 1. Sociology and Gerontology, Miami
University, Oxford, Ohio, 2. University of Michigan, Ann
Arbor, Michigan
This research explored the moderating effect of the trans-
portation environment on the relationships among gender,
race, and driving reduction and cessation (DRC). We hypoth-
esized that the higher likelihood of DRC among women and
racial minorities may be partially explained by high conges-
tion/roadway density. Models fully interacted by gender and
race were also fit to explore whether the relationships among
DRC and the other covariates were differentially affected by
these demographics.
The transportation environment was operational-
ized using a measure of roadway density calculated from
Geographic Information Systems data, and with congestion
data from the Urban Mobility Scorecard. Seven waves of
data from the Health and Retirement Study were combined
with this environmental data, and discrete time survival anal-
ysis techniques were used in the analysis; driving reduction
(DR) and driving cessation (DC) were analyzed as separate
outcomes.
A significant interaction was observed between roadway
density and gender in the model assessing DR (higher den-
sity only affected men), but not in the DC model. This was
counter to our original hypothesis, and may be related to the
decreased likelihood of men to change their driving habits
overall. Interactions between the transportation environment
and race were not statistically significant in the DR mod-
els, but were significant in the models assessing DC (White
and Hispanic older adults had higher odds of DC given
more congestion). The models fully interacted by gender and
race also revealed several additional significant interactions
among other covariates in the models and DRC, including
relationship status, age, education, and household size.
THE CREATION OF AGE-FRIENDLY ENVIRONMENTS
IS ESPECIALLY IMPORTANT TO FRAIL OLDER
PEOPLE
H.van Dijk, A.P.Nieboer, J.Cramm, Institution of Health fair test. However, hearing self-evaluations are still insuf-
Policy & Management, Erasmus University Rotterdam,
Rotterdam, Zuid-Holland, Netherlands
Worldwide efforts are being made to reduce reliance on
expensive long-term care, resulting in a shift toward deinsti-
tutionalisation and ageing in place. However, we lack insight
into whether neighbourhoods are able to meet both frail and
non-frail older peoples environmental needs. Based on the
WHO framework for age-friendly cities, this study aimed
IAGG 2017 World Congress
37
to characterise the relationship between frailty and ageing
in place, and to identify differences in neighbourhood char-
acteristics supporting ageing in place missed by frail and
non-frail older people. A concurrent nested mixed-methods
approach was used. For quantitative evaluation, a sample of
945 independently living older adults residing in four districts
of Rotterdam was asked to complete a questionnaire in 2013
[response rate, 62% (n = 558)]. In addition, 32 qualitative
interviews were conducted with frail and non-frail older
people. The results demonstrated that gender, age, and espe-
cially frailty were related to missed neighbourhood charac-
teristics. Qualitative data showed that older people display
awareness of their increasing frailty and often acknowledge
tics enabling them to age in place. Thus, this study supported
our expectation that the personenvironment fit is not static.
Expectations regarding neighbourhood characteristics seem
to dissipate with advanced age and increasing frailty. Diversity
in frailty level, gender, and age, but also the interrelatedness
of age and frailty, should be accounted for in the identifica-
tion of social and physical neighbourhood characteristics that
community-dwelling older adults need to age in place.
DISCREPANCY OF SELF-ASSESSMENTS AND
STANDARDIZED TESTS IN VISION/HEARING
ABILITIES IN THE ELDERLY
G.G.Haanes1, G.Eilertsen2, 1. Nursing, University of Faroe
Islands, Trshavn, Faroe Islands, 2. University College of
South East Norway, Drammen, Norway
Aim: To investigate whether answers provided by older
home-care recipients to the question Do you think your
vision/hearing is good (0), not so good (1), poor (2), or very
poor (3)? can be used to identify those who have vision and
hearing problems, and whether these elderly can provide a
valid self-report of their vision and hearing.
Methods: Receiving operating characteristic (ROC) anal-
ysis was used to compare self-evaluations of vision and hear-
ing with those yielded by a gold-standard test. The vision and
hearing performances of 93 people, aged 80 years in the
home-care setting were screened with a LogMAR chart and a
portable pure-tone audiometer and a self-assessment screen.
Results: Comparisons of the findings using the cutoff
point on the self-assessment scale with those of the gold-
standard tests, yielded 40 false negatives for vision and 18
false negatives for hearing, indicating that a significant pro-
portion of older people report their vision and hearing abili-
ties as being good when standardized tests indicate that they
are not.
Conclusion: Area under the ROC curve for self-assess-
ment of vision was 69%, indicating the self-assessment
question was a poor test. Area under the ROC curve for self-
assessment of hearing was 73%, which may be considered a
ficient for deciding who should be referred to a specialist for
hearing examination.
HOME MODIFICATION PROGRAM CHALLENGES:
BALANCING BEHAVIORS, PREFERENCES, NEEDS,
AND COST
N.Brossoie, Center for Gerontology, Virginia Polytechnic
Institute & State University, Blacksburg, Virginia
38
According to AARP, 90% of older adults in the United
States want to remain living in their homes for as long as
possible. Yet, housing data suggest that many homes may not
be designed to accommodate the needs of older residents,
and may need to be modified. In this study data collected
from a rural home modification pilot program in Southwest
Virginia was analyzed to identify the challenges faced in iden-
tifying, prioritizing, and initiating home modification pro-
jects. The means-based program served 24 homeowners aged
55+ living at or below 80% of the adjusted median income.
Amixed-method approach was used to analyze survey and
interview data. Analysis uncovered challenges to program
management and sustainability. Residents often sought home
modifications in lieu of making changes to their behaviors
and preferences that caused problems (e.g., removing throw
rugs to reduce falls). Residents frequently miscalculated the
need for modifications, the scope of work needing to be
done, and the prioritization of changes. Moreover, residents
often perceived some upgrades to their homes as essential
even though they would not personally utilize the changed
space. Program leaders reported struggling with modify-
ing homes in which the value of homes were less than the
costs of modifications, and complying with the well-intended
demands of non-custodial family members when they con-
flicted with resident wishes. Findings were used to develop
a matrix to guide decision-making in future home modifi-
cation programs that accounts for the competing demands
of residents and their families, contractors, and program
resources and sustainability.
SESSION 155 (SYMPOSIUM)
IMPROVING QUALITY AND ACCESS TO PALLIATIVE
CARE IN THE UNITED STATES ACROSS CARE
SETTINGS
Chair: S.Enguidanos, University of Southern California,
Los Angeles, California
Co-Chair: N.Dudley, University of California, San
Francisco, Los Altos, California
Innovative delivery models that provide access to qual-
ity palliative care programs across care settings are needed
for an aging U.S. population living longer with advanced
and serious illness. The 2015 Institute of Medicine report
Dying in America highlighted the need for primary pal-
liative care for diagnosis of advanced illness that includes
basic symptom management, advanced care planning, and
referral to specialty palliative care as symptoms progress. In
addition, the National Consensus Project (2013) suggests
palliative care be delivered according to patient/family val-
ues and beliefs. This symposium examines need identifica-
tion and care provision in the context of advanced illness
care for various populations of older adults and discusses
the impact on policy and health care transformation. This
symposium is composed of four distinct presentations: (1)
a national description of older adults with advanced illness
in primary care settings who may benefit from primary pal-
liative care; (2) qualitative interviews with a Veteran patient
sample with advanced illness and hospital staff regarding the
role of religion and spirituality in care delivery; (3) findings
from a feasibility study testing an intervention to provide
primary palliative care to older adults during the transition
Innovation in Aging, 2017, Vol. 1, No. S1
from hospital to home; and (4) lessons learned from a col-
laboration with a state-wide private insurance company to
develop, test, and broadly implement a reimbursement model
for the provision of home-based palliative care by primary
care providers. These presentations represent efforts across
the U.S.to improve access and quality of care in the context
of life-limiting illness.
IDENTIFYING OLDER ADULTS IN U.S. PRIMARY
CARE SETTINGS TO BENEFIT FROM PRIMARY
PALLIATIVE CARE
N.Dudley, C.S.Ritchie, M.I.Wallhagen, B.Cooper,
K.Patel, S.Chapman, University of California, San
Francisco, San Francisco, California
Community-based palliative care is an important com-
ponent of advanced illness management to address complex
care needs of older adults living longer near end of life. There
is an urgent need to provide primary palliative care in pri-
mary care settings by all clinicians that includes basic pain
and symptom management, and discussions about advance
care planning. However, a description of older adults in
primary care settings with advanced illness and symptom
burden who would benefit from primary palliative care is
lacking. This study uses data from the National Ambulatory
and National Hospital Ambulatory Medical Care Surveys
from 20092011 to provide a national description of health
care utilization of older adults with advanced illness and
symptoms in primary care settings who may benefit from
primary palliative care.
REGISTERED NURSES PROVIDING PRIMARY
PALLIATIVE CARE DURING TRANSITION FROM
HOSPITAL TO HOME
S.Izumi, B.Basin, J.McCalmont, M.Presley, J.G.Baggs,
Oregon Health and Science University, Portland, Oregon
Although inclusion of palliative care throughout the illness
trajectory is recommended, the majority of palliative care in
the United States is still limited to hospital settings. There
is no established program ensuring continuity of palliative
care outside of hospitals. We conducted a feasibility study
testing an intervention where registered nurses provided pri-
mary palliative care (PPC) to older adults with chronic illness
during the transition from hospital to home. PPC delivered
by nurses included symptom management, advance care
planning, and communication with healthcare providers.
Compared to 15 patients who received care from non-nurse
health coaches, 15 patients who received PPC from nurses
in addition to the coaching had fewer symptom-related re-
hospitalizations, more conversations about advance care
planning, and higher satisfaction with their care. Provision of
PPC by nurses through the care transition showed potential
as an effective and affordable intervention to ensure continu-
ity of palliative care beyond the hospital setting.
SUSTAINING THE FUTURE OF PRIMARY PALLIATIVE
CARE
S.Enguidanos, A.N.Rahman, Leonard Davis School
of Gerontology, University of Southern California, Los
Angeles, California
Despite significant strides in transforming end-of-life
care, access to palliative care is limited and palliative care
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Innovation in Aging, 2017, Vol. 1, No. S1
programs and services remain precariously positioned in the
U.S.health care system. Concrete, permanent funding mech-
anisms are needed to improve and sustain access to palliative
care, particularly in primary care settings. This session pre-
sents learnings from a pilot study developed in collaboration
with a state-wide private insurance company to develop, test,
and broadly implement a reimbursement model for the provi-
sion of home-based palliative care by primary care providers.
We will discuss developing relationships with insurers and
present the core components of the care model, adaptations
of the model for provision in primary care, and metrics that
support widespread implementation across states. Finally,
we will discuss the impact of this project on policy and its
potential for health care transformation through expanded
evidence and market pressures.
SESSION 160 (SYMPOSIUM)
AGE-FRIENDLY COMMUNITY CHANGE:
ADVANCING GLOBAL RESEARCH, POLICY, AND
PRACTICE
Chair: E.A.Greenfield, Rutgers, The State University of
New Jersey, New Brunswick, New Jersey
Discussant: J.Barratt, International Federation on Ageing,
Toronto, Ontario, Canada
The concept of age-friendliness, as well as strategic initia-
tives to make localities more age-friendly, has captured the
attention of various stakeholders worldwide. Age-friendly
champions include professional organizations, philanthro-
pies, national governments, local officials, service providers,
private citizens, and beyond. Academic research in this area
has emerged arguably more slowly over the past 10 years.
Accordingly, this symposium aims to serve as a catalyst for
the engagement of additional gerontological research to
accelerate systematic knowledge development on age-friendly
community change processesnot only to enhance the efforts
of local communities, but to benefit aging research more
broadly. The first paper will introduce age-friendly as an
emerging international field of research, policy, and practice
and will identify opportunities for research to strengthen
community change. The subsequent papers will provide
examples of such possibilities. One paper will showcase
efforts in Manchester, United Kingdom, demonstrating how
empowering older adults as co-researchers can enhance the
development and evaluation of age-friendly actions. Another
paper will highlight work in Shanghai, China, focusing on
the role of researchers during the exploratory phases for age-
friendly community change through fieldwork and surveys
with organizations that facilitate support for older adults. An
additional paper will present research conducted in the north-
eastern United States, demonstrating the utility of cross-site
qualitative research for developing theories of change under-
lying age-friendly initiative processes. Jane Barratt--Secretary
General of the International Federation on Ageing and a
global leader in aging policy--will offer insights as discussant.
KNOWLEDGE DEVELOPMENT FOR AGE-FRIENDLY
COMMUNITY INITIATIVES
A.J.Lehning1, E.A.Greenfield2, 1. University of Maryland,
Baltimore, Baltimore, Maryland, 2. Rutgers, The State
University of New Jersey, New Brunswick, New Jersey
IAGG 2017 World Congress
39
This paper will provide an introduction to age-friendly
as an emerging international field of research, policy, and prac-
tice. The presenters will provide a history of the age-friendly
movement, including the World Health Organizations initia-
tive and how age-friendly efforts have emerged across diverse
national contexts over the past decade. The presenters will
then describe knowledge development concerning age-
friendly community initiatives, noting that much of what has
been written in this area has been published in the gray
literature. While peer-reviewed publications on age-friendly
efforts are growing in number, many remain descriptive or
theoretical. Based on a review of the literature, this paper will
identify opportunities for researchers to employ both quali-
tative and quantitative research methodologies to deepen
systematic knowledge building concerning age-friendly
community initiatives. The authors will describe how such
knowledge development has the potential to strengthen age-
friendly policies and practices, while also making meaningful
advances to gerontological research more broadly.
PUBLIC GERONTOLOGY IN ACTION: CO-DEFINING
GOALS OF AGE-FRIENDLY EFFORTS WITH OLDER
CO-RESEARCHERS
T.Buffel, C.Phillipson, The University of Manchester,
Manchester, United Kingdom
Age-friendly community initiatives have the potential to
empower older people to advocate on their own behalf, yet
there has been relatively little scholarly discourse on translat-
ing this principle into practice. This paper aims to address
this gap by exploring older people as co-researchers in devel-
oping age-friendly communities in Manchester, UK. Through
the application of a participatory methodology, older people
were involved not only as the research target group, but also
as experts and actors in the various stages of the research,
including the planning, design, and realization of the pro-
ject. The presentation will reflect on both challenges and
opportunities concerning the involvement of older people
as co-researchers, and will discuss the research approach as
a tool for creating community networks on the one hand
and empowerment of older people on the other. The pres-
entation will also consider the implications of the findings
for developing age-friendly communities in complex urban
environments.
A CASE EXAMPLE OF RESEARCH TO PLAN AGE-
FRIENDLY ACTION IN SHANGHAI, CHINA
L.Fang, J.Wang, W.Zhang, Chinese Academy of Social
Sciences, Beijing, China
Shanghai, China, has been a member of the World Health
Organizations Global Network of Age-Friendly Cities since
it was founded in 2006. Although the initiative has inspired
government proclamations and some policy reforms over
the years, much of the age-friendly action remains at the
early stages of exploration. As part of continuing to develop
plans for potentially new programs, we conducted fieldwork
research and surveys with organizations that provide services
to older adults in the greater Shanghai area. Acentral finding
of our research is the availability of older adult mutual assis-
tance programs in many parts of the region, although not
all. Moreover, the programs that do exist are operating inde-
pendently from the citys age-friendly community initiative.
40
Additional research to understand why these programs have
developed in particular locations is necessary to identify
place-based leverage points for age-friendly actions, as well
as place-based variation in the outcomes such initiatives.
A FRAMEWORK TO DESCRIBE THE EARLY
PLANNING PHASE OF AGE-FRIENDLY COMMUNITY
INITIATIVES
E.A.Greenfield, Rutgers, The State University of New
Jersey, New Brunswick, New Jersey
This study employed a grounded theory approach to
develop an empirically grounded framework of age-friendly
community initiatives (AFIC) objectives and resources in the
early planning period. Iconducted in-depth interviews with
leaders of nine newly formed AFCIs in northern New Jersey
(U.S.) at two points during the first six months of their pro-
jects. Results indicated three inter-related aims of the plan-
ning period: (a) building relationships, (b) harnessing data,
and (c) raising the visibility of older adults and the AFCI. To
achieve these objectives, leaders reported drawing on social
and human capital within and among stakeholders, includ-
ing the lead organization, consultants, organizational part-
ners, municipal leaders, individual volunteers, funders, and
web-based resources. The framework can be used to assess
organizational and community readiness to begin an AFCI,
target areas for resource development, and track AFCIs
early accomplishments. Findings also offer implications for
research on the effectiveness and expansion of AFCIs.
SESSION 165 (SYMPOSIUM)
GLOBAL COUNCIL ON BRAIN HEALTH:
ADVANCING INTERNATIONAL DIALOGUE TO
PROMOTE WELL-BEING
Chair: S.Lock, AARP, Washington, District of Columbia
As people live longer, the need for clear, trustworthy infor-
mation on brain and cognitive health is greater than ever.
Launched in 2015, the Global Council on Brain Health is an
independent collaborative of scientists, clinicians, scholars and
policy experts convened by AARP to provide the foremost
thinking on what people and professionals can do to maintain
and improve brain health. The goal of the Council is to trans-
late scientific research into actionable recommendations for
the public that will help drive behavior change in individuals
across communities and cultures. This symposium will feature
leading researchers from the UK, US and Canada to highlight
recommendations issued by the Council. It will showcase three
consensus documents generated by the Council that are based
on the latest research advancements. Particular emphasis
will be placed on Council recommendations that are aimed
at improving brain health in three areas: physical exercise,
sleep and social engagement. In sum, this symposium brings
together leaders at the forefront of this international effort to
discuss the scientific and policy dimensions of brain health.
PHYSICAL ACTIVITY AND BRAIN HEALTH
T.Liu-Ambrose, University of British Columbia, Vancouver,
British Columbia, Canada
The GCBH convened to examine research focused on
the impact of physical activity on brain health. Eight issue
specialists representing four continents arrived at consensus
Innovation in Aging, 2017, Vol. 1, No. S1
statements to summarize the impact of physical activity on
brain health: (1) Follow current public health recommenda-
tions of 150 minutes of weekly, moderate-intensity aerobic
activity and two or more days a week of moderate-intensity,
muscle-strengthening activities. In addition to purposeful
exercise, lead a physically active lifestyle throughout the day.
(2) Identify meaningful and enjoyable ways to increase and
maintain physical activity. (3) Incorporate physical activity
as a part of a healthy lifestyle to help reduce the risk of cogni-
tive decline, and (4) When focusing on the impact of physi-
cal activity on brain health, stakeholders and policy makers
should take into account the breadth of scientific evidence
(i.e. animal studies, epidemiological studies, and randomized
controlled trials) while recognizing the knowledge gaps.
SLEEP AND BRAIN HEALTH
K.Yaffe, UCSF, San Francisco, California
This talk will provide an overview of the consensus docu-
ment on sleep and cognitive health. Recommendations issued
by the Council addressed how sleep patterns change as indi-
viduals grown older. Sleep hygiene will also be discussed dur-
ing this talk as a way of maintaining and improving cognitive
health. Particular focus will be placed on the implementa-
tion of non-pharmacological methods as a way of improv-
ing sleep patterns. Afull discussion of the recommendations
relating to sleep duration, sleep timing, sleep quality, napping
and sleep disorders as we age will be discussed.
SOCIAL ENGAGEMENT AND BRAIN HEALTH
L.Clare, University of Exeter, Exeter, United Kingdom
The relationship between social engagement and brain
health will be the third topic examined by the GCBH. Abroad
range of contextual lifestyle factors will be considered in the
consensus document and recommendations, including social
engagement, social isolation, social networks, social sup-
port, living situation, marital status and loneliness. There are
structural (e.g. family size), functional (e.g. level of support)
and appraisal (e.g. attitudes, beliefs, mood) aspects involved
in shaping each persons experience of social engagement
or isolation. The relationship between stress, resilience and
social engagement will also be discussed. Current evidence
indicates a link between isolation and poor health outcomes
and mortality; however, more research is needed to assess
the impact of loneliness. Although it is widely accepted that
supporting social connections is beneficial, there is as yet
little robust evidence for the effectiveness of interventions
addressing loneliness and isolation.
THE PUBLIC MESSAGING OF SCIENCE: WHAT THE
EVIDENCE TELLS US ABOUT GETTING IT RIGHT
J.Goodwin1, S.Lock2, 1. University of Loughborough,
Loughborough, United Kingdom, 2. AARP, Washington,
District of Columbia
Although it is often stated that the production of new
knowledge is an intrinsically valuable objective, health sci-
ence research is duty bound to show the public value of its
work. However, a common criticism of empirical science is
its failure of translation into society-useful outcomes. For
example a common perception is that science is expert driven
rather than society led, with little interaction between the two
in the translation process. No more is this more important
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
than in brain health, in which the public understanding is
parsimonious. Within this context we review the key ele-
ments of research-based societal change and will present
new models of knowledge transfer and impact, including the
WHO knowledge transfer model for ageing and health, its
application in real life settings and the example of the Global
Council for Brain Health whose remit is the presentation of
reliable public messages derived from expert evidence.
SESSION 170 (SYMPOSIUM)
TECHNOLOGY-ENABLED SOLUTIONS FOR
IMPROVING HEALTH OF ETHNICALLY DIVERSE
OLDER AMERICANS
Chair: S.Levkoff, University of South Carolina, Columbia,
South Carolina
Co-Chair: H.Chen, Brigham Womens Hospital,
Cambridge, Massachusetts
Discussant: D.A.Lindeman, University of California,
Berkeley
Over the past decade, substantial research has identified
the role that health information technology (HIT) can play
in enhancing health, through assisting with medication com-
pliance, acquisition of information and skills for managing
illness, and providing socio-emotional support to enhance
retention of positive behavioral change. Despite the emer-
gence of HIT and its evidence in supporting a variety of
health outcomes, there has been less penetration of HIT in
ethnic minority populations, where cultural values often play
a role in mitigating access to HIT. This session provides an
overview of four different studies, all of which are focused
on developing culturally-competent HIT interventions for
ethnic minority older adults with a range of health problems,
including dementia, congestive heart failure, and HIV. The
studies were all developed through focus groups with the at-
risk populations, who identified needs, barriers, and facili-
tators to overcome barriers identified. In addition, iterative
usability testing was conducted during the development of
all HIT programs. Each presentation will focus on the unique
contributions of the different theories (e.g., social learning,
positive psychology, adult education/andragogy, behavio-
ral economics, digital technology, cultural adaptation, and
evidence-based care) that went into the development of the
HIT program.
SUPPORTING MEDICATION ADHERENCE IN HIV+
OLDER AFRICAN AMERICANS
P.Weitzman1, M.Pagan-Ortiz1, J.Xing1, X.Lu1, based intervention ideal. This session presents the findings
S.Levkoff1,2, 1. Environment and Health Group,
Cambridge, Massachusetts, 2. University of South Carolina,
Columbia, South Carolina
African Americans, who account for almost half of people
living with an HIV diagnosis, are less likely than white HIV
patients to receive antiretroviral therapy (ART), to be adher-
ent to ART, and achieve viral suppression. Neurocognitive
changes brought on by both HIV and aging processes, along
with greater pill burden in older patients, make medica-
tion adherence especially challenging for older African
Americans with HIV. This session will present results of a
Phase Ifeasibility study that demonstrated the effectiveness
IAGG 2017 World Congress
41
of a text-messaging program, which included pill remind-
ers with motivational and health educational messages to
support a positive outlook and healthy living, in increasing
medication adherence among older African Americans with
HIV. Qualitative data suggest: a sense of fatalism among
newly-diagnosed patients places them at high risk for non-
adherence; rapid decline in health post-diagnosis prompts
non-adherent patients to become adherent; and, motiva-
tional messages are supportive in preventing intentional
lapses (drug holidays).
MOBILE HEALTH FOR IMPROVING SELF-CARE FOR
AFRICAN AMERICAN ELDERS WITH CONGESTIVE
HEART FAILURE
H.Chen1,3, S.Heiney2, E.Shi3, S.Levkoff2,3, 1. Psychiatry,
Brigham Womens Hospital, Cambridge, Massachusetts, 2.
University of South Carolina, Columbia, South Carolina, 3.
Environment and Health, Cambridge, Massachusetts
African-Americans (AA) with congestive heart failure
(CHF) are typically sicker, poorer, less educated, and have
more co-morbid conditions than White older adults with
CHF. Despite evidence of benefits of home tele-monitoring
on mortality and hospitalizations, few care models have
been designed specifically for African-Americans with CHF.
This session reports on an intervention program conducted
in South Carolina, where rates of hospitalization for CHF
are among the highest in the country. The intervention was
informed by qualitative research documenting specific needs
for improving self-care and treatment compliance as identi-
fied by AA patients in a hospital-based Home Care Program.
The low-cost intervention utilizes a mobile phone with a soft-
ware application that: monitors CHF symptoms; improves
self care by providing educational and motivational messages
to reduce risks for CHF progression; and improves health
care navigation by making it easy for patient to connect to
health care providers.
USING WEBSITE AND VIDEO FOR SAFE SEX
EDUCATION WITH OLDER DIVORCED WOMEN
P.Weitzman1, M.Pagan-Ortiz1, J.Xing1, X.Lu1,
S.Levkoff1,2, 1. Environment and Health Group,
Cambridge, Massachusetts, 2. University of South Carolina,
Columbia, South Carolina
HIV is on the rise among American women over age 50.
The increase coincides with the rise in gray divorce. Few inter-
ventions promote safe sex practices among older divorced
women. Access, stigma and privacy concerns make a web-
from a Phase I study utilizing a website based on positive
psychology and social learning principles to promote wellbe-
ing post-divorce in older divorced women. Safe sex educa-
tion was embedded in the website, as well as videos of older
divorced women talking about real-life experiences with dat-
ing and safe sex. Safe sex self-efficacy improved among all
users. Perceived HIV risk scores of those who viewed the site
with videos significantly improved. Qualitative data revealed
strong acceptability and appeal of the videos. The text and
graphics only web-based intervention proved effective at
promoting HIV/STD prevention; the addition of videos
increased both impact and appeal among users.
42
A SELF-DIRECTED LEARNING (SDL) SYSTEM FOR
CHINESE DEMENTIA CAREGIVERS
N.An1,2, H.Chen2,3, J.Yang Sharir2, S.Levkoff2, 1.
Hefei University of Technology, Hefei, Anhui, China,
2. Environment and Health Group, Cambridge,
Massachusetts, 3. Brigham and Womens Hospital, Boston,
Massachusetts
Ethnic Chinese dementia caregivers experience signifi-
cant burden and reduced quality of life, and are not likely
to seek skills training due to cultural barriers. To overcome
barriers to help seeking, an online self-directed learning
(SDL) intervention program to provide both caregiving and
self-care skills was developed. The computer software to
implement the SDL program has an engagement design,
relying on theories of: adult education/andragogy; behavio-
ral economics; digital technology; cultural adaptation; and
evidence-based dementia care skills. The program, in Chinese
language, uses brief videos, quizzes, progress tracking, and
text message reminders to ensure continual and effective
learning. Together with the educational website (www.love-
andhelp.com) that provides knowledge information and an
online community for increasing socio-emotional support
for caregivers, the SDL program is part of the overall strat-
egy of using health information technologies to enhance the
overall caregiving capacity for dementia care.
SESSION 175 (SYMPOSIUM)
LONG-TERM CARE POLICY TRENDS IN CHINA,
TAIWAN, JAPAN AND KOREA: IMPLICATIONS FOR
AGING IN ASIA
Chair: Y.W.Glavin, Case Western Reserve University/ Taipei
Medical University, Mayfield Village, Ohio
Co-Chair: F.K.Ejaz, Benjamin Rose Institute on Aging,
Ohio
This Symposium compares LTC policy trends in China,
Taiwan, Japan and Korea. Presentations include use of
diverse methodologies ranging from analyses of national
datasets (Japan and Taiwan), to reviews of public programs
(China) and a literature review on the impact of public
policies (Korea). Overall, two significant policy issues are
covered: 1)Development of health, long term and commu-
nity-based care; and 2)Impact on caregiving.
Dr. Sun will review Chinas policies of elderly income sup-
port (500 million participants), medical care insurance (95%
covered), social services that support facility-based care and
policy support for medical and care integration.
Dr. Wakui will examine service utilization and care pat-
terns based on findings from the Comprehensive Survey of
Living Conditions in Japan; and discuss policy and practice
implications for balancing formal and informal care.
Dr. Nakashima will review Japans Integrated Community
Care, challenges associated with aging-in-place and ways of
improving care coordination and promoting preventive care.
Dr. Chee will review the literature on the impact of Koreas
Long-Term Care Insurance on older adults and their caregiv-
ers. Apilot qualitative study corroborates the research litera-
ture and found that people now support elder care through
both public programs and traditional family caregiving.
Dr. Glavin will review data from the: 1) National LTC
Study that describes Taiwans disability population (2.89%)
Innovation in Aging, 2017, Vol. 1, No. S1
and high public support (89%) for national LTC insurance;
and 2)Integrated Health and LTC Study that stresses impor-
tance of unified assessment, coordinated financing, and inte-
grated care and capitations.
Dr. Ejaz will serve as a moderator.
STATE POLICIES REGARDING THE CHINESE
ELDERLY POPULATION
R.Sun, Cleveland State University, Cleveland, Ohio
Chinas policies to improve the well-being of the elderly
are in three major dimensions. There are two major pro-
grams in the economic arena: 1)the establishment of old age
support insurance in both cities and countryside. There are
about 500 million participants and over 130 million elderly
currently receiving monthly benefit. 2)The minimum living
protection program, which is aimed to cover those in poverty
or with low income. There are two parallel programs in med-
ical care: 1)basic health care insurance, which covers 95%
of the elderly in both urban and rural areas. 2)medical aid
policy, which is aimed to help those in poverty or with low
income, or childless, or in other special circumstances. For
social services, the state and local governments are promot-
ing to build more facilities, for-profit or non-profit, such as
elderly housing, day care, assisted living, and nursing homes.
IMPACTS OF CHANGING FAMILIES ON PUBLIC
LONG-TERM CARE INSURANCE PROGRAM IN
JAPAN
T.Wakui1, E.M.Agree2, I.Kai3, 1. Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan, 2. Johns Hopkins
University, Baltimore, Maryland, 3. The University of
Tokyo, Tokyo, Japan
Balancing formal and informal care system is a key to sus-
taining long-term care programs; however, the interrelated
impacts between formal and informal care have been over-
looked. In Japan, while women traditionally bear most of
the caregiving roles in multigenerational households, trends
toward delayed marriage and changes in family structure
are leading to a greater variety in caregiving arrangements,
such as son caregiving, multiple caregiving or unmarried-
child caregiving. Analysis of the Comprehensive Survey of
Living Conditions (CSLC: n=2248) national data suggested
that patterns of services utilized differed by caregiver type.
For example, son caregivers were more likely to use formal
services in ADL care, compared to daughter and daughter-in
law caregivers. Findings have important implications for pol-
icy and practice and suggest that service utilization is linked
to caregiver characteristics. Sustainability of the public long-
term care program by balancing formal and informal care is
discussed.
REVIEW OF JAPANS INTEGRATED COMMUNITY
CARE, IMPACTS AND CHALLENGES IN SUPPORTING
AGING IN PLACE
T.Nakashima1,2, 1. Rutgers University, Camden, New
Jersey, 2. SUNY at Albany, Albany, New York
The Japanese government implemented a long-term care
insurance program called Integrated Community Care
System to help older adults age in place. Municipal govern-
ments and Community General Support Centers are required
to establish the Integrated Community Care System through
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
collaborations with long-term care services, healthcare, pre-
vention programs, housing, and daily life support services.
Administrators, practitioners, researchers and policy
makers are struggling with issues related to care coordina-
tion and increased efficiency in order to promote a higher
quality of care for older adults. In this presentation, three
important issues will be discussed to explain the challenges
to supporting aging in place. These issues are: 1)how to com-
bine medical and long-term care in the provision of home
care, 2)how to enhance the functions of various community-
based services, 3)how to promote preventive care and daily
life support services involving the members of the commu-
nity as volunteers.
THE CONCEPTION OF ELDER CARE IN THE
CONTEXT OF LONG-TERM CARE POLICY IN KOREA
K.Chee1, H.Lee2, 1. Sociology, Texas State University, San
Marcos, Texas, 2. Catholic University of Daegu, Daegu,
Korea (the Republic of)
This study investigated how Koreas Long-Term Care
Insurance Program implemented in 2008 has affected the
ideas and experiences of elder care. According to the research
literature, this program has helped reduce family caregivers
care burden and stress. In addition, elders were found to
uphold traditional values of filial piety and preferred family
care to institutional care, though family care was still more
burdensome for caregivers. Qualitative data from our pilot
study with seven adults (aged 23 to 61 years) corroborate
these themes, but show that respondents emphasize inde-
pendence for both young and old, and believe that family
and society should be jointly responsible for elder care. We
discuss our findings in light of their implications for research
and practice. Future research could use the life course frame-
work to examine cohort differences between perspectives of
elders and their caregivers regarding what constitutes ideal
elder care.
LONG-TERM CARE AND CARE INTEGRATION IN
TAIWAN AND MAINLAND CHINA: OPPORTUNITIES
AND DIRECTIONS
Y.W.Glavin1, L.Hu2, 1. School of Nedicine, Case Westernh
Reserve University/ Taipei Medical U, Mayfield Village,
Ohio, 2. School of Public Health Peking Union Medical
College, Beijing, China
National LTC Need Study (NLTCNS) conducted in
20092011 and 20152016, indicated Taiwans disability
rate in general population is 2.89%; in elderly population is
16.50%; the disabled population is estimated to raise from
740,000 in 2014 to 1,200,000 in 2031. After the implemen-
tation of National Health Insurance in 1995, Taiwan is in the
process of developing the long term care system. NLTCNS
indicated high public support for long term care insurance
(87%), although new administration now considers a tax-
based financing. Integrated Health and LTC Study (IHLTCS)
was funded in 2015 to explore integration strategies and
resources needed to support system integration. Presenters
will discuss findings from both NLTCNS and IHLTCS to
describe Taiwans disability population, service utilization,
issues causing fragmentation and stakeholder opinions.
Aproposal outlining focus areas to initiate care integrations
and tools and external support required will be discussed.
IAGG 2017 World Congress
43
SESSION 180 (SYMPOSIUM)
ADAPTATIONS OF EVIDENCE BASED TRANSITIONAL
CARE MODELS IN THE U.S.
Chair: M.D.Naylor, University of Pennsylvania School of
Nursing
M.Pauly, Wharton School, University of Pennslyvania,
Philadelphia, Pennsylvania
Derived from rigorous study in well-designed clinical
trials, evidence-based interventions (EBI) often are incor-
porated into health care practices, yet little is known about
how they are adapted to local contexts. In this symposium,
we will describe a mixed methods study of adaptations of
the Transitional Care Model (TCM) funded by the Robert
Wood Johnson Foundation. First, we will describe the TCM,
a rigorously tested EBI proven to improve care, enhance
outcomes and reduce costs among vulnerable chronically ill
older adults. Then, we will discuss the rationale for the use of
Stirmans System of Classifying Modifications to Evidence-
Based Programs to explore the potential adaptations of
EBIs, including those classified as contextual (e.g., external
or internal system factors) or content (e.g., EBI components,
frequency and mode of delivery) related. Using data from
a national survey of expert practitioners based in diverse
health and community-based organizations, we will then
describe 344 programs who reported use of the TCM. The
presentation will highlight common content adaptations and
perceived contextual barriers and facilitators in implemen-
tation of EB transitional care interventions. Next, we will
summarize findings from our qualitative analysis of inter-
views with expert practitioners based in 26 unique organiza-
tions that reported implementation of the TCM and describe
both the nature of content and contextual adaptations of the
TCM and the rationale for these adaptations. Practice, policy
and research implications of findings related to adaptations
of the TCM and other EBIs will be examined.
ADAPTATIONS OF EVIDENCE-BASED
INTERVENTIONS: THE CASE OF THE
TRANSITIONAL CARE MODEL
M.D.Naylor1,2, K.B.Hirschman1,2, M.Toles2,3, E.Shaid1,2,
K.McCauley1,2, M.Pauly4, 1. University of Pennsylvania
School of Nursing, Philadelphia, Pennsylvania, 2.
NewCourtland Center for Transtions and Health,
Philadelphia, Pennsylvania, 3. University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, 4.
Wharton School, University of Pennslyvania, Philadelphia,
Pennsylvania
For over 20years, multiple National Institute of Health
funded randomized control trials and comparative effective-
ness studies of the TCM have demonstrated enhanced patient
experiences with care, improved health and reduced costs for
older adults with multiple chronic conditions. Additionally,
rigorous translational studies, supported by many founda-
tions, have resulted similar quality and cost benefits for this
vulnerable patient group. Similar to other EBIs, however,
limited empirical data are available which describe how the
TCM has been adapted in real world clinical practice.
In this session, we will explore the rationale for rigorous
examination of adaptions of the TCM and describing the
aims of this study, the basis for using Stirmans System of
44
Classifying Modifications to Evidence-Based Programs and
the reasoning behind the use of a mixed methods approach.
We also will describe how findings contribute to the body of
knowledge related to adaptations of EBIs.
PHASE I: AQUANTITATIVE EVALUATION OF
ADAPTATIONS OF THE TRANSITIONAL CARE
MODEL
K.B.Hirschman1,2, M.Toles2,3, O.F.Jarrin1,4, E.Shaid1,2,
M.Pauly5, M.D.Naylor1,2, 1. University of Pennsylvania
School of Nursing, Philadelphia, Pennsylvania, 2.
NewCourtland Center for Transtions and Health,
Philadelphia, Pennsylvania, 3. University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, 4. Rutgers, The
State University of New Jersey, School of Nursing, Newark,
New Jersey, 5. Wharton School, University of Pennslyvania,
Philadelphia, Pennsylvania
This session will summarize findings from a national sur-
vey designed to identify common adaptations of the TCM
across diverse health and community-based settings. Targeted
respondents were expert practitioners (i.e., clinicians or clini-
cal leaders of transitional care programs). Aweb-based sur-
vey was conducted (September 2014 to January 2015). Of
the 582 unique respondents who completed the survey, 344
reported use of the TCM alone or in combination with other
EB transitional care models. The hospital-to-home design, a
key TCM feature, was adapted by 60% of respondents. Two
common adaptations of the TCMs nine core components
related to staffing and care continuity. Specifically, 55% of
respondents reported use of diverse clinicians vs. advanced
practices nurses to deliver the TCM (contextual adaptation)
and 52% of programs ended TCM services at hospital dis-
charge (content adaptation). Practice and research implica-
tions of study findings will be explored.
PHASE II: QUALITATIVE ASSESSMENT OF
ADAPTATIONS OF THE TRANSITIONAL CARE
MODEL
M.Toles2,3, K.B.Hirschman1,3, E.Shaid1, O.F.Jarrin1,4, conducting an informed/ongoing (here and now) consent
M.Pauly5, M.D.Naylor1,3, 1. University of Pennsylvania
School of Nursing, Philadelphia, Pennsylvania, 2. University
of North Carolina at Chapel Hill, Chapel Hill, North
Carolina, 3. NewCourtland Center for Transtions and
Health, Philadelphia, Pennsylvania, 4. Rutgers, The State
University of New Jersey, School of Nursing, Newark, New
Jersey, 5. Wharton School, University of Pennslyvania,
Philadelphia, Pennsylvania
This session will describe findings from the studys
qualitative phase designed to explore expert practitioners
perceptions of the rationale for adapting the TCM. Study
investigators developed a questionnaire, interviewed 26
purposefully-selected TCM practitioners from the Phase
I survey, conducted thematic analysis and described the
characteristics and value of common contextual and con-
tent adaptations. Contextual adaptations were common. The
TCM was commonly delivered by registered nurses and in a
variety of settings (e.g., hospitals, integrated health systems,
home care, etc.). Content adaptations also were common.
Most often, visits were provided for higher-risk patients dur-
ing hospital to home transitions but separate staff provided
hospital and home services. Respondents offered diverse
Innovation in Aging, 2017, Vol. 1, No. S1
goals for adapting the TCM including: expanding the reach
of services, engaging patients, and collaborating with multi-
ple clinicians. All respondents anticipated future TC program
growth. Findings suggest the need to rigorously evaluate the
effects of adaptations on health and cost outcomes.
SESSION 185 (SYMPOSIUM)
A NEW LENS ON QUALITATIVE METHODS IN
AGING: CHALLENGES IN RECRUITING, ANALYZING,
AND MIXED METHODS
Chair: C.Koren, University of Haifa, Hod Hasharon, Israel
Co-Chair: M.Roes, German Center for Neurodegenerative
Diseases (DZNE), Witten, Germany
Discussant: A.J.Schwartz, East Carolina University,
Greenville, North Carolina
This symposium addresses several challenges qualitative
researchers from several countries encountered as they stud-
ied varied experiences of older adults in increasingly aging
societies. Presenters have investigated interpersonal relation-
ships within institutional settings (Washburn & Williams),
the phenomenology of becoming an older person (Washburn
& Williams), late-life re-partnering and its influences on
intergenerational family relations (Koren), and health beliefs
of older Latinos with cancer (Carrion & Nedjst-Haiem).
Among the challenges the presenters have faced are address-
ing the ethical rights of special populations such as older
persons living with dementia (Roes & Panke-Kochinke)
and how best to approach older members of various ethnic
backgrounds to participate in a research study (Carrion &
Nedjst-Haiem).
Washburn and Williams will discuss how quantitative
data in two mixed methods studies were used to better
understand the intended meaning of participants responses
in semi-structured interviews. Recruitment issues are
addressed in two presentations. Roes and Panke-Kochinke
will explain how to identify the capacity to give consent and
process whereas Carrion and Nedjst-Haiem will illustrate
how to overcome recruitment barriers with older Latinos
with cancer emphasizing how it promotes successful qualita-
tive research by providing rich data. Koren will explain how
to analyze data from a study with multi-generational families
based on qualitative interviews conducted individually with
each family member, discussing this approach in relation to
qualitative dyadic analysis and qualitative methods in family
research. As discussant, Schwartz will integrate, draw con-
clusions, and facilitate discussion on challenges using quali-
tative methods in research on aging.
QUALITATIVE DATA ANALYSIS OF THE
MULTIGENERATIONAL FAMILY UNIT: THE CASE OF
LATE-LIFE STEPFAMILIES
C.Koren, University of Haifa, Hod Hasharon, Israel
With life expectancy rising, families expanding to three,
four, even five generations are becoming more common. Thus,
new phenomena in aging and family studies are expected
to develop requiring qualitative methodology. Along with
the perspectives of the older generation those of the other
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Innovation in Aging, 2017, Vol. 1, No. S1
multigenerational family members will become increasingly
important for understanding the meaning of aging.
The aim of this presentation is to illustrate how to con-
duct a qualitative study with multi-generational families. The
emphasis is on the analysis of such units based on qualitative
interviews conducted individually with each family mem-
ber using data from a large qualitative study on the mean-
ing of late-life repartnering from a family intergenerational
perspective.
The study included 19 stepfamily-units (38 mutigenera-
tional family-units) a total of 107 participants (38 partners,
37 adult children, 32 young and adult grandchildren).
The method will be discussed in relation to qualitative
dyadic analysis and qualitative methods in family research.
ADDRESSING RECRUITMENT CHALLENGES IN
QUALITATIVE RESEARCH AMONG OLDER LATINOS
WITH CANCER
I.V.Carrion1, F.R.Nedjat-Haiem2, 1. Social Work,
University of South Florida, Tampa, Florida, 2. New
Mexico State University, Las Cruces, New Mexico
This paper addresses the challenges and presents strate-
gies that facilitate recruitment in qualitative research in a
cancer care study with older Latinos. We analyzed factors
that influence the recruitment process when conducting qual-
itative studies using a priori codes and constant comparison
within a grounded theory framework.
Recruiting Latinos with cancer in a qualitative study
entail understanding their beliefs and knowledge of research
studies and the ability to articulate benefits of participating
in research studies in the individuals language of preference.
In order to ensure successful recruitment approaches, quali-
tative researchers must develop a research team that reflects
the population which is being recruited as well as attend to
gender ascribed health beliefs, transportation constraints,
immigration issues and language barriers.
Overcoming recruitment barriers with older Latinos
with cancer is vital in order to successfully conduct quali-
tative research studies. The findings will address the gaps
in psycho-social care literature and inform evidence-based
interventions.
MANAGING ONGOING CONSENT IN RESEARCH
WITH PEOPLE LIVING WITH DEMENTIA
B.Panke-Kochinke1,3, J.Serbser1, J.Dreyer1, M.Roes1,2, 1. port availability, home and neighborhood environments,
German Center for Neurodegenerative Diseases (DZNE),
Witten, Germany, 2. University of Witten/Herdecke, Witten,
Germany, 3. University of Osnabrueck, Osnabrueck,
Germany
People living with dementia have the right to decide
whether or not they want to participate in qualitative research
and to give their informed/ongoing consent. How to create
participation is also related to the question in what way(s)
concepts of autonomy and self-determination are defined.
However, as the symptoms of dementia progresses, the cog-
nitive ability to give verbal consent diminishes and finally is
lost, and therefore influencing the decision process. Although
it seems ethically challenging to (not) let people with demen-
tia participate in research, they must be protected against the
risks of research participation. As a result, researchers have
tended to seek the consent (assent) of the relatives of persons
IAGG 2017 World Congress
45
with dementia that has progressed beyond the early stages.
The aim of this presentation is to exemplify how to identify
the capacity to give consent, and how concepts of autonomy
and self-determination support an informed/ongoing consent
process.
MIXED METHODS APPROACHES TO INCREASING
OUR UNDERSTANDING OF THE LIVED EXPERIENCE
OF OLDER ADULTS
A.M.Washburn, S.Williams, National University, La Jolla,
California
This presentation will explain how quantitative data in
two studies with a mixed methods design were used to better
understand the intended meaning of participants responses
in semi-structured interviews. In the first study, 17 commu-
nity-dwelling older adults answered questions about their
experience of aging in place and completed several quantita-
tive measures. Analysis of the interview transcripts employed
a phenomenological-hermeneutic strategy; participants
responses to the quantitative measures were then used to
inform further interpretations of their answers. In the second
study, 40 nursing home residents answered questions about
their interpersonal day-to-day social interactions and inter-
personal relationships. Athematic analysis of their responses
was followed by additional analyses using data from meas-
ures of social cognition, as well as nursing staffs ratings of
their social behavior. In both studies, several widely-held
assumptions about the nature of older adults lived experi-
encefor example, that loneliness and boredom are com-
monplaceare belied by the findings.
SESSION 190 (SYMPOSIUM)
ACCESS TO SERVICES AMONG VULNERABLE
ELDERS: ADDRESSING SOCIAL, ECONOMIC, AND
ENVIRONMENTAL BARRIERS
Chair: M.B.Ryvicker, Visiting Nurse Service of NY, New
York, New York
Co-Chair: K.Ornstein, Mount Sinai Hospital, New York
City, New York
Discussant: C.M.Murtaugh, Visiting Nurse Service of NY
The ability of older adults to access and effectively navi-
gate health and social services may depend on a myriad of
factors. Physical disability and mobility issues, social sup-
access to transportation, and provider factors all form the
landscape in which a person navigates and accesses services.
This symposium will synthesize recent research that explores
a range of social, economic, and environmental barriers to
older adults access to services, identifies unmet service needs
that may be linked to these barriers, and examines differ-
ent approaches to overcoming these barriers in vulnerable
populations. The first paper examines the epidemiology of
homebound status, focusing on socioeconomic factors, using
data from the National Health and Aging Trends Study
(NHATS), a nationally representative longitudinal survey
of older adults in the United States. The second presenta-
tion uses the NHATS to examine demographic, clinical, and
functional variations in types of transportation used to get
to medical appointments. The third paper describes a pilot
study of an in-home assessment tool to identify necessary
46
home improvements to overcome environmental barriers for
homebound older adults. The fourth presentation describes
a community-based initiative to identify neighborhood prob-
lems and barriers faced by older adults in accessing services.
This collection of papers draws on multiple disciplines,
including nursing, geriatrics, epidemiology, and the social sci-
ences. The discussion will explore policy and practice impli-
cations of a multi-dimensional perspective on access and
navigation barriers among vulnerable elders at high risk of
unmet needs and poor health-related quality of life.
HOW DO ECONOMIC FACTORS DRIVE
HOMEBOUND STATUS?
K.Ornstein, T.Soones, A.Siu, Icahn School of Medicine at
Mount Sinai, New York, New York
There is a large and growing population of individuals with
serious illness living in the community who are poor, home-
bound, and heavily reliant on caregiver support. Individuals
of middle-income who do not qualify for Medicaid and lack
the financial cushion of those with greater wealth may be
especially vulnerable to becoming homebound. Using data
from the National Health and Aging Trends Study, a nation-
ally representative sample of Medicare beneficiaries, we
prospectively examine the association between homebound
status, caregiving and income. Among community-dwelling
non-homebound individuals, those in the highest income
brackets are least likely to become homebound or to be in
nursing homes over 2years of follow-up. This work demon-
strates the role of economic factors on residence and quality
of life and suggests that we need to expand policy initiatives
to better serve those income groups most vulnerable to the
costs related to living in the community with serious illness.
TRANSPORTATION TO MEDICAL APPOINTMENTS
AMONG VULNERABLE ELDERS
M.B.Ryvicker1, K.Ornstein2, 1. Visiting Nurse Service
of New York, New York, New York, 2. Icahn School of
Medicine at Mount Sinai, New York, New York
Prior research on chronically ill elders has identified sub-
stantial subpopulations with unmet needs for outpatient care,
even in urban areas fairly saturated with providers. This raises
questions about barriers to effective healthcare navigation
among vulnerable elders. We examined demographic, clinical,
and functional variations in types of transportation used to
get to medical appointments. Using data from the National
Health and Aging Trends Study, we found that whites were
more likely to drive themselves to the doctor (59%), com-
pared to Blacks (42%) and Hispanics (35%). Nonwhites and
those with lower education levels relied more heavily on rides
from others, shuttles for seniors and public transit. Individuals
who relied on rides or other forms of transit within the past
year were 50% more likely to visit the ED in the subsequent
year, controlling for selected characteristics. Further work
is needed to expand transportation options for underserved
elders to promote effective healthcare navigation.
A PILOT STUDY ASSESSING IN-HOME ACTIVITY
PERFORMANCE AMONG VULNERABLE OLDER
ADULTS IN NEW YORK CITY
D.Russell1, S.L.Szanton2, J.L.Feinberg1, K.H.Bowles1, 1. tional migratory life course demonstrate better wellbe-
Visiting Nurse Service of New York, New York, New York,
Innovation in Aging, 2017, Vol. 1, No. S1
2. Johns Hopkins University School of Nursing, New York,
New York
Decreased physical function is a common modifiable risk
factor for nursing home admission and increases odds of
hospital readmission by 320%. Nearly half of older adults
leave the hospital with new difficulty completing activities
of daily living, with many adults homebound. Achallenging
home environment can lead to further functional decline.
This presentation will discuss findings from the In-Home
Occupational Performance Evaluation (I-HOPE), a measure
of in-home activity performance, to identify environmental
barriers homebound patients face and identify needed home
improvements. It will also include findings from interviews
with building staff regarding facilitators and barriers to
making needed home improvements. This work will enhance
understanding of the functional and home modification
needs among a population of vulnerable older adults. This
pilot can serve as a catalyst for new models to mitigate envi-
ronmental barriers and improve functional status for home-
bound patients, thus improving access to services.
A COMMUNITY-BASED INITIATIVE TO IDENTIFY
AND ADDRESS BARRIERS IN OLDER ADULTS
ACCESS TO SERVICES
M.Oberlink, Visiting Nurse Service of New York, New
York, New York
Older adults living in low-income communities often
have difficulties accessing services in their own neighbor-
hoods because: they lack knowledge about what services are
available or the services simply dont exist; they lack reliable
transportation to access the services or are unaware about
transportation alternatives that might be available in their
community; or they are fearful of leaving their homes in
high-crime areas. The AdvantAge Initiative is a project that
has conducted surveys and focus groups with thousands of
older adults across the country asking them to identify neigh-
borhood problems and barriers to navigating their commu-
nities and accessing services. Findings are communicated to
stakeholders who use this information to plan strategies to
remove barriers and make their communities more aging-
friendly. We will discuss access and navigation barriers
such as misperceptions about services and inconveniently
located servicesand how communities have addressed
these barriers.
SESSION 195 (SYMPOSIUM)
THE SAME OR DIFFERENT? UNDERSTANDING
AGEING WELL AND THE TRANSNATIONAL
MIGRANT LIFE COURSE
Chair: C.Victor, Brunel University-London, United
Kingdom
Discussant: S.Torres, Uppsala University, Uppsala,
Sweden
The healthy migrant effect consistently demonstrates
that those who migrate across international borders have
lower rates of mortality and morbidity than the destina-
tion country, although we do not know if this holds for
measures of wellbeing. Do older people with a transna-
ing outcomes than their peers in their countries of origin
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and destination and how do outcomes vary between dif-
ferent migratory pathways? We use 3 domains of wellbe-
ing: loneliness, subjective health status/disability and life
satisfaction/quality of life to explore the impact of a life
course that involved transnational migration on ageing
well. Comparing migrant and non-migrant Turkish fami-
lies Baykara-Krumme and Fokkema show that family cohe-
sion is stronger in non-transnational migrant families. Klok
and colleagues demonstrate how a sense of belonging to
either ones own group or the larger society in the country
of settlement protects against loneliness but transnational
belonging does not. Klokgieters explores whether factors
of social participation, religious coping and motivation to
migrate help maintain high levels of wellbeing in a context
of migration stress among Turkish and Moroccan migrants.
Victor and Burholt demonstrate heterogeneity across well-
being outcomes according to migratory pathway. Those
who left India demonstrate wellbeing outcomes comparable
with their peers in both country of origin and destination
whilst those from China fare worse than either. We con-
clude by synthesing variations in ageing well within and
between those with migratory life courses, how these com-
pare with peers in countries of destination and origin, and
propose an agenda for further research.
THE IMPACT OF MIGRATION ON FAMILY
SOLIDARITY TYPES
H.Baykara-Krumme1, T.Fokkema2, 1. University Duisburg-
Essen, Duisberg, Germany, 2. Netherlands Interdisciplinary
Demographic Institute, The Hague, Netherlands
This paper aims to expand knowledge on the effects of
international migration on parent-adult child relationships.
We develop a typology of families, include non-migrant fam-
ilies in the country of origin for comparison, and consider
transnational families. Analyses are based on the Turkish
2000 Families Study, using information on adult non-cores-
ident children about their relationships with their parents.
Latent class analysis shows four family solidarity types whose
prevalence differ across the migrant groups. The proportion
of the full-solidarity type is larger and that of the autono-
mous family type is smaller in first- and second-generation
migrant families than in stayer families in Turkey. In trans-
national families there is less full solidarity and autonomous
relationships are more common. All migrant groups display
less advice-oriented and more material-oriented support
relationships. These results indicate stronger family cohe-
sion in non-transnational migrant families and few changes
across migrant generations. Observed differences are not due
to composition effects.
LONELINESS AND SENSE OF BELONGING AMONG
OLDER TURKISH AND MOROCCAN MIGRANTS TO
THE NETHERLANDS
J.Klok, T.Van Tilburg, B.Suanet, M.Huisman, Vrije not present a consistent pattern in levels of wellbeing com-
Universiteit Amsterdam, Amsterdam, Netherlands
We examine how sense of belonging functions as a pro-
tective mechanism against loneliness. Drawing on Berrys
work (1980) on acculturation strategies (i.e. integration,
assimilation, separation and marginalization), we expect
that more belonging contributes to less loneliness. We add
a transnational belonging perspective and argue that this
IAGG 2017 World Congress
47
could also function as a protection against loneliness, as it
acknowledges the importance of place attachment. Using
LASA data on older migrants aged 5566, we distinguish
Berrys acculturation strategies in our sample. Whether
transnational belonging is a separate dimension of belong-
ing, remains unclear. Regression analysis shows that the
marginalized are lonelier than those with a stronger sense
of belonging but that transnational belonging contributes
to greater loneliness not less. We conclude that a transna-
tional sense of belonging among older migrants needs to
be explored further. We will do so qualitatively and try
to expose the mechanisms through which a transnational
belonging is lived.
RELIGIOUS COPING, SOCIAL PARTICIPATION, AND
MOTIVATION TO MIGRATE AND THE WELL-BEING
OF OLDER MIGRANTS
S.Klokgieters, T.Van Tilburg, D.J.Deeg, M.Huisman, Vrije
Universiteit Amsterdam, Amsterdam, Netherlands
Stress resulting from the experience of migration is an
important risk factor for a low level of wellbeing in older
immigrants. Especially with regards to labour immigrants,
studies show that they experience a number of stressors
throughout their life course, including feelings of loss, and
language barriers. However, not all immigrants experience
these stresses in similar magnitude. Furthermore, some
immigrants may possess resources that help them deal
with the stresses associated with the experience of migra-
tion. This study examines the buffering resources that may
help some immigrants overcome migration stress and main-
tain high levels of wellbeing while others succumb to these
stressors. Data were collected from 255 Turkish and 199
Moroccan respondents in the context of the Longitudinal
Aging Study Amsterdam. Linear regression analyses demon-
strated that while migration stress is negatively associated
with wellbeing, religious coping, motivations to migrate and
active participation in organizations do not moderate this
relationship.
AGEING WELL: ACOMPARATIVE STUDY OF INDIAN
AND CHINESE MIGRANTS TO ENGLAND AND
WALES
C.Victor1, V.Burholt2, 1. Brunel University-London,
London, United Kingdom, 2. Swansea University, Swansea,
United Kingdom
Are older migrants from India and China to the UK age-
ing better than their peers in the host community or country
of origin? We examine 3 dimensions of wellbeing: quality of
life, loneliness and self-rated health using data from a sur-
vey of older people from minority communities and using
the English Longitudinal Study of Ageing and the Indian and
Chinese Longitudinal Studies of Ageing for comparison. Our
sample of Indian (N=164) and Chinese (N=117) migrants did
pared with their peers in their country of origin or majority
community. Indian migrants reported loneliness prevalence
of 10% in all 3 groups; life satisfaction and health rating
were comparable with the majority community but higher
than country of origin. Chinese migrants reported higher lev-
els of loneliness and lower levels of self-rated health than
their peers in either comparator group.
48
SESSION 200 (SYMPOSIUM)
IMPLEMENTING COMMUNITY-BASED FALLS
PREVENTION RESEARCH INTO PRACTICE:
INTERNATIONAL PERSPECTIVES
Chair: C.Meyer, Royal District Nursing Service Institute, St
Kilda, Victoria, Australia
Co-Chair: K.D.Hill, Curtin University, Perth, Western
Australia, Australia
Strong evidence exists for falls prevention interventions
in community-dwelling older people; yet, the rate of falls,
hospitalization rates and injury rates resulting from a fall
across the globe are not declining. One in three community-
dwelling older people experience a fall within a given year,
with this rate increasing substantially for particular clinical
groups such as people with dementia (6080%). Adherence
to falls prevention strategies is problematic, being cited as
related to lack of personal relevance and appropriate advice;
thus, uptake and participation in falls prevention activities is
challenging. This symposium draws on international experts
to highlight and discuss the issues facing falls prevention
practitioners, particularly related to implementing falls pre-
vention evidence into policy and practice.
AUSTRALIAN EXPERIENCES IN SUPPORTING FALLS
PREVENTION POLICY TO PRACTICE THROUGH
PARTNERSHIPS
K.D.Hill, Curtin University, Perth, Western Australia,
Australia
This presentation will discuss two approaches in
Australian states aiming to support improved falls preven-
tion outcomes. The first approach involved a partnership
between the Victorian State Government Department of
Health, researchers and practitioners in falls prevention.
This four year initiative involved (1) using State hospitaliza-
tion to inform targeting of falls prevention initiatives, (2)
surveying older people relating to preferences/intention/
participation in falls prevention activities, (3) reviewing
Government departments for gaps/overlap in falls preven-
tion activities, and (4) development of sustainability guide-
lines to support falls prevention initiatives optimize longer
term sustainability.
The second activity involved the development and imple-
mentation in Western Australia of a falls prevention Model
of Care, providing a framework within the health and care
system to support improved falls prevention activity uptake,
coordination and outcomes. Broader implications of these
approaches will be discussed.
LESSONS LEARNED FROM U.S. INJURY PREVENTION
INITIATIVES: IMPLICATIONS FOR INTERNATIONAL
EFFORTS
M.G.Ory1, M.Smith1, T.E.Shubert2, 1. University of
Georgia, Athens, Georgia, 2. University of Northern
Carolina, Chapel Hill, North Carolina
As a national leader in falls prevention, the US Centers
for Disease Control and Prevention has funded several
state-wide initiatives to examine the impact of multi-level
approaches to falls prevention for older adults. A 5-year
evaluation conducted by Texas A&M and its partners at
Innovation in Aging, 2017, Vol. 1, No. S1
the University of Georgia and University of North Carolina
has tested the scalability and sustainability of group based
community-based programs, home-based individualized
programs, and clinical practice changes for increased screen-
ing and referral for those with falls risk. Findings from sur-
veys and objective functional assessments demonstrate the
success of interventions such as Stepping on and Tai-CHI
as well as the American adaptation of Otago in terms of
improvements in fall-related functional abilities and mobil-
ity. There has also been a growing appreciation of clinic-
based approaches and the importance of enhancing linkages
to community programs. This presentation will highlight
lessons learned and implications for international efforts in
falls prevention.
IMPLEMENTING FALLS PREVENTION IN MALAYSIA
M.Tan, University of Malaya, Kuala Lumpur, Malaysia
Only 8% of the Malaysian population is aged over
60 years, but this will increase to 15% of by 2025.
Malaysias healthcare system is, however, heavily burdened
with ongoing infectious diseases and the rising epidemic of
non-communicable diseases. Emerging age-related condi-
tions has, therefore, been given little attention. The burden
of falls is already taking its toll, with overcrowded hospitals
and oversubscribed care home places. The public receive
falls education through one-off articles or talk shows by
the media and public awareness sessions organised by non-
profit agencies. Regular group exercise programmes organ-
ized by non-governmental organizations and individuals
are in existence. These are occasionally supported by local
government grants. New private sector initiatives are now
emerging for secondary falls prevention. Our recently com-
pleted randomized-controlled trial evaluating a hospital-
based multifaceted intervention programme found that
compliance to strength and balance exercises was high.
Multi-agency working is now urgently required to address
this emerging issue.
COMMUNITY-ENGAGED AND POLICY RELEVANT
FALLS PREVENTION RESEARCH IN CANADA AND
INDIA
S.Johnson, University of Regina, Regina, Saskatchewan,
Canada
Falls among seniors are a global issue. While it has been
estimated that 70% of the worlds older adults are and will
be in low and middle income countries (LMIC), most of the
research in the area of falls emerge from high income coun-
tries (HIC). This presentation will highlight two examples
from community-based falls research projects in Canada
(intervention study) and in India (epidemiological study). The
Canadian example will highlight an integrated partnership
which enabled a falls prevention intervention to be embed-
ded within the health system infrastructure to reach older
home care clients. The Indian example will highlight the data
gaps and an epidemiological study on functional capacity
and falls in seniors. The implications of these two examples
for the implementation of research into practice and policy,
uptake among seniors, sustainability of intervention after the
research phase, and scope for global engagement and part-
nership for translational research will be discussed.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
ACTION RESEARCH TO UNDERSTAND FALLS
PREVENTION FOR PEOPLE WITH DEMENTIA
C.Meyer1,2, K.D.Hill3, S.Hill2, B.Dow4, 1. Royal District
Nursing Service Institute, St Kilda, Victoria, Australia, 2.
LaTrobe University, Bundoora, Victoria, Australia, 3. Curtin
University, Perth, Western Australia, Australia, 4. National
Ageing Research Institute, Parkville, Victoria, Australia
The final presentation addresses a specific population
group people with dementia. In the Australian community
care sector care managers and assessment officers are respon-
sible for assessing the needs of older people and co-ordinat-
ing service referrals, including for falls prevention; while
direct care workers are responsible for day to day personal/
domestic care. Health professionals are a source of advice
and guidance, yet feel their knowledge and skills may be
inadequate. While having differing roles, these workers are
all responsible for implementing falls prevention strategies.
This paper examines knowledge of falls prevention for peo-
ple with dementia; and of barriers and opportunities of trans-
lating this knowledge into practice. Action research sessions
were utilized and thematic analysis undertaken. This study
has implications for falls prevention in community-dwelling
people with dementia, highlighting limited understanding
of evidence-based strategies and broad health system con-
straints, but small incremental changes impact older people
for preventing falls.
SESSION 205 (SYMPOSIUM)
INSIGHTS GAINED FROM THE DEVELOPMENT
OF COMMUNITY PARAMEDICINE PROGRAMS IN
CANADA
Chair: S.Sinha, Mt Sinai Hospital, Toronto, Ontario,
Canada
Co-Chair: N.Foster, Mt Sinai Hospital, Toronto, Ontario,
Canada
Older adults are the highest users of paramedical and
ambulance services. These older adults typically strug-
gle with polymorbidity, functional impairments, and social
frailty. Most calls received by paramedics from older adults
are neither time-sensitive nor immediately life-threatening.
Paramedics are increasingly seeing older individuals in pre-
crisis situations who need more support to help them age in
place.
The need to work differently to meet the needs of older
adults has given strength to the community paramedicine
movement across Ontario. In 2014, Ontarios Ministry of
Health invested $6 million to support the development of 30
community paramedicine demonstration projects that allow
paramedics to fill unique care gaps, and better integrate care
for older patients.
Our proposed symposium will highlight insights gained
from the community paramedicine demonstration projects
through four talks: 1)First-Year Outcomes of the MOHLTC
Funded Community Paramedicine Demonstration Projects
by Dr. Samir Sinha, 2)Establishing the Effectiveness of the
Independence at Home Community Paramedicine Model,
by Ms. Nicoda Foster, 3) Lessons Learned from Renfrew
Countys Community Paramedic Response Unit Program
by Mr. Michael Nolan and 4)Evaluating the Effectiveness
IAGG 2017 World Congress
49
of Community Referrals by Emergency Medical Services by
Dr. Amol Verma.
The goal of our symposium is to enhance the awareness
of attendees of community paramedicine, the diverse models
of care it can represent and their ability to positively impact
patients and providers and the health systems. The sympo-
sium will conclude with an interactive discussion exploring
the facilitators and barriers to the implementation of effec-
tive community care models for the elderly.
FIRST-YEAR OUTCOMES OF THE MOHLTC-FUNDED
COMMUNITY PARAMEDICINE DEMONSTRATION
PROJECTS
S.Sinha1,3, M.Nolan2, N.Foster3, 1. University of Toronto,
Toronto, Ontario, Canada, 2. County of Renfrew Paramedic
Services, Toronto, Ontario, Canada, 3. Sinai Health System,
Toronto, Ontario, Canada
In 2014, Ontarios Ministry of Health and Long-Term
Care (MOHLTC) invested $6 million to support the devel-
opment of 30 Community Paramedicine (CP) Demonstration
Projects across the province. This investment supported the
development of a variety of locally driven models that could
allow paramedics to fill unique care gaps, and better inte-
grate care for vulnerable patients in their communities. The
30 funded projects focused on activities related to conduct-
ing assessments and referrals, preventative home visits and
Wellness Clinics. In the first 15 months, a total of 19,077
patients were enrolled across the 30 projects that engaged
1865 paramedics and 381 local primary, home and com-
munity care providers. Community paramedics completed
32,807 assessments and achieved a 14% overall decrease in
the volume of 911 calls from patients enrolled more than six-
months in a program. Therefore, community paramedicine
activities have the potential to improve patient and system
outcomes.
ESTABLISHING THE EFFECTIVENESS OF THE
INDEPENDENCE AT HOME COMMUNITY
PARAMEDICINE MODEL
S.Sinha1,2, A.Thurston3, J.Klich3, N.Foster2, 1. University
of of Toronto, Toronto, Ontario, Canada, 2. Sinai Health
System, Toronto, Ontario, Canada, 3. Toronto Paramedic
Services, Toronto, Ontario, Canada
Older adults are the highest users of paramedical ser-
vices. To improve care integration, the Independence at
Home initiative (IAH) was launched to broaden the scope
of practice of paramedics to provide proactive home visits
for low-income older adults who were high-users of 911
services (i.e. 5 911 calls 6-months). During the first-year,
908 primary and follow-up visits were conducted with 588
patients where paramedics conducted holistic assessments
to ascertain unmet health and social care needs. Outcomes
for 111 clients enrolled over a 3-month period for whom
6-months pre and post follow-up data was available showed
that pre enrolment this group made 301 911 calls (17% from
10 high-users) resulting in 246 (82%) ED visits. Six-months
following the visit there were 154 911 calls (19% from six
high-users) resulting in 103 (67%) ED visits. Overall, this
program reduced 911 calls by 41% and ED transports by
42% six-months after enrolment.
50
LESSONS LEARNED FROM RENFREW COUNTYS
COMMUNITY PARAMEDIC RESPONSE UNIT
PROGRAM
M.Nolan1, S.Sinha2,3, 1. The County of Renfrew Paramedic
Service, Pembroke, Ontario, Canada, 2. University of
Toronto, Toronto, Ontario, Canada, 3. Sinai Health System,
Toronto, Ontario, Canada
The County of Renfrew Community Paramedic Response
Unit (CPRU) program was designed to improve emergency
response times, promote prevention activities and support
older adults living in the community. Community Paramedics
focus on preventative measures to support clients live inde-
pendently. In 2015, 222 patients were enrolled in CPRU and
received a total of 1186 home visits and 2874 assessments
from community paramedics. An evaluation of the CPRU
demonstrated following the first year of implementation
demonstrated that all enrolled patients remained independ-
ent and were still living in their own home. Further, clients
had a 35% decrease in hospital admissions one-year after
being enrolled in the program. This same cohort experienced
an 83% reduction in total hospital readmission rates 30, 60
and 90days after receiving a visit from the paramedic.
EVALUATING THE EFFECTIVENESS OF COMMUNITY
REFERRALS BY EMERGENCY MEDICAL SERVICES
A.Verma1, J.Klich2, A.Thurston2, J.Scantlebury1, A.Kiss3,
G.Seddon4, S.Sinha1,5, 1. University of Toronto, Toronto,
Ontario, Canada, 2. Toronto Paramedic Services, Toronto,
Ontario, Canada, 3. Institute of Clinical Evaluative
Sciences, Toronto, Ontario, Canada, 4. Toronto Central
Community Care Access Centre, Toronto, Ontario, Canada,
5. Sinai Health System, Toronto, Ontario, Canada
Beginning in 2006, Toronto Emergency Medical Services
(EMS) developed the Community Referrals by EMS (CREMS)
program in which paramedics directly refer patients for
home care and community support services such as meals
on wheels. This retrospective cohort study assessed the uti-
lization of home and community support services and EMS
services among individuals who received CREMS referral in
Toronto, Canada in 2011 and 2012. In all, 2,382 individuals
received CREMS referral, with a mean age of 79.0years (SD
13.6). In the 6months after CREMS referral, there was an
adjusted increase of 17.4 hours of support services per per-
son (95% CI: 1.74, 33.09, p=0.03) and an adjusted reduction
in calls to EMS by 0.19 fewer mean calls per person (95%
CI -0.31, -0.06, p=0.004). The CREMS Program may repre-
sent a simple and effective way to address unmet needs for
community-dwelling elders.
SESSION 210 (SYMPOSIUM)
FOOD INSECURITY IN MEXICAN OLDER ADULTS
AND ITS IMPACT IN GERIATRIC CONDITIONS
Chair: R.Castrejn-Prez, Instituto Nacional de Geriatria,
Mexico, DF, Mexico
Co-Chair: M.U.Perez-Zepeda, Instituto Nacional de
Geriatria, Mexico, DF, Mexico
Discussant: M.Cesari, Universit de Toulouse III Paul
Sabatier, Toulouse, France
Aged population imposes new challenges for individu-
als, health systems and society as a whole. Areality that can
Innovation in Aging, 2017, Vol. 1, No. S1
overtake Mexico and other countries with low and middle
income is the simultaneous existence of additional blocks of
priorities such as unequal social development, poverty, hun-
ger, low levels of education, infectious diseases so that aging
can be marginalized as a priority. Malnutrition and its both
sides, undernutrition and obesity remains as a serious issue
in several world regions. Food insecurity (FI) is understood
as the access to sufficient, safe and nutritious food that meets
the dietary needs and food preferences of people at all times,
and under all conditions (physical, social and economic). FI
may promote malnutrition which has been recognized as
important for developing children, as well as to the health
of older adults. It is known that undernutrition is a com-
mon problem of older adults. Mexico face the dilemma of
a double burden of health-related problems, along with the
continuously growing group of older adults there are still
unresolved issues of poverty such as the availability of food
for the population. Because of these, it is relevant to gen-
erate new information on how food insecurity may have a
deleterious effect on aging. In this symposium, two com-
mon problems for the geriatric population will be covered
in order to describe its association with food security: frailty
and sarcopenia. Presented results could be used in order to
design tailored programs to those older adults in risk for
food insecurity.
FOOD INSECURITY AND FRAILTY: ASECONDARY
ANALYSIS OF THE MEXICAN HEALTH AND
NUTRITION SURVEY 2012
C.Garcia-Pena, M.U.Perez-Zepeda, Geriatric
Epidemiology Research, Instituto Nacional de Geriatria,
Mexico, DF, Mexico
Objectives: To determine the association between food
insecurity and frailty in older adults of a middle-income
country. Methods: Cross-sectional analysis of a representa-
tive nation-wide survey on health and nutrition. Descriptive
analyses of food insecurity and frailty, and multivariate
regressions were performed. Results: From a total of 7,108
60-year or older adults with a mean age of 70.7 a 54.7%
were women. Food security categories were: 26.3% food
security, 40.3% mild food insecurity, 20.5% moderate food
insecurity and 12.9% severe food insecurity. Food insecurity
categories were associated with frailty, being the severe cat-
egory the highest coefficient of 0.465 (95% CI 0.3870.542)
after adjustment for confounding. Conclusions: Food inse-
curity may play a major role in aging by its association with
frailty, which is in turn a condition that render the older
adult in a higher risk to develop adverse outcomes.
FOOD INSECURITY AND ITS ASSOCIATION WITH
SARCOPENIA ELEMENTS
M.U.Perez-Zepeda, Geriatric Epidemiology Research,
Instituto Nacional de Geriatria, Mexico, DF, Mexico
Objectives: To describe the association between sarcope-
nia elements and food insecurity in a group of community-
dwelling older adults. Methods: Cross-sectional analysis
of of 60-year or older community-dwelling adults from
Mexico City. Food insecurity was measured by the ELCSA
survey, and considered components of sarcopenia were:
muscle mass, gait speed and handgrip strength. Results:
From a total of 168 older adults with a mean of age of
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Innovation in Aging, 2017, Vol. 1, No. S1
76.7 (SD 10.1) and 76.8% were women, 22.9% had food
insecurity. Appendicular muscle mass had a mean of 6.3kg
(SD 1.08), gait speed of 0.87m/s (SD 0.27) and handgrip
strength of 15.4 (SD 8.43). Amultiple linear regression was
performed for each of the variables of sarcopenia, adjusted
for age, sex and comorbidity; only appendicular muscle
mass had a marginal significance (-0.35 [95% CI -0.75
to 0.03], p=0.078). Conclusions: According to our data,
there is a lack of association between sarcopenia and food
insecurity.
SESSION 215 (PAPER)
ISSUES AFFECTING ACUTE HOSPITALIZATION OF
OLDER ADULTS
THE IMPACT OF MULTIMORBIDITY, RACE,
AND GENDER ON OUTCOMES AFTER ACUTE
HOSPITALIZATION IN NHATS
O.Sheehan1, H.Amjad1, J.Huang1, C.Boyd1, J.Prvu
Bettger2, D.L.Roth1, 1. Johns Hopkins University School
of Medicine, Baltimore, Maryland, 2. Duke University,
Durham, North Carolina
Many disparities exist in access and quality of health-
care among minority populations. The National Health and
Aging Trends Study (NHATS) is a nationally representative
and racially diverse sample of 8245 older Americans receiv-
ing federal Medicare health insurance. We linked the survey
with administrative claims data to investigate potential dis-
parities in outcomes (discharge destination, mortality and
Emergency Department (ED) visits) after acute hospitaliza-
tion. We also examined whether the impact of multimorbid-
ity on outcomes differed by race or gender groups.
Of the 7609 community dwelling older adults in NHATS,
1842 were hospitalized at least once in the 2 years after
baseline interview and 1584 had continuous fee for service
Medicare insurance coverage. Over half of the population
(n=929, 57.3%) had 4 or more chronic conditions. The pres-
ence of 4 chronic conditions was strongly associated with
repeat hospitalizations (odd ratio (OR) 1.78; 95% confi-
dence interval (CI) 1.48 - 2.14), ED visits (OR 1.84; CI 1.38
- 2.46) and mortality 1year after hospitalization (OR 1.46;
CI 1.06 - 2.01).
Race and gender effects were identified in outcomes
including discharge destination with men less likely than
women to be discharged to a Skilled Nursing Facility or
rehabilitation hospital and Blacks and Hispanics more likely
than Whites to receive skilled Home Health Care. The effect
of multimorbidity, however, remained consistent across race
and gender groups. NHATS provides a unique opportunity
to study the complex relationship between multimorbidity,
disparities and acute medical events and allows us to better
understand where interventions should be targeted.
RE-ENGINEERING ON-DEMAND CARE IN SENIOR
LIVING AND HOME HEALTH
K.Riddleberger, M.Prather, DispatchHealth, Denver,
Colorado
In 2013, DispatchHealth was founded by clinical lead-
ers who saw a need to decrease the number of lower acuity
IAGG 2017 World Congress
51
emergency room and 911 visits. DispatchHealth is a Denver,
CO based healthcare company that provides mobile, onsite
medical assessment and treatment for patients with acute
care needs. Our model provides a high tech, low cost care
delivery option that extends the capabilities of the patients
care team. The vehicles are staffed by board-certified
Emergency Medicine clinicians, equipped with advanced
treatment capabilities, and connectivity to the health infor-
mation exchange that allows for state-of-the art care in
the convenience of the home, office or senior care facility.
Our goal is to provide patients quality, convenient care in
their time of need with the goal of breaking the cycle of
acute care and returning that patient to their primary care
provider.
DispatchHealth was created with the Triple Aim in mind.
To date, we have saved over $2 million dollars in acute care
delivery costs. Our average cost for a visit is $250 and the
average cost for an emergency room visit is $2400. We track
the savings related to ER diversion for all of our patients.
Patients that have bounced back to the ER within 30days
for the same complaint are removed from our savings cal-
culation and therefore, negatively affect the overall savings
number.
IDENTIFYING COMPLEX HIGH NEEDS
PATIENT POPULATIONS FOR PERFORMANCE
MEASUREMENT STRATIFICATION
M.Henry, D.Roman, D.Bardach, J.Puhek, B.Rehm,
M.Barton, P.Lighter, NCQA, Washington, District of
Columbia
Performance measurement targeting the needs of vul-
nerable patient populations, including older adults and
adults with disabilities, requires a strategy for identifying
patients with complex needs. Using cost and utilization as
a proxy for complex needs, we evaluated a data set repre-
senting 2.4 million Medicare Advantage enrollees for the
years 20122013. Using established value sets of ICD codes
used in HEDIS to define 17 common chronic conditions,
we identified six conditions associated with the highest
rates of emergency department use, in-patient admissions
and readmissions, per patient cost, and physician visits. We
also evaluated the relationship between these variables and
number of chronic conditions. We found that psychotic dis-
orders, substance abuse, pulmonary conditions (excluding
asthma), heart failure, stroke, and major neuromuscular
disease were associated with the highest cost and utiliza-
tion. Patients with one or more of these conditions com-
prised 16% of the population. When compared to the rest
of the population, these patients accounted for 3.5 times the
ED visits, 7.2 times the in-patient admissions, and 3.9 times
the cost. Results were similar for 17% of patients with three
or more of the seventeen conditions considered. When com-
pared to the rest of the population, these patients had 3.7
times the number of ED visits, 8.3 times the number of in-
patient admissions, and 3.9 times the cost when compared
to patients without one of the conditions. We concluded
that the presence of high burden conditions or multiple
chronic conditions can be used to identify a population of
patients associated with high cost and utilization variables
for the purposes of measurement.
52
EFFECTIVENESS OF AN INTERVENTIONAL
PROGRAM TO REDUCE RE-ADMISSION RATES
ACUTE CARE OF THE ELDERLY
M.Schapira, M.B.Outumuro, F.Giber, C.Pino,
M.Mattiussi, G.Perman, M.Montero Odasso, L.Garfi,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Care for older adults in hospitals requires to combine
comprehensive and multidisciplinary approach to both, their
health and social status. Acute diseases and inadequate man-
agement and complications n the period of transition from
the hospital to the home, often causes the onset of disability
or its aggravation. Transitional care model provides the pos-
sibility of continuity of care, to improve communication of
the treating team with the patient and family and make more
efficient plan of care implementation.
Objectives: To assess whether comprehensive, multidis-
ciplinary intervention would reduce the re-hospitalization
within 30 days, emergency consultations and mortality
within 6months.
Material and Methods: randomized single blinded con-
trolled clinical trial. Two hundred forty participants were
randomly allocated in two arms: usual care and intervention.
Population: Older adults aged 75years or more, which were
discharged from one internal medicine ward.
The team is coordinated by a geriatrician who acts as case
manager. The general functions of the multidisciplinary team
are management protocols to reduce risk of falls, delirium
and immobility, adequacy of treatment and care, family sup-
port, early discharge planning and joint monitoring post hos-
pital discharge.
Results: The 30 days re-hospitalization rate was 35%
in the control group and 18.3% in the intervention group
(p=0.003). Emergency consultations within 6months were
60% in the control group and 43.3% in the intervention
group (p=0.009). Mortality rate decreased in the interven-
tion group although was not statistical significant.
Conclusions: The co-management of elderly vulnerable
patients in internal medicine with geriatricians, assisted by a
multidisciplinary team proved to reduce hospitalizations and
emergency visits during the 6months follow up.
ARTIFICIAL INTELLIGENCE AND PREDICTION OF
PROLONGED LENGTH OF HOSPITAL STAY AMONG
OLDER ADULTS
C.Launay1, H.Rivire3, G.Duval3, O.Beauchet2,
C.Annweiler3, 1. CHUV Lausanne, Lausanne, Switzerland,
2. Mc Gill University, Montral, Quebec, Canada, 3. CHU
Angers, Angers, France
Background. With the rapid growth of elderly patients
visiting the Emergency Department (ED), it is expected
that there will be even more hospitalisations following ED
visits in the future. The aim of this study was to examine
the age effect on the performance criteria of the 10-item
brief geriatric assessment (BGA) for the prolonged length
of hospital stay (LHS) using artificial neural networks
(ANNs) analysis.
Methods: Based on an observational prospective cohort
study, 1117 older patients (i.e., aged >65years) ED visitors
hospitalized in acute care wards in a University Hospital
(France) were recruited. The 10-items of BGA were recorded
during the ED visit and prior to discharge to acute care
Innovation in Aging, 2017, Vol. 1, No. S1
wards. The top third of LHS (i.e., >13days) defined the pro-
longed LHS. Analysis was successively performed on par-
ticipants categorized in 4 age groups: aged >70, >75, >80
and >85years. Performance criteria of 10-item BGA for the
prolonged LHS were sensitivity, specificity, positive predic-
tive value [PPV], negative predictive value [NPV], likelihood
ratios [LR], area under receiver operating characteristic curve
[AUROC]). The ANNs analysis method was conducted using
the modified multilayer perceptron (MLP).
Results. Values of criteria performance were high (sensitiv-
ity>89%, specificity>96%, PPV>87%, NPV>96%, LR+>22;
LR-<0.1 and AUROC>93), regardless of the age group.
Conclusions. Age effect on the performance criteria of
the 10-item BGA for the prediction of prolonged LHS using
MLP was minimal with a good balance between criteria, sug-
gesting that this tool may be used as a screening as well as a
predictive tool for prolonged LHS.
SESSION 220 (SYMPOSIUM)
PRESIDENTIAL SYMPOSIUM: LONG-TERM
OUTCOMES OF MILITARY SERVICE ON AGING:
INTERNATIONAL PERSPECTIVES
Co-Chair: C.M.Aldwin, Oregon State University, Corvallis,
Oregon
Discussant: R.A.Settersten, Oregon State University
Many studies of aging have been conducted on samples
that include WWII and Korea-era veterans; thus, military
service a hidden variable in aging research. The impact of
service on later life development and aging is poorly under-
stood, yet its effects are often broad and long-ranging, and
can alter lives in positive as well as negative ways. This sym-
posium considers the long-term effects of military service on
health and well-being of veterans who served in the armed
forces. Presenters are from several nations (Israel, Canada,
Vietnam, Korea, and United States), and use a lifespan/life
course perspective to examine the impact of service on later-
life outcomes in veterans from various conflicts. Solomon
and colleagues examine long-term effects of being a POW
among Israeli veterans. Pedlar examines changes in Canadian
veterans after service, and compares them to non-veterans.
Korinek examines older Vietnamese war survivors, and the
impact of wartime exposure on intergenerational relations.
Kang and colleagues provide a lifespan examination of the
long-term effects of combat exposure in Korean Vietnam
War Veterans, while Lee and colleagues examine possible
pathways for positive outcomes of combat exposure among
US veterans from WWII and Korea. Dr. Settersten will be our
discussant, focusing on common themes among studies, and
the implications of military service for changing lives across
countries.
PREMATURE AGING AMONG FORMER PRISONERS
OF WAR: RESULTS OF ATHREE DECADE
LONGITUDINAL STUDY
Z.Solomon1,2, S.Avidor1,2, A.Ohry3, 1. I-Core Research
Center for Mass Trauma, Tel Aviv, Israel, 2. Tel Aviv
University, School of Social Work, Tel Aviv, Israel, 3. Tel
Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
Research suggests that trauma experienced at an earlier
stage of life may be implicated in premature or accelerated
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Innovation in Aging, 2017, Vol. 1, No. S1
aging in later stages. Premature aging, in this respect, evinces
in various domains, particularly in health impediments and
mortality. The current study prospectively assessed the long
term impact of war and war captivity on mortality, medi-
cal assessments of morbidity and self-rated health among
Israeli combat veterans and former prisoners of war (POWs).
Participants were evaluated at four points in time over three
decades. Results revealed that war captivity was implicated
in premature aging in all domains. Ex-POWs exhibited mor-
tality rates four times higher than comparable veterans who
were not held captive. Ex POWs health outcomes were
worse than those of controls when assessed both by medical
professionals and via self-report measures. Differential post-
traumatic stress disorder (PTSD) trajectories mediated the
relationship between captivity and health. Theoretical and
clinical implications will be discussed.
WELL-BEING IN THE LIFE AFTER SERVICE OF
CANADIAN MILITARY VETERANS
D.Pedlar, Veterans Affairs Canada, Charlottetown, Prince
Edward Island, Canada
This presentation reports on the well-being of Canadian
military Veterans based on findings from three cycles (2010,
2013, 2016) of the large-scale population-based Life After
Service program of research. Apartnership between Veterans
Affairs Canada, the Department of National Defense, and
Statistics Canada, this national study uses cross sectional and
longitudinal survey and data linkage methodologies to report
on the well being of regular force and reserve Veterans across
key domains of well-being (e.g., adjustment to civilian life,
health, finances, employment, social integration). Compared
to other Canadians, Veterans have higher levels of chronic
mental and physical health conditions, much higher levels
of functional impairment in the community and workplace,
comparable levels of unemployment, higher levels of sui-
cide, and are about half as likely to experience low income.
Challenges facing Veterans in the transition to civilian life
and links between military service and well being in later life
will be discussed.
INTERGENERATIONAL RELATIONSHIPS IN
FAMILIES INFLUENCED BY WAR: ASTUDY OF
VIETNAMESE WAR SURVIVORS
K.Korinek1, B.P.Teerawichitchainan2, 1. Sociology,
University of Utah, Salt Lake City, Utah, 2. School of Social
Sciences, Singapore Management University, Singapore,
Singapore
Research conducted among U.S. veterans demonstrates
that war exposure and PTSD can strain the very family rela-
tionships that lend support for post-conflict readjustment,
but can also generate uniquely supportive service-based
friendships. We need to better understand how military ser-
vice and war exposure influence intergenerational relation-
ships in less developed, post-conflict settings where wars
violence has concentrated, and where family systems are cen-
tral to old-age support. We contribute to scholarship on mili-
tary service and older adult wellbeing by assessing structures
and quality of family relationships among Vietnamese older
adult war survivors, a population whose widely diverse war
exposures has received scant scholarly attention. Our analy-
ses of 405 older adults surveyed in the Vietnam Health and
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53
Aging Study (2010), provide evidence to suggest that particu-
larly stressful war exposures tend to visit lasting strain upon
intergenerational relationships, especially in less-developed
countries that have experienced war.
A LIFESPAN PERSPECTIVE ON COMBAT EXPOSURE
AMONG KOREAN VIETNAM WAR VETERANS
S.Kang2, H.Lee1,2, S.Choun1, C.M.Aldwin1, A.Spiro3,4,
1. Oregon State University, Corvallis, Oregon, 2. Korea
Military Academy, Seoul, Korea (the Republic of), 3. Boston
University Schools of Public Health and Medicine, Boston,
Massachusetts, 4. VA Boston Health Care System, Boston,
Massachusetts
Although 320,000 South Korean army troops fought in
the Vietnam War, few studies of Korean Vietnam War veter-
ans exist. We used a lifespan developmental perspective to
predict PTSD symptoms in later life among 450 male Korean
Vietnam War veterans (Mage = 66.98, SD = 3.04). They
completed mail surveys about prewar (prior stressors, child-
hood family environment), warzone (combat exposure, per-
ceived control, unit cohesion, appraisals of military service),
and postwar experiences (post-deployment stressors, social
support, and PTSD symptoms). PTSD symptoms in later
life were independently predicted by warzone (29.6%) and
postwar factors (11.0%); some were protective (desirable
appraisals and social support), but most were risk factors
(combat exposure, unit cohesion, undesirable appraisals, and
postdeployment stressors). While prewar variables accounted
for 3.7% of the variance, they moderated the relationship
between combat exposure and PTSD symptoms. The findings
highlight the importance of a lifespan perspective on under-
standing the long-term impacts of combat exposure.
DOES COMBAT EXPOSURE HAVE POSITIVE
LONG-TERM EFFECTS? FINDINGS FROM THE VA
NORMATIVE AGING STUDY
H.Lee1,2, S.Choun1, C.M.Aldwin1, A.Spiro3,4, 1. HDFS,
Oregon State University, Corvallis, Oregon, 2. Korea
Military Academy, Seoul, Korea (the Republic of), 3. Boston
University Schools of Public Health and Medicine, Boston,
Massachusetts, 4. VA Boston Health Care System, Boston,
Massachusetts
While research has documented long-term negative
effects of combat exposure, we focused on possible long-
term positive effects via positive appraisals of military ser-
vice. We also assessed the effects of optimism and education
using 1,006 male veterans from the VA Normative Aging
Study surveyed in 1990 and 1991 (Mage = 62, SD = 7,
range = 4489). We assessed their combat exposure, desir-
able appraisals of and unit cohesion during military ser-
vice, dispositional optimism, and psychological well-being.
Structural equation models showed that combat exposure
had direct effects on positive appraisals of military service
and unit cohesion, even controlling for optimism, but only
indirect effects on psychological well-being through the pos-
itive appraisals. While optimism also predicted well-being in
late life, it did not moderate the effect of combat experience
on positive appraisals but did mediate the effects of edu-
cation. Thus, combat exposure had only indirect effects on
psychological well-being in later life.
54
SESSION 225 (PAPER)
HEALTH CARE ISSUES AND POLICY
COMORBIDITY, DISABILITY, AND FRAILTY PROFILES
AS DETERZMINANTS OF HOSPITALIZATION
AMONG OLDER ADULTS
E.Belanger4, N.Sirven1, C.Gomes2, R.Guerra2, TREATMENT CHOICES
J.M.Guralnik3,5, 3. 1. Universit Paris Descartes, Paris,
France, 2. Universidade Federal do Rio Grande do Norte
Natal, Natal, Brazil, 3. University of Maryland School of
Medicine, Baltimore, Maryland, 4. Brown University School
of Public Health, Providence, Rhode Island
Population aging increases the need to better understand
the determinants of hospitalization in order to improve
the quality of services. However, usual health measures
often prove to be poorly predictive of hospitalization. The
aim of this research is to determine whether physiologi-
cal health measures designed for older adults, namely the
Short Physical Performance Battery (SPPB) (Guralnik etal.,
1994), frailty phenotypes (Fried et al., 2001), and profiles
of functional decline (Lunney et al., 2003), are better pre-
dictors of hospital use. We use longitudinal data from the
International Mobility in Aging Study (IMIAS), carried out
between 2012 and 2014 in four countries (Canada, Brazil,
Colombia, Albania) among individuals aged 6574 at base-
line (n=1724). Differences between health systems provide
additional insights into the determinants of hospitalization.
Health profiles from 2012, besides other confounders, are
used to explain hospitalization in 2014. SPPB scores are com-
puted using objective measures of gait speed, chair-stands,
and balance. Frailty phenotype variables are created accord-
ing to Frieds classification into robust, pre-frail, and frail.
Four profiles of functional decline are created: (1) terminal
illness cancer and at least one ADL disability; (2) organ
failure heart or lung disease and at least 2 ADL disabilities,
(3) low reserve stroke or more than 2 ADL disabilities, and
(4) other respondents. Sample attrition is corrected by means
of a Heckman selection Probit model. Our results indicate
that a score below 8 on SPPB, the pre-frailty phenotype, and
a profile of organ failure are significantly associated with
hospitalization. Cross-country differences are discussed.
OBSTACLES TO DISCHARGING ELDERLY HOSPITAL
PATIENTS IN THAILAND
S.Wivatvanit, Faculty of Nursing, Chulalongkorn
University, Thailand, Bangkok, Pathumwan, Thailand
In Thailand, the current increase of chronic illnesses from
non-communicable diseases poses limitations for both the
patient and caregiver for continuing care at home. This study
investigated the obstacles to discharging elderly patients in
general hospitals under the Ministry of Public Health in
Thailand. A multi-stage sampling technique was employed
to obtain a sample of 1,186 patients who were waiting to be
discharged from the hospital. Data were based upon inter-
views with patients and family caregivers. Of the patients
who were interviewed, a quarter of them had returned to
the hospital due to inadequate care at home and the large
majority (90%) were elderly patients. Descriptive analyses
indicated that there were some key obstacles to discharge.
Innovation in Aging, 2017, Vol. 1, No. S1
The most common obstacles included: 24.5 % of patients
reported that they did not have family members who could
provide the necessary care and 11.5 % lacked necessary
assistive devices at home.
ADVANCE CARE PLANNING CONVERSATIONS BY
MD OR NP/PA YIELD SIMILAR LIFE-SUSTAINING
E.Chen1, C.T.Pu2, J.Ragland2, J.Schwartz2, M.Fairbanks2,
J.E.Mutchler1, 1. University of Massachusetts, Boston,
Massachusetts, 2. Partners HealthCare, Boston,
Massachusetts
Recent changes in Medicare payment policy authorized
reimbursement to clinicians for conducting advance care
planning conversations with seriously ill individuals. This
study examined whether end-of-life care preferences differed
when advanced practice clinicians (nurse practitioners or
physician assistants) vs. physicians conducted advance care
planning conversations.
Medical Orders for Life-Sustaining Treatment (MOLST)
and electronic health records data were collected from 600
patients at 3 hospitals in Eastern Massachusetts. Aggressive
care was defined as a preference for All Treatment compared
to a preference to Limit Any Treatment on the MOLST.
Logistic regression analyses estimated the odds for aggressive
treatment taking into account patient age, sex, race/ethnicity,
severity of illness (Charlson Score), patient vs. proxy deci-
sion-maker, and palliative vs. non-palliative care clinician.
Nearly one-half (48%) of the patients were under the
care of advanced practice clinicians. Proxy decision-mak-
ers signed 43% of the MOLST forms. Overall, 1:3 (36%)
patients or proxy decision-makers chose All Treatment.
Mean Charlson Score was 8 (SD=3). Mean patient age was
71 (SD=15); 49% were male; and 83% were non-Hispanic
White. Patients were evenly divided between palliative and
non-palliative care settings.
A highly significant model accounting for 42% of the vari-
ation in the outcome (pseudo R2=0.421; p0.001) showed no
difference in the odds for preferring aggressive life-sustaining
treatments between patients under the care of advanced
practice clinicians vs. physicians (OR=0.83; p=0.46).
These results are consistent with other studies showing
no difference in clinical outcomes between patients under the
care of advanced practice clinicians compared to physicians
in intensive care settings.
PROXY DECISION-MAKERS CHOOSE LESS
AGGRESSIVE END-OF-LIFE INTERVENTIONS THAN
PATIENTS
E.Chen1, C.T.Pu2, J.Ragland2, J.Schwartz2, M.Fairbanks2,
J.E.Mutchler1, 1. University of Massachusetts, Boston,
Massachusetts, 2. Partners HealthCare, Boston,
Massachusetts
Proxy decision-makers are needed for an estimated one-
third of older Americans approaching death. Prior research
used hypothetical illness scenarios to examine concord-
ance between principals and their proxy decision-makers
treatment choices, and found high disagreement and a ten-
dency for proxy decision-makers to err toward aggressive
intervention.
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Innovation in Aging, 2017, Vol. 1, No. S1
This study used primary data collected from a severely
ill patient population (N=593) at three hospitals in
Massachusetts. Responses (from July 2012-January 2014)on
the Physician (or Medical) Orders for Life-Sustaining
Treatment (MOLST) were categorized into All Treatment
(aggressive) vs. Limit Treatment (non-aggressive). Logistic
regression analyses estimated the odds for aggressive treat-
ment taking into consideration patient age, sex, race/ethnic-
ity, severity of illness (Charlson Score), MD vs. Advanced
Practice Clinician (MD vs. NP/PA), and palliative vs. non-
palliative care clinicians.
Over one-third (36%) chose All Treatment. Proxy deci-
sion-makers signed 43% of the forms. Mean Charlson Score
was 8 (SD=3). Mean age was 71 (SD=15); 49% were male;
and 83% were non-Hispanic White. Palliative care clinicians
administered 50% of the MOLSTs and 48% were signed by
non-MDs.
A highly significant model (pseudo R2=0.421; p0.001)
revealed that proxy decision-makers were nearly 60% less
likely to choose All Treatment compared to patient decision-
makers (OR=0.43; p0.001).
This is the first known study to compare the aggressive-
ness of proxy vs. patient end-of-life care decisions using
actual clinical choices rather than hypothetical scenarios.
Hospital policy makers may wish to ensure that preferences
for life-sustaining treatments are documented for patients
who need proxy decision-makers to reduce the likelihood of
administering unwanted treatment.
SENIOR HIGH COST HEALTHCARE USERS: HOW DO
THEY DIFFER?
J.Lee1,3,2, S.Muratov3,8, J.Tarride8, M.Paterson6, diovascular events is well established, but there is increasing
T.Gomes7,6, W.Khuu6, A.Holbrook4,3,5, 1. Division of interest for its potential use for the prevention of ageing-
Geriatric Medicine, McMaster University, Hamilton,
Ontario, Canada, 2. Geriatric Education and Research
in Aging Sciences (GERAS) Centre, Hamilton, Ontario,
Canada, 3. Department of Clinical Epidemiology &
Biostatistics, McMaster University, Hamilton, Ontario,
Canada, 4. Division of Clinical Pharmacology, McMaster
University, Hamilton, Ontario, Canada, 5. Centre for
Evaluation of Medicines, Hamilton, Ontario, Canada, 6.
Institute for Clinical Evaluative Sciences (ICES), Toronto,
Ontario, Canada, 7. Li Ka Shing Knowledge Institute, St.
Michaels Hospital, Toronto, Ontario, Canada, 8. Program
for Assessment of Technologies and Health (PATH)
Research Institute, St. Josephs Healthcare Hamilton,
Hamilton, Ontario, Canada
High cost users (HCUs) are a small proportion of the
population that use disproportionate healthcare resources. In
2011, 5% of the population in Ontario, Canada accounted
for 65% ($19.8 billion) of provincial health expenditures.
Understanding HCU multi-morbidity and drug use is required
to target interventions to improve clinical outcomes and con-
tain healthcare costs. This study aimed to compare senior
HCUs to non-HCUs based on demographics, co-morbidities,
medication use, health service utilization, clinical outcomes
and costs. We conducted a retrospective population-based
matched cohort analysis of incident senior HCUs defined
as Ontarians age 66years in the top 5% of total health-
care costs in FY2013. Healthcare and prescription drug
utilization data were obtained from health administrative
IAGG 2017 World Congress
55
databases. The primary outcomes were annual total health-
care expenditures per patient, total drug costs per patient
and drug-to-total healthcare expenditure ratio. Secondary
outcomes were one-year mortality and hospitalization rate.
Senior HCUs (n=176,604) accounted for $4.9 billion in
total healthcare expenditures and $433 million in medica-
tion costs in FY2013. Compared to non-HCUs (n=529,812)
on a per patient basis, HCUs incurred higher total health-
care costs ($27,697 vs. $2233) and higher medication costs
($2453 vs. $842). HCUs were characterized by greater poly-
pharmacy (>5 medications, 87.7% vs. 47.6%) and multi-
morbidity (median John Hopkins Expanded Diagnosis
Clusters [EDCs], 14 vs. 10). HCUs had higher annual mor-
tality (10.39% vs. 0.72%) and hospitalization rates (3.20 vs.
0.06 hospitalizations per 1000 person-years). Compared to
non-HCUs, senior HCUs are frail, multi-morbid and vulner-
able. The contribution of prescribing and medication utiliza-
tion quality deserves further study.
SESSION 230 (SYMPOSIUM)
DOES ASPIRIN HAVE AROLE IN FALLS, FRACTURES,
AND FRAILTY?
Chair: G.Peeters, Monash University, Melbourne, Victoria,
Australia
Co-Chair: A.Barker, Monash University, Melbourne,
Victoria, Australia
Discussant: A.Newman, University of Pittsburgh,
Pittsburgh, Pennsylvania
Aspirin is among the most frequently prescribed and used
drugs globally. Its use for the secondary prevention of car-
related conditions. This symposium will provide an overview
of the existing evidence regarding the effects of aspirin on
inflammatory and bone remodeling pathways, the adverse
effects of aspirin, and the findings of prior studies that have
investigated aspirin use and fracture and frailty outcomes.
The first presentation will discuss how aspirin may influence
fracture risk via its effects on low-grade inflammation. The
presented work is based on a comprehensive review of the
literature including evidence from biomedical, clinical and
epidemiological studies. The second presentation includes
new data and builds on the first presentation by demonstrat-
ing the potential cost savings and improved quality of life if
aspirin would be prescribed for the prevention of fractures.
During the third presentation, original work will be pre-
sented demonstrating the positive and negative associations
of antiplatelet agents (i.e. aspirin and/or clopidogrel) with
risk of falls and cardiovascular events in older women with
ischemic heart disease. In the fourth presentation, a theoreti-
cal overview will be given of how aspirin may affect frailty
based on existing evidence. Finally, the findings will be sum-
marized by the discussant, who will discuss the presented
findings in terms of clinical implications and impact.
ASPIRIN FOR THE PREVENTION OF FRACTURES IN
OLDER ADULTSA REVIEW OF THE LITERATURE
A.Barker, G.Peeters, J.Talevski, A.Investigator Team,
School of Public Health and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia
56
Despite several osteoporosis therapies being available,
fractures remain a persistent source of pain, disability and
healthcare utilization worldwide. In 2012, 140,822 low-
trauma fractures occurred in Australia at a cost of $2.75
billion. By 2022 the number of fractures is projected to
increase 30%. The World Health Organization has identified
fracture prevention as a public health priority. Aspirina
widely available, simple and inexpensive drugmay pro-
vide a novel adjunct to current fracture prevention thera-
pies. Aspirin is regularly taken by 19% of adultsmostly for
preventing cardiovascular events. Cardiovascular benefits
largely arise from anti-platelet effects. Anti-inflammatory
effects may confer other benefits. Epidemiological studies
suggest low-grade inflammation is associated with increased
bone loss and fracture risk. Aspirin may effect fracture risk
via anti-inflammatory pathways. This review summarizes
existing evidence regarding inflammation and bone, anti-
inflammatory and adverse effects of aspirin, findings of prior
studies of aspirin and fracture outcomes and future research
directions.
REDUCED FRACTURE RISK IN OLDER ADULTS
TAKING LOW DOSE ASPIRIN: MODELING COSTS
AND QUALITY OF LIFE
K.Sanders1,2, J.Watts3, J.Abimanyi-Ochom3, A.Barker4,
1. Australian Catholic University, Melbourne, Victoria,
Australia, 2. The University of Melbourne, Melbourne,
Victoria, Australia, 3. Deakin University, Melbourne,
Victoria, Australia, 4. Monash University, Melbourne,
Victoria, Australia
Aspirin is generally associated with prevention of cardio-
vascular events. However, observational studies report asso-
ciations between low grade inflammation, bone remodelling
and fracture risk1.
Modelled Australian data showed cost savings and
improved quality of life associated with a 12% reduction in
fracture risk in adults aged 70+ years taking 100mg aspi-
rin daily. The model assumed uniform fracture risk reduc-
tion across gender and fracture sites, and included quality
adjusted life years (QALYs) and costs specific to fracture site
for age and gender.
The model predicts nine fractures per annum are averted
per 1,000 older adults on daily low-dose aspirin. Fractures
averted in women and men, respectively: hip 1.65, 0.92; ver-
tebral 5.77, 2.12; wrist 4.10, 0.70; other sites 8.26, 5.59.
The predicted savings are AUD$148,993 and 1.59 QALYs.
Daily low-dose aspirin costs AUD$10,000 - $30,000/1,000
person-years.
If RCT findings confirm reduced fracture risk, daily aspi-
rin may substantially reduce fracture burden in older adults.
1
Barker etal, 2015; 2Watts etal, 2013.
ANTI-PLATELET AGENT USE; FALL RISK VERSUS
CARDIOVASCULAR RISK IN OLDER WOMEN
G.Peeters5,2,1, S.E.Tett2, S.Hollingworth2, D.Gnjidic3,
S.N.Hilmer4, A.J.Dobson2, R.Hubbard2, 1. School of
Public Health and Preventive Medicine, Monash University,
Melbourne, Victoria, Australia, 2. The University of
Queensland, Brisbane, Queensland, Australia, 3. University
of Sydney, Sydney, New South Wales, Australia, 4. Royal
North Shore Hospital, Sydney, New South Wales, Australia,
Innovation in Aging, 2017, Vol. 1, No. S1
5. Global Brain Health Institute, University of California
San Francisco | Trinity College Dublin, Dublin, Ireland
Patients with acute coronary syndrome are prescribed
anti-platelet agents to prevent new cardiovascular events.
Associations between anti-platelet agents and fall-related
hospitalizations and cardiovascular events were examined
in older women with ischemic heart disease (IHD). 2002
2011 surveys from the Australian Longitudinal Study on
Womens Health linked with administrative hospital, phar-
maceutical and death registry data were used. 885 women
(82.72.7years) had prior admission for IHD. There were
636 anti-platelet agent users (36.0% aspirins, 27.8% clopi-
dogrel and 36.2% combination), 192 fall-related hospitali-
zations and 314 cardiovascular events including 82 deaths.
Compared with non-users, users had higher risks of car-
diovascular events (hazard ratio [HR]=1.32, 95% confi-
dence interval [CI]=1.041.68) and cardiovascular deaths
(HR=1.64, CI=1.002.68), but not falls (HR=1.17, CI=0.83
1.64). In the context of other recommended medications,
anti-platelet agent use was not associated with fall risk,
but was associated with an increased risk of cardiovascular
events in older women with IHD.
EVIDENCE FOR THE POTENTIAL ROLE OF ASPIRIN
IN THE PREVENTION OF FRAILTY
S.Ward1, A.Newman2, A.M.Murray3,4, R.Woods1,
J.McNeil1, 1. Monash University, Melbourne, Victoria,
Australia, 2. University of Pittsburgh, Pittsburgh,
Pennsylvania, 3. Hennepin County Medical Center,
Minneapolis, Minnesota, 4. University of Minnesota,
Minneapolis, Minnesota
The interaction between aspirin and frailty is of inter-
est, in particular because of growing use of aspirin by older
populations. Aspirin may dampen systemic inflammation
associated with frailty development, as well as reduce the
incidence, and thus cumulative burden, of age-related dis-
eases. Conversely frailty may increase the risk of aspirin-
associated adverse events. The ASPREE primary prevention
trial measures self-reported physical activity, and weight
annually, and grip strength and 3 meter gait speed at base-
line and even years post randomization to low dose aspirin
or placebo. At baseline, average gait speed and grip strength
were respectively 1.00.3m/s and 28.510.2kg in 6574
age group (n=11163), 0.90.3m/s and 24.99.3kg in 7584
age group (n=7219) and 0.80.3m/s and 21.08.4kg in
the 85+ age group (n=732). These combined measures will
facilitate an analysis of a differential effect of aspirin in frail
participants, as well as measurement of the effects of aspirin
on frailty outcomes.
SESSION 235 (SYMPOSIUM)
QUANTIFICATION AND ANALYSIS OF BIOLOGICAL
AGING: GENETIC, GENOMIC, AND BIOMARKER
GEROSCIENCE TOOLS
Chair: D.W.Belsky, Duke University School of Medicine,
Durham, North Carolina
Discussant: T.T.Perls, Boston University Medical Campus,
Boston, Massachusetts
Quantification of biological aging is a major frontier for
translational geroscience. Aging is recognized as a leading
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
cause of disease and disability. It is hypothesized that inter-
vention to slow the biological process of aging can simul-
taneously prevent/delay many different chronic diseases,
extending healthspan. To develop such interventions meth-
ods are needed to quantify the biological process of aging in
humans. The symposium participants use several promising
approaches to quantify biological aging, including genetic,
genomic, and physiologic-index-based methods. Key applica-
tions of these tools are in identifying novel therapeutic targets
to slow aging and extend healthspan, and in measuring effec-
tiveness of such therapies. With the aim of advancing those
applications, our symposium focuses on (1) genetic research
to identify molecular mechanisms of biological aging; and
(2) linkages between biological aging measurements and
age-related disease, with an eye toward intervention evalu-
ation. The overarching goal of this years symposium is to
provide an update on several ongoing programs of biological
aging research and to position research on biological aging
within the broader field of geroscience. We view biological
aging research as a bridge connecting clinical and basic-biol-
ogy investigations of aging mechanisms with demographic/
epidemiologic studies of aging populations. In sum, our sym-
posium will integrate bioinformatic, clinical, and population
research on biological aging and report on recent advances in
the geroscience research agenda.
MOLECULAR SIGNATURES OF BIOLOGICAL AGING
P.Sebastiani, T.T.Perls, Boston University, Boston,
Massachusetts
Many blood biomarkers correlate with physical function,
anabolic response and healthy aging but their joint signa-
ture on aging phenotypes is unknown. We measured nine-
teen blood biomarkers that include some tests from total
blood counts, lipid biomarkers, markers of inflammation
and frailty in 4,704 participants of the Long Life Family
Study (LLFS) and analyzed them using an agglomerative
algorithm to group LLFS participants into clusters character-
ized by different biomarker signatures. The analysis identi-
fied 26 biomarker signatures that correlated with different
aging phenotypes and predict morbidity and mortality. The
predictive value of some of these signatures was replicated
in the Framingham Heart Study. The analysis shows that
various molecular signatures of circulating biomarkers exist
and their significant association with morbidity and mor-
tality suggest that these patterns represent different forms
of biological aging. We will describe ongoing analyses that
extend this work to include genetics and genomic data to
better characterize the biological mechanisms underlying
different signatures. A better understanding of the genetics
underlying different signatures may identify targets for drug
development.
AN OBJECTIVE MEASURE OF INDIVIDUAL HEALTH
AND AGING FOR POPULATION SURVEYS
A.Cohen, University of Sherbrooke, Sherbrooke, Quebec,
Canada
To perform effective surveillance of aging populations
and forecast trends in morbidity and mortality, simple,
objective measures of individual health states are needed.
We used biological principles to develop and validate a
robust, flexible biomarker-based health index for use in
IAGG 2017 World Congress
57
population surveillance and economic analysis. Using 28
commonly available biomarkers in two datasets (WHAS and
NHANES), we consider individuals as points in biomarker
space and measure health as Mahalanobis distance to an
ideal state of health, defined alternatively with population
parameters or clinical thresholds. Surprisingly, population
parameters outperform clinical thresholds, implying that
clinical thresholds are imprecise and population means may
provide a robust metric of healthy aging. Using the index,
we show that low economic status is associated with acceler-
ated biological aging in young (aged 2040) and middle-aged
(4164), but not older adults (aged 65+) in our US datasets.
We discuss implications for biological aging quantification in
population surveillance.
EPIGENETIC AGE OF THE PRE-FRONTAL CORTEX
AND ALZHEIMERS DISEASE PATHOLOGY
M.Levine, University of California, Los Angeles, Los
Angeles, California
Molecular biomarkers of brain aging are needed to
advance understanding of age-related neurodegeneration.
We developed a highly accurate epigenetic biomarker of
tissue age, the epigenetic clock based on DNA methyla-
tion levels. Here, we examine association between epigenetic
age and Alzheimers disease (AD), cognitive decline, and
AD-related neuropathology in 700 dorsolateral prefrontal
cortex (DLPFC) samples from the Religious Order Study and
Rush Memory and Aging Project. Results shows increased
epigenetic age acceleration is associated with post-mortem
AD diagnosis (P=0.009), increased neuropathology--neuritic
plaques (P=0.0002), diffuse plaques (P=.046), Neurofibrillary
tangles (P=0.009), and amyloid load (P=0.002)--and steeper
declines in global cognitive functioning in the years leading
up to their death (P=0.004). Results also suggest neuropatho-
logical markers mediate associations between epigenetic age
and cognitive decline. Finally, genetic complex trait analy-
sis (GCTA) revealed that epigenetic age acceleration, diffuse
plaques (r=0.24), and working memory (r=-0.35) may share
a common genetic profile.
GENETICS OF LATE ONSET ALZHEIMERS DISEASE:
CONNECTION WITH AGING, HEALTH, AND
LONGEVITY TRAITS
A.I.Yashin, Duke University, Durham, North Carolina
Despite numerous studies confirming importance of
genes in the origin of late onset Alzheimers disease (AD),
the details of genetic mechanisms remain elusive. Studying
pleiotropic effects of genetic variants associated with AD
on other health, and longevity related traits might clarify
some fundamental aspects of this pathology and identify
key connections with aging related changes. For this pur-
pose we performed genome wide association studies of AD
and other traits using case-control (LOADFS) data and lon-
gitudinal data (FHS and CHS). In the analyses of these data
allowed us to detect pleiotropic associations of AD with
other aging, health, and longevity related traits. The use of
information on functional roles of detected genes (APOE,
TOMM40, APOC1, PVRL2 among others) as well as on
corresponding signaling and metabolic pathways provides
us with important insights about possible causes of this
health disorder.
58
SESSION 240 (SYMPOSIUM)
TRAUMA-INFORMED INTERVENTIONS FOR OLDER
ADULTS WITH PTSD AND TRAUMA-RELATED
PROBLEMS
Chair: A.Pless Kaiser, VA Boston Healthcare System,
Boston, Massachusetts
Co-Chair: E.H.Davison, VA Boston Healthcare System,
Boston, Massachusetts
Discussant: S.Thorp, University of California, San Diego
and, San Diego, California
Older adults make up an increasing percentage of the
world population, and a majority have been exposed to trau-
matic events during their lifetime. Posttraumatic stress disor-
der (PTSD) and other trauma-related problems influence the
lives of many older adults, and there is limited research on
interventions designed to decrease symptoms and improve
functioning and quality of life among older adults who
are impacted by trauma. The aim of this symposium is to
present findings from several trauma-informed interven-
tions for PTSD and trauma-related problems among older
adults developed in various countries, as well as to discuss
special considerations for interventions designed to treat
older adults with symptoms related to earlier life trauma
exposure. The first paper describes results from an RCT
comparing the efficacy of Narrative Exposure Therapy with
Present Centered Therapy for older adults with PTSD. The
next paper presents findings from a study investigating an
internet-based cognitive-behavioral writing intervention for
older adults with PTSD related to WWII experiences. Third,
we include a paper examining an intervention designed to
promote successful processing and meaning-making among
Veterans with later-adulthood trauma reengagement. Finally,
we present epidemiological data on exposure to traumatic
events, PTSD, and trauma-related disorders across several
countries, present common reactions to trauma among older
adults from a lifespan developmental perspective, and dis-
cuss implications for interventions designed for older adults.
Together, these papers make important contributions to the
research and provide strong support for interventions with
older adults with trauma-related disorders, as well as provide
recommendations for treatment with this special population.
NARRATIVE EXPOSURE THERAPY VS. PRESENT-
CENTERED THERAPY WITH OLDER ADULTS:
RESULTS FROM AN RCT
J.Lely1, J.van den Bout2, J.J.ter Heide1,3, N.van der functioned relatively successfully into adulthood, but begin
Aa1,3, J.W.Knipscheer1,3,2, R.J.Kleber3,2, 1. Foundation
Centrum 45, Arq Research Program, Diemen, Netherlands,
2. University Utrecht, Utrecht, Netherlands, 3. Arq
Psychotrauma Expert Group, Diemen, Netherlands
Older adults present a growing population in our soci-
ety and in our mental health system. Among older adults,
PTSD is a serious, but frequently hidden psychiatric disor-
der with various potential trajectories. Elderly patients may
have been exposed to multiple traumatic events. Narrative
Exposure Therapy (NET) was developed to address cumu-
lative traumatic memories and aims at connecting them to
context and meaning within an autobiographic narrative.
Present Centered Therapy (PCT) targets current stressors
with a solution-focused approach. In an RCT we investigated
Innovation in Aging, 2017, Vol. 1, No. S1
the benefits of NET, compared to PCT, for older adults
(>55 years, living independently) presenting with PTSD.
Preliminary results showed that treatments and assessments
were well-tolerated. Challenges were found in recruitment,
treatment retention, and treatment interference by comorbid
health problems. NET appears to be a safe and feasible out-
patient treatment for older adults suffering from PTSD. PCT
showed notable treatment effects as well, but NET demon-
strated more sustained results.
RESULTS OF AN INTERNET-BASED COGNITIVE-
BEHAVIORAL THERAPY FOR PTSD IN OLDER
ADULTS
P.Kuwert3, M.Boettche1, C.Knaevelsrud2, 1. BZFO,
Berlin, Germany, 2. Freie Universitt, Berlin, Germany, 3.
University Medicine Greifswald, Greifswald, Germany
In an internet-based manualized cognitive-behavioral
writing therapy, older adults (M = 70.9 years, SD = 4.56)
with World War II-related PTSD were examined at four
assessment points (pre, post, three- and six-months follow-
up). Results revealed a significant decrease in PTSD sever-
ity scores (Cohens d=0.43) and significant improvements
on secondary clinical outcomes of quality of life (Cohens
d=0.48), self-efficacy (Cohens d=0.38), and posttraumatic
growth (Cohens d = 0.33) from pre- to posttreatment. All
improvements were maintained at follow-ups. Participants
reported high working alliance (M=6.09, SD=.87, range
17). The findings provide promising insights into evidence-
based age-specific treatment for PTSD. With regard to
demographic change and taking into account the fact that
early-lifetime war-associated traumatization has a disabling
impact, it is a matter of urgency that clinical routine should
effectively reach and address the needs of older adults.
LATER-ADULTHOOD TRAUMA REENGAGEMENT:
FINDINGS FROM DISCUSSION GROUPS WITH
OLDER COMBAT VETERANS
E.H.Davison1,2, A.Pless Kaiser1,2, J.Wachen1,2, L.King1,2,
D.King1,2, J.Moye1,3, 1. National Center for PTSD,
VA Boston Healthcare System, Boston, Massachusetts,
2. Boston University School of Medicine, Boston,
Massachusetts, 3. Harvard Medical School, Boston,
Massachusetts
Later-adulthood trauma reengagement (LATR) is a
phenomenon occurring among older Veterans who were
exposed to stressful war-zone events in early adult years,
to reminisce about combat-related experiences as they con-
front challenges of aging (e.g., retirement). LATR is con-
ceptualized as a meaning-making process which may lead
to growth or increased distress. The purpose of this study
was to examine whether Veterans experiencing LATR ben-
efited from a 10-week psychoeducational group presented
from a lifespan developmental perspective. Thirteen older
(Mage = 68) male combat Veterans completed discussion
groups. Assessments of LATR, posttraumatic stress, positive
appraisals of military experience, life satisfaction, resilience,
and meaning-making were collected at baseline, post-group,
and follow-up. Descriptive statistics revealed variability
in individual responses on measures of distress, but that
positive perceptions (e.g., positive appraisals) tended to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
increase. Additionally, the intervention was well-received:
retention was high and qualitative responses indicated high
satisfaction.
TRAJECTORIES OF TRAUMA-RELATED DISORDERS
ACROSS THE LIFE-SPAN: EVIDENCE AND CLINICAL
IMPLICATIONS
M.Kaiser, H.Glaesmer, Medical Psychology and Medical
Sociology, Leipzig University, Leipzig, Germany
Trauma-related disorders in younger people have gained
extensive attention in research and clinical work. However,
little knowledge exists about long-term consequences of
traumatic experiences (TE) across the lifespan. TEs are
associated with negative outcomes for mental and physical
health. Processing of TEs may take different developmental
paths. Symptoms may dissipate over time, become chronic,
or be reactivated in association with physical aging and age-
specific stressors (e.g. retirement). Collective, or generation-
specific TEs may be related to unique reactions in old age.
There are no longitudinal epidemiological studies on post-
traumatic stress symptomatology in the German popula-
tion. Therefore, no conclusion can be drawn about incidence
or course of PTSD in the older adult German population.
Nevertheless, research shows higher prevalence in trauma-
related disorders in this group compared to younger adults,
thus underlining the long-term impact of TEs in late life.
Implications for therapeutic interventions for elderly patients
with trauma-related disorders will be discussed.
SESSION 245 (SYMPOSIUM)
CROSS-NATIONAL EXPLORATION OF OLDER
ADULTS ALCOHOL USE
Chair: A.A.Moore, University of California, San Diego, San
Diego, California
Co-Chair: A.Towers, Massey University, Palmerston North,
New Zealand
Data on alcohol and older populations will be presented
from multiple international studies. The presentations will
address the epidemiology of alcohol consumption. Specifically
data will be shared on cross national drinking patterns, life-
course trajectories and risks of chronic disease,exiting the
labor market and its impact on risk for problem drinking,
binge drinking and angina in low and middle income coun-
tries, and demographic, socioeconomic and health factors
associated with alcohol consumption.
CROSS-NATIONAL PATTERNS OF OLDER ADULTS
DRINKING: RESULTS FROM AN INTERNATIONAL
INVESTIGATION
A.Towers1, N.Minicuci2, I.Rocco2, J.Sheridan3, P.Kowal4, forced out had an increased but non-significant risk of binge
D.Newcombe3, 1. School of Public Health, Massey
University, Palmerston North, New Zealand, 2. Consiglio
Nazionale delle Ricerche, Padova, Italy, 3. University of
Auckland, Auckland, New Zealand, 4. World Health
Organization, Geneva, Switzerland
Older adults are at significant risk of harm from alco-
hol use but there is no consensus as to the general patterns
and prevalence of drinking in this population, nor how such
trends might differ between countries. A collaboration of
international researchers harmonised alcohol use data from
IAGG 2017 World Congress
59
government-funded studies of ageing to investigate drink-
ing patterns in older adults from nine countries around the
world: United States, England, China, Ghana, India, Mexico,
the Russian Federation, South Africa, and New Zealand. The
results show substantial differences across countries in rates
of abstinence, frequency of alcohol use, quantity consumed
on a typical day, and rates of infrequent and frequent heavy
drinking. Substantial gender differences in drinking patterns
were evident both between and within countries. These find-
ings suggest that drinking is common in older adult popula-
tions in most countries, that typical daily drinking amounts
differ substantially between countries but that frequent
heavy drinking is rare.
ALCOHOL CONSUMPTION OVER THE ADULT LIFE
SPAN AND RISK OF CHRONIC DISEASE IN OLDER
AGE
A.Britton1, S.Bell1,2, 1. University College London,
London, United Kingdom, 2. Cambridge University,
Cambridge, United Kingdom
Alcohol consumption changes over the life span. Analysis
of longitudinal data, with repeat alcohol measures, is neces-
sary to reveal changes within the same individuals as they
age. Such data are scarce and few studies are able to capture
multiple decades of the life course. Therefore we examined
alcohol consumption trajectories (volume and frequency)
using data from multiple cohorts that cover different and
overlapping periods of the life course (combined sample
size of over 60,000 men and women). We then explored the
importance of taking a life course perspective by analyzing
how different trajectories are associated with differing risk of
developing several chronic diseases, such as coronary heart
disease, stroke and cancer.
THE IMPACT OF FORCED EXIT FROM WORK ON
PROBLEMATIC DRINKING IN OLDER EUROPEANS
M.Hyde1, A.Towers2, 1. Centre for Innovative Ageing,
Swansea University, Wales, United Kingdom, 2. Massey
University, Palmerston, New Zealand
Job loss is known to increase alcohol use in the general
population. Yet few studies have examined how forced exit
from work impacts on the drinking patterns of older adults.
This is important as older adults can be at greater risk from
alcohol-related harm. Using waves 4 and 5 of the Survey of
Health, Ageing and Retirement in Europe we assessed the
impact of forced exit on drinking patterns in people aged 50+
from 16 countries (N=15,774). Reason for exiting work did
not differentially influence average drinking frequency and
quantity. However unforced exit decreased the risk of binge
drinking (OR 0.73: 95%CI 0.56-.95) whilst those who were
frequency compared to those still employed (OR 1.28: 95%CI
0.971.70). The results suggest that how one leaves the labour
market impacts on the risk of problem drinking in later life.
BINGE DRINKING AND INCIDENT ANGINA
PECTORIS AMONG OLDER ADULTS IN LOW-AND
MIDDLE-INCOME COUNTRIES
P.Martinez1, T.Clausen2, 1. Alcohol Research Group,
Emeryville, California, 2. Norwegian Center for Addiction
Research, University of Oslo, Oslo, Norway
60
The association between binge drinking and angina pec-
toris (AP) among older adults remains controversial, and
much of the evidence comes from developed countries. This
study estimated the effect of binge drinking on incident
AP among adults aged 50+ in four low and middle income
(LAMI) countries. We used longitudinal data from WHOs
Study of Global AGEing and Adult Health on 7,462 individ-
uals from Ghana, India, Mexico, and Russia. We compared
binge drinkers (5+ drinks/day for men, 4+ for women) to
lifetime abstainers, former drinkers, and light drinkers. We
fitted multivariate logistic regression models to estimate risk
of incident AP at 5-year follow-up. Binge drinkers were more
likely than lifetime abstainers (OR=2.07, p=0.04) and for-
mer drinkers (OR=2.50, p=0.02) to have incident AP, but not
compared to light drinkers. Future research and prevention
efforts should focus on the risk binge drinking poses for AP
among older adults living in LAMI countries.
ALCOHOL CONSUMPTION IN OLDER ADULTS:
RESULTS FROM SAGE, ELSA, HRS AND SHARE
N.Minicuci1, N.Naidoo2, S.Chatterji2, P.Kowal3,4, 1.
National Research Council, Neuroscience Institute, Padova,
Italy, 2. World Health Organization, SAGE, IER/HSI,
Geneva, Switzerland, 3. World Health Organization, SAGE,
Geneva, Switzerland, 4. Research Centre for Generational
Health and Ageing, University of Newcastle, Newcastle,
New South Wales, Australia
Two waves (2004 and 2010)of four longitudinal studies
were included in an ex-post harmonization process of nine
domains: socio-demographic and economic, health states,
self-reported health and mental state, health examinations,
physical and mental performance tests, risk factors, chronic
conditions, social network, and subjective well-being.
Drinking habits varied substantially across studies in older
adults. Almost 90% of respondents in ELSA consumed alco-
hol, compared to 69% in SHARE, 55% in HRS and 34% in
SAGE. Heavy drinkers were found to be highest in respond-
ents from HRS and lowest in ELSA. Adjusting for gender
and age, multivariable analyses examined the association
between drinking profiles, abstainers versus not abstainers,
and frequent heavy drinkers versus infrequent heavy drink-
ers, and other selected factors. Detailed results will be shown.
Modifiable factors to address problem drinking in older
adults need to be addressed by health systems.
SESSION 250 (SYMPOSIUM)
TAKING LEISURE SERIOUSLY: LEISURE-BASED
INTERVENTIONS TO SUPPORT COGNITIVE HEALTH
Chair: S.Belleville, Institut Universitaire de Geriatrie de
Montreal, Montreal, Quebec, Canada
Discussant: N.Anderson, Rotman Research Institute,
Baycrest, Toronto, Ontario, Canada
Older adults are looking for ways to increase their cogni-
tion and prevent age-related cognitive decline. In this sym-
posium, we will assess whether participation in cognitively
stimulating leisure activities improves cognition in older
adults. Alarge number of epidemiological studies have indeed
shown that being engaged in such activities is associated with
better cognitive health in older adults. Thus, interventions
involving leisure activities might help to prevent cognitive
Innovation in Aging, 2017, Vol. 1, No. S1
decline while at the same time being ecologically valid and
easy to implement in the community. The symposium will
present studies that have developed and tested leisure-based
interventions meant to stimulate cognition in older adults. It
will cover programs that rely on a variety of leisure activi-
ties, ranging from crafts, music and artistic production to
technological learning and volunteering. Furthermore, the
symposium will touch on major issues related to the use of
leisure activities as a way to increase cognition. In addition
to measuring the potential for these interventions to improve
cognition, the symposium will address effects on well-being,
the role of family members, the potential for web-based
applications, the most effective intervention modalities and
their effects on brain function.
EARLY-LIFE AND LATE-LIFE COGNITIVE LIFESTYLE
AS AWAY TO PROMOTE COGNITIVE RESERVE IN
OLDER ADULTS
S.Belleville, A.Cordire, G.Ducharme-Lalibert, B.Boller,
Research Center, Institut Universitaire de Geriatrie de
Montreal, Montreal, Quebec, Canada
The reserve hypothesis suggests that some individuals
develop a form of resilience against the detrimental effects
of brain damage. Inter-individual differences in reserve have
been related to a range of differences in cognitive lifestyle.
This presentation will examine the evidence suggesting that
differences in early-life education and late-life engagement in
mentally stimulating leisure activities determine differences
in baseline cognition and age-related cognitive decline. It
will also assess the effects of early-life education and men-
tally stimulating leisure activities in late life on critical brain
parameters, including brain volume, cortical thickness, and
task-related activation. Based on these findings, this talk
will discuss the potential for leisure-based interventions and
present evidence of the impact of those interventions on
cognitive and brain function in healthy older adults. It will
conclude by presenting ENGAGE, a currently held project
developed to increase reserve with enriched leisure activities.
LESS IS MORE: COMPLEX VOLUNTEER JOBS AND
MORE VOLUNTEERING ATTENUATE THE BENEFITS
OF VOLUNTEERING
N.Anderson1, M.Binns1, E.Krger2, T.Damianakis3,
L.M.Wagner4, D.R.Dawson1, S.Bernstein1, 1. Baycrest
Health Science, Toronto, Ontario, Canada, 2. Laval
University, Qubec, Quebec, Canada, 3. University of
Windsor, Windsor, Ontario, Canada, 4. University of
California, San Francisco, California
Research has identified higher cognitive functioning
among seniors who held more cognitively or socially com-
plex occupations. We tested the influence of occupational
complexity and number of hours of volunteer work on cog-
nitive, physical, and psychosocial benefits. Agroup of previ-
ously non-working and non-volunteering adults aged 5686
were assessed prior to (n=169), mid-way (n=97), and after
a year (n = 75) volunteering. Cognitive, physical, and psy-
chosocial measures were related to demographic variables,
time, and job characteristics with random-effects models.
Younger and female participants had higher levels of cogni-
tion (verbal and visual episodic memory, working memory).
Interestingly, cognitive improvement evident in the first six
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Innovation in Aging, 2017, Vol. 1, No. S1
months was attenuated among volunteers working more
hours or in more socially or physically complex roles. No
changes were found in physical or psychosocial functioning.
Cognitive improvement was found among new post-retire-
ment volunteers greater if not volunteering too much or in
overly challenging roles.
ENGAGEMENT IN MENTALLY CHALLENGING
ACTIVITIES ENHANCES NEURAL EFFICIENCY
I.McDonough1,2, S.Haber2, G.N.Bischof3, D.C.Park2,
1. The University of Alabama, Tuscaloosa, Alabama, 2.
University of Texas at Dallas, Dallas, Texas, 3. University
Hospital Cologne International, Cologne, Germany
We tested how an intervention aimed to increase challeng-
ing leisure activities affected cognition and brain function.
Thirty-nine participants engaged in 15 hours of activities per
week over 14 weeks in either high-challenge activities (digital
photography and quilting) or low-challenge activities (social-
izing or performing low-challenge cognitive tasks). Brain
function was assessed using fMRI during a semantic classifi-
cation task with two levels of demand pre and post interven-
tion. The High-Challenge group, but not the Low-Challenge
group, showed increased modulation of brain activity in
regions associated with attention and semantic processing
that stemmed from decreases in brain activity during the easy
condition (neural efficiency). These effects were greater for
those who spent more time committed to the program, who
were older, and who gained most in cognition. Mentally chal-
lenging activities may be neuroprotective and an important
element to maintaining a healthy brain into late adulthood.
LEVERAGING TECHNOLOGY TO PROMOTE
ENGAGEMENT IN LEISURE ACTIVITIES IN SENIORS
WITH COGNITIVE DECLINE
K.Murphy1, A.Altschuler1, G.Rowe1, L.Hasher1,2, York
M.Gordon1, P.Spadafora3, L.Tsotsos3, A.Szczepura4, Co-Chair: I.Gutierrez, RAND Corporation
1. Baycrest Health Science, Toronto, Ontario, Canada,
2. University of Toronto, Toronto, Ontario, Canada, 3.
Sheridan Centre for Elder Research, Oakville, Ontario,
Canada, 4. Coventry University, Coventry, United Kingdom
Leisure participation is associated with health benefits
and withdrawal from leisure is a commonly associated out-
come of cognitive decline. We investigated the feasibility of
a web-based app ArtOnTheBrain to promote involvement
in enjoyable recreation in seniors with cognitive decline.
ArtOnTheBrain employs artwork focused activities involv-
ing learning, solving puzzles, and socializing with storytell-
ing and discussion. Iterative qualitative feedback interviews
were undertaken to drive customizations of the app and
establish user acceptability with two groups of 6 participants
experiencing mild cognitive impairment, early dementia, and
their family members. All participants became independent
in navigating the app. Those experiencing cognitive decline
commented it made them feel smart and their opin-
ion mattered. Family valued opportunity for enjoyable
interactions outside those concerning daily responsibilities.
Technology can be leveraged to support engagement with
complex recreation to improve well-being with future inves-
tigated secondary outcomes examining benefits in social net-
works, life space, cognition, and health service utilization.
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61
MUSIC PRACTICE AS AMEANS TO PROMOTE
RESERVE AND COGNITIVE MAINTENANCE IN
AGING
A.Moussard1, C.Fouquet1, L.Cuddy2, S.Belleville1,
K.Mahalingam3, N.Anderson3, 1. Research Center, Institut
Universitaire de Geriatrie de Montreal, Montreal, Quebec,
Canada, 2. Queens University, Kingston, Ontario, Canada,
3. Rotman Research Institute, Baycrest, Toronto, Ontario,
Canada
Music practice (playing music or singing) involves many
interacting cognitive processes and brain areas. As a conse-
quence, we can speculate that music practice could benefit
non-musical activities. Many studies have indeed shown that
music practice is associated with enhancement of different
aspects of cognition and brain processing in younger adults.
More recently, similar observations in older adult musi-
cians, compared to non-musician controls, have suggested
that being engaged in musical activities could contribute to
the development of some form of cognitive or brain reserve,
which may help cognitive and brain maintenance in aging.
Moreover, a limited number of intervention studies have
shown improved cognitive outcome after short-term music
training in non-musician older adults. By presenting an over-
view of relevant literature and recently collected behavioural
and brain data, this presentation aims to provide a better
understanding of the effects of short- and long-term music
training on older adults cognition.
SESSION 255 (SYMPOSIUM)
INDIVIDUAL, EMPLOYER, AND JOB-RELATED
INFLUENCES ON LATE WORK CAREERS OUTCOMES
AND WORK ABILITY
Chair: D.Hochfellner, New York University, Brooklyn, New
Discussant: G.Fisher, Colorado State University
Workforce trends indicate that many individuals are
working until later ages, and that older people want to stay
on the labor market even beyond retirement age. At the same
time we also have evidence that older workers face barri-
ers trying to pursue their late work careers. From the work-
ers perspective job demands, work ability and motivations
change. From a macro perspective technological change and
occupational change make it harder for older workers to
fulfill job requirements. In turn, employers can provide pos-
sibilities to bridge these gaps to enables longer work lives.
This session seeks to address older workers careers from the
individual, the establishment and macro perspective and dis-
cuss how factors such as job training, job motivations, occu-
pational changes mitigate careers. What enables longer work
lives by adapting the work environment to suit an aging
workforce and what discourages longer careers by incentiv-
izing for example earlier retirements. Dr. Gwenith Fisher will
serve as the discussant for the session. In this role she will
summarize and integrate the findings across the papers pre-
sented in the session and offer recommendations for future
research. Dr. Fisher is an expert on aging workforce issues
and has published more than 50 peer-reviewed papers and
serves on four editorial boards of top psychology journals.
62
IN-COMPANY TRAINING FOR OLDER EMPLOYED
WORKERS: RESULTS FROM ARANDOMIZED
CONTROLLED TRIAL
G.J.van den Berg2, C.Dauth1, P.Homrighausen1,3,
G.Stephan1,4, 1. Institute for Employment Research,
Nuremberg, Germany, 2. University of Bristol, Bristol,
United Kingdom, 3. University of Mannheim, Mannheim,
Germany, 4. University of Erlangen-Nuremberg,
Nuremberg, Germany
Even though older workers labor market participation
has increased, their labor market participation remains
far below the employment ratios of other age groups.
Investments in the human capital of older workers are
important to increase and maintain their employability.
Nevertheless, older workers participation in in-company
training is comparatively low. We examine governmental
subsidized in-company training for older employed work-
ers in Germany applying an experimental information treat-
ment approach. We sent out information brochures on this
program to randomly selected eligible workers to investigate
to what extent knowledge about the program increases pro-
gram participation and subsequently their employment prob-
ability, wages, and other job characteristics. For this purpose,
we use individual register data with daily precision matched
with survey data. Furthermore, we analyze to which extent
the subsidy produces deadweight losses. The latter occurs if
the subsidy induces firms to substitute unsubsidized for sub-
sidized training.
TECHNOLOGICAL CHANGE AND EMPLOYMENT OF
OLDER WORKERS
I.Gutierrez2, D.Hochfellner1, 1. Center of Urban Science
and Progress, New York University, Brooklyn, New York, 2.
RAND Corporation, Santa Monica, California
The effects of technological change on earnings have
been studied widely, showing a bias in favor of skilled
workers. Economic models suggest an age bias might also
exist: technological change depreciates human capital if it
is not paired with trainings, and evidence suggests older
workers participate less in training activities. However,
still little is known about the extent to which older work-
ers are particularly affected by technological change. In
this paper we use more than 10years of panel information
on German employers, including earnings and employment
administrative data, and survey information on technolog-
ical change (including the introduction of new production
processes and technologies, innovation of products and
reorganization of human resources), to investigate how
technological change impact the flows of older workers
into and out of employers, the share of older workers in
the workforce, and the wage of older workers relative to
their younger peers.
JOB CHARACTERISTICS, OCCUPATIONAL
TRANSITIONS, AND RETIREMENT IN OLDER
WORKERS
A.Sonnega, B.McFall, University of Michigan, Ann Arbor,
Michigan
A range of sociodemographic and economic charac-
teristics have been shown to predict both earlier and later
retirement. Less is known about the role of occupations and
Innovation in Aging, 2017, Vol. 1, No. S1
their characteristics on the work choices of older workers.
Knowing more about the occupations that workers seem to
stay in longer or leave earlier may point the way to policy
interventions that are beneficial to both individuals and sys-
tem finances. This project uses detailed occupational catego-
ries and work characteristics in the Health and Retirement
Study (HRS) linked to information in the Occupational
Information Network (O*NET) to examine compositional
changes in occupations held by older workers over time; to
provide some basic and interesting information about rela-
tionships between occupations and their characteristics and
retirement outcomes; and to shed some light on which occu-
pations and associated characteristics might encourage or
discourage longer working lives.
WORKING AFTER RETIREMENT AND ITS
RELATIONSHIP WITH LIFE SATISFACTION
E.Dingemans, K.Henkens, Netherlands Interdisciplinary
Demographic Institute, The Hague, Netherlands
This research studies differences in life satisfaction
between full retirees and working retirees (bridge employ-
ees) and argues that these differences may depend on varia-
tions in the income position of retirees. The hypothesis is that
especially for those with low pension income, bridge employ-
ment is an important tool to supplement income in order to
foresee in both material and psychological well-being. This
hypothesis is tested using data from the Survey of Health,
Aging and Retirement in Europe project (SHARE), waves 2,
4 and 5.The analytical sample consists of about 53000 retir-
ees (aged 6075) in 17 countries. The results show that life
satisfaction differs between full retirees and bridge employees
and across countries. Working retirees report higher levels of
well-being compared with full retirees, also after controlling
for the effects of traditional predictors of well-being such as
income, partner status and health.
SESSION 260 (PAPER)
END-OF-LIFE PLANNING AND TRANSITIONS
END-OF-LIFE PLANNING AND DECISION-MAKING:
THE IMPORTANCE OF FAMILY TIES
T.M.Cooney1, A.Shapiro2, C.E.Tate3, 1. University
of Colorado--Denver, Denver, Colorado, 2. California
State University San Marcos, San Marcos, California, 3.
ACCORDS, School of Medicine, University of Colorado,
Anschutz Medical Campus, Aurora, Colorado
The critical role offspring play in their parents later lives
is well established; while some assume caregiving responsi-
bilities, others provide companionship, and emotional and
instrumental support. Less is known about offsprings contri-
butions to their parents end-of-life (EOL) decision-making
and to care choices during the dying process. We analyzed
several waves of data from different modules of the U.S.
Health and Retirement Study (HRS) to examine whether
relationship quality with offspring predicts aging parents
engagement in EOL planning, and whether parents discuss
EOL wishes with offspring, name a child as Durable Power
of Attorney (DPA), or whether offspring act as decision-mak-
ers in care discussions near parents end-of-life. We linked
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Innovation in Aging, 2017, Vol. 1, No. S1
2012 and 2014 HRS Exit Interview datacollected for
deceased respondents, with their prior core data from 2008,
2010, or 2012, and self-administered questionnaire data,
resulting in 1227 cases who identified as parents. Regression
results revealed that parents engagement in EOL planning
was greater for unmarried respondents, and was not asso-
ciated with relationship quality (i.e., supportiveness, strain,
contact) with offspring. But, for parents who discussed EOL
wishes, children were more likely to be involved in such
discussions if the parent was unmarried, and the children
were rated higher on supportiveness. Perceiving their chil-
dren as supportive also predicted an increased likelihood
of parents naming a child as DPA. Regarding cases where
treatment decisions were required near the parents time of
death, children were more likely to assume a major decision-
making role if their parent had earlier rated them as high on
supportiveness.
HOW DOES EDUCATION AFFECT TRANSITIONS
BETWEEN CARE SETTINGS IN OLDER ADULTS
NEAR THE END OF LIFE?
S.Kelfve1,2, J.W.Wastesson2, S.Fors2, K.Johnell2, L.Morin2, group and in comparison to the control group. In summary,
1. National Institute for the Study of Ageing and Later
Life, Linkping University, Norrkping, Sweden, 2. Aging
Research Center, Karolinska Institutet & Stockholm
University, Stockholm, Sweden
High socioeconomic status (SES) is often associated with
better resources to organize home care and avoid burden-
some transitions between care settings near the end of life.
However, high SES is also associated with better resources and
greater desire to seek specialist care in the final stages of the
disease. Using register data covering all individuals 65years
and older who died in Sweden in 2013 (n=75,722), we aimed
to investigate the association between level of education and
different transition patterns in the last month of life. Overall,
52% of community-dwelling individuals and 16% of nurs-
ing home residents died in hospital facilities. In the commu-
nity, individuals with tertiary education were more likely to
die in hospitals than individuals with only primary educa-
tion (adjusted OR=1.22, 95% CI=1.151.30). No difference
was found in the nursing home setting (p=0.115). Among
community-dwellers, the association between education and
in-hospital death was found for all population sub-groups
(e.g. sex, age, number of comorbidities, cause of death). This
association was however stronger for individuals who died
from cancer compared with organ failure. In addition, older
people with tertiary education had more planned hospital
admissions and were more often hospitalized over the entire
last 2 weeks of life. Our results suggest that education does
affect end-of-life transitions (including in-hospital death),
especially for old people in ordinary living.
LIFE, DEATH, AND LEGACY: IS TALKING ABOUT
DEATH GOOD FOR YOUR HEALTH?
K.Stott, J.J.Benson, S.Kerr, A.Jones, A.Ermer, Human ing 20132014, 88.6% (AHCD) and 91.1% (POLST) out of
Development and Family Science, University of Missouri,
Columbia, Missouri
Research has shown that many people are uncomfort-
able discussing end-of-life care and death. Popular opinion
polls have supported these findings as many respondents
rank death as their most avoided discussion topic. Findings
IAGG 2017 World Congress
63
have indicated that many have not shared their end-of-life
care preferences with even their closest family and friends.
However, other research suggests discussions about death
can be good for health and well-being. In order to under-
stand this phenomenon better, we conducted a randomized
controlled trial to test the efficacy of a death awareness
workshop in promoting healthy behaviors and death anxiety.
Data from 89 participants in the Life, Death, and Legacy
study were used to address our research focus. Implementing
a Pretest-Posttest randomized experimental design, the con-
trol group completed an individual writing assignment about
a fear-inducing topic (becoming quadriplegic). The treat-
ment group attended a two-hour workshop that included
discussion topics such as aging, mortality, and relationships.
ANCOVA was used to compare group differences on a
number of outcomes measuring health behaviors and anxi-
ety about death. Significant differences were found between
groups on post-test scores. The treatment group reported less
fear of death, less aversion to the topic of death, and higher
scores in healthy nutrition attitudes. These statistically sig-
nificant differences were detected both within the treatment
our findings suggest talking about death can be helpful in
terms of assuaging fear and anxiety about death. These find-
ings have important implications for practice in hospice and
palliative care settings.
PROVIDER PERSPECTIVES ON ADVANCE
CARE PLANNING DOCUMENTATION IN THE
ELECTRONIC HEALTH RECORD
E.Dillon1, J.Chuang1, A.Gupta2, S.Tapper6, S.Lai3,
P.Yu4, C.S.Ritchie5, M.Tai-Seale1, 1. Palo Alto Medical
Foundation Research Institute, Mountain View, California,
2. Stanford University, Palo Alto, California, 3. Palo Alto
Medical Foundation, Palo Alto, California, 4. Hartford
HealthCare, Hartford, Connecticut, 5. UCSF School of
Medicine, San Francisco, California, 6. Palo Alto Medical
Foundation, Santa Cruz, California
Advance care planning (ACP) is valued by patients and
clinicians yet documenting ACP in an accessible manner is
problematic. In order to understand how providers incor-
porate electronic health record (EHR) ACP documentation
into clinical practice we interviewed providers in primary
care and specialty departments about ACP practices (n=13),
and analyzed EHR data on 358 primary care providers
(PCPs) and 79 specialists at a large multispecialty group
practice. Structured interviews were conducted with thirteen
providers with high and low rates of ACP documentation
in primary care, oncology, pulmonology, and cardiology
departments. EHR problem list data on advance health care
directives (AHCD) and physician orders for life-sustaining
treatment (POLST) were used to calculate ACP documenta-
tion rates. Examining seriously ill patients 65 years with
no pre-existing ACP documentation seen by providers dur-
79 specialists had zero ACP documentations. Of 358 PCPs,
29.1% (AHCD) and 62.3% (POLST) had zero ACP docu-
mentations. Interviewed PCPs believed ACP documentation
was beneficial and accessible, while specialists more often did
not. Specialists expressed more confusion about document-
ing ACP, whereas PCPs reported standard clinic workflows.
64
Providers cited lack of interoperability between outpatient
and inpatient EHR systems, uncertainty about who should
document ACP, lack of a single well-known location for
ACP in the EHR, and lack of time and compensation as con-
cerns. Results suggest providers desire standardized work-
flows for ACP discussion and documentation. New Medicare
reimbursement and increasing quality metrics for ACP are
incentives for healthcare systems to address barriers to ACP
documentation.
A LONGITUDINAL EDUCATIONAL APPROACH
TO IMPROVING END-OF-LIFE CARE IN JAPANESE
NURSING HOMES
S.Kobyashi1, A.Kawakami3, Y.Seki2, R.Rokkaku2, 1. analyses the impact of demographic changes and health
Department of Nursing, School of Health Science, Tokyo
university of Technology, Tokyo, Japan, 2. Dokkyo Medical
University, Mibu-machi, Japan, 3. Tokyo University, Tokyo,
Japan
This study aimed to clarify the effect of a longitudinal
educational approach for end-of-life care in nursing homes
in Japan. Recently, nursing homes in the Japanese Long-
term Insurance system have been required to perform new
roles, including providing end-of-life care for residents. The
situation brought anxieties to their staffs. Therefore, we
conducted an educational approach for six nursing homes
in Tokyo, Japan between June 2013 and March 2016. We
established two kinds of participants. One group was 10
core members who participated in workshops about end-
of-life care. The other group was general staff, who were
affected by the core members on the job. The Job Content
Questionnaire (JCQ) was used to measured job strain. The
questionnaire determined the subjects, ages, gender, types of
job, the experiences of end-of-life care, and scores for job
strain. In order to promote more and better responses to our
questionnaire, we decided not to assign linking identity num-
bers to the general staff. It obtained 215 (47.5%) responses
from the general staffs at the initial research and the second
time 245 (54.2%). There were no dropouts among the core
members. Approval for this study was obtained through the
Tokyo University of Technology Research Board in 2013.
Before implementation of this educational approach, par-
ticipants average age was 40.28years, 55.8% were female,
average job tenure at current nursing home was 109months.
The score of work environment was significantly improve-
ment whereas the emotional demands, quantitative and qual-
itative job overload did not change.
SESSION 265 (SYMPOSIUM)
TRENDS IN LONGEVITY, HEALTH, AND
FUNCTIONING AMONG VERY OLD PEOPLETHE
NORDIC CASE
Chair: M.K.Jylha, University of Tampere, Tampere, Finland
Co-Chair: S.Fors, Aging Research Center
The unprecedented decline in old age mortality and the
consequent increase of very old people are rapidly changing
the landscape of aging, and create new challenges for health
and social care. In this symposium we take advantage of
several representative population-based studies and exhaus-
tive national registers to explore trends in longevity, health
and functioning among very old people, as well as trends in
Innovation in Aging, 2017, Vol. 1, No. S1
long-term care in the Nordic countries. Denmark, Finland,
Iceland, Norway, and Sweden are high-income countries
with largely shared egalitarian norms and traditions, and
welfare states with universal health care. Since the 1990s, all
the Nordic countries have experienced a rapid increase of the
very old population and, simultaneously, major reforms in
their elderly care. The first paper describes the demographic
changes showing remarkable differences between the five
countries. The second paper analyses the trends in function-
ing and health of very old people in Sweden and Finland. The
third paper explores whether there are socioeconomic differ-
ences in health and functioning of very old people and how
these differences have changed over time. The fourth paper
trends on the use of health and long-term care, using Finland
as an example.
THE AGING POPULATION IN FIVE NORTHERN
EUROPEAN COUNTRIES: DEMOGRAPHIC CHANGES
FROM 1990 TO 2014
T.Hj Jrgensen, C.Nilsson, Section of Social Medicine,
Department of Public Health, Faculty of Health and
Medical Sciences, University of Copenhagen, Denmark,
Copenhagen, Denmark
The Northern European countries are known for their
similarities, but also differences in longevity. However,
demographic differences between the oldest old are less
explored. We investigated demographic changes and dif-
ference between the oldest old in five Northern European
countries from 19902014. Demographic information was
collected from national statistical databases and the Human
Mortality Database. The gender-ratios for 85+ and 90+ year
old decreased from 19902014 in most of the countries.
The proportion of 85+ and 90+ year old, life expectancy at
age 85- and 90-years, and the proportion reaching 85- and
90-years increased from 19902014 for both genders in all
the countries. Yet, there were great differences in the pace of
these increases and there were still great differences between
the countries in 2014. In conclusion, demographic markers
of the oldest old have become more similar in the Nordic
European countries, however there still remains remarkable
difference between the countries.
CHANGE AND STABILITY: TRENDS IN HEALTH AND
FUNCTION AMONG THE OLDEST OLD IN FINLAND
AND SWEDEN
S.Fors1, M.K.Jylha2, 1. Aging Research Center, Karolinska
Institutet & Stockholm University, Stockholm, Sweden,
2. School of Health Sciences and Gerontology Research
Center, University of Tampere, Tampere, Finland
One of the key tasks of public health research, in the light
of population ageing, is the tracking of trends in health and
function among older adults. In this study, we have explored
trends in health and physical function among the oldest old
in Finland and Sweden during the period 1992 2014. The
study is based on the SWEOLD survey from Sweden, and
the Vitality 90+ survey from Tampere, Finland. The results
show that, for most measures of health, the prevalence either
increased or remained stable throughout the period. For
ADL disabilities, on the other hand, there was some indica-
tions of a decrease in the prevalence over time in both in
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Innovation in Aging, 2017, Vol. 1, No. S1
Sweden whereas the prevalence remained stable in Finland.
In sum, these results suggests that different health measures
may follow different trends and, thus, underscore the impor-
tance of using multiple health indicators when monitoring
health trends in the older population.
TRENDS IN HEALTH INEQUALITIES AMONG THE
OLDEST OLD IN FINLAND AND SWEDEN
L.Enroth1, S.Fors2, 1. School of Health Sciences and
Gerontology Research Center, University of Tampere,
Tampere, Finland, 2. Aging Research Center, Karolinska
Institutet & Stockholm University, Sweden, Stockholm,
Sweden
Trends in socioeconomic health differences are largely
unexplored for the oldest old. The study examines socioeco-
nomic differences in functioning and health among the old-
est old in two Nordic countries. The Vitality 90+ Study is a
population based survey of the oldest old (90+) in Tampere,
Finland, with comparative data from 2001, 2007 and 2014.
The SWEOLD survey is a nationally representative survey of
the oldest old (77+) in Sweden with comparable data from
1992, 2002 and 2011. Socioeconomic differences in mobil-
ity, activities of daily living and in self-rated health were
estimated in cross-sectional setting in three waves and over
time. The results suggested better functioning and health
for the better off in both countries. The study suggests that
despite the increasing survival and positive societal changes,
the association between socioeconomic status and health is
remarkably stable for the oldest old over the last decades.
LONGER LIVES MEAN HIGHER NEED FOR LONG-
TERM CARE AT THE END-OF-LIFE
M.Aaltonen1,2, L.Forma2, J.Pulkki2, J.Raitanen2,3, mobilizing caregivers as a valuable healthcare resource.
P.Rissanen2, M.K.Jylha2, 1. Institute for Advanced Social
Research, University of Tampere, Tampere, Finland,
2. Faculty of Social Sciences (Health Sciences) and
Gerontology Research Center, University of Tampere,
Tampere, Finland, 3. UKK-Institute for Health Promotion
Research, Tampere, Finland
Death is increasingly postponed to a very old age. Both
high age and closeness of death are major contributors to use
of care.We used nationwide register based data to identify
care profiles during the last two years of life among those
who died at the age of 70 or older in Finland in 1998 (N=
34,116) and 2013 (N=38,087). From 1998 to 2013, the
number of those who died at very old age, with dementia,
and with multi-morbidity, increased. Most people stayed at
home until the last year of life, but nine in ten were in long-
term care or in hospital during the last six months. In future,
people may have more healthy years, but simultaneously the
last years are lived with more severe disability. Postponed
death will increase the need for use of long-term care, but
also the need for home care in the last years of life.
SESSION 270 (SYMPOSIUM)
INFORMAL CAREGIVER CONTRIBUTIONS TO CARE
DURING HEALTHCARE TRANSITIONS
Chair: B.Buurman, University of Amsterdam, Amsterdam,
Netherlands
IAGG 2017 World Congress
65
Co-Chair: J.Prvu Bettger, Duke University, Durham, North
Carolina
Discussant: H.Buck, The Pennsylvania State University,
University Park
A persons social network of family and friends is an
important system of support for general health and well-
being. When ill and hospitalized acutely, this network of
family and friends can become a workforce of informal car-
egiving with varying degrees of involvement. Although the
concept of informal caregiving is not new, the trend of lev-
eraging caregivers as trained and informed participants of a
healthcare team is increasing. Informal caregivers can play a
key role in addressing the gaps in care continuity that exist
globally when patients transition home from the hospital. In
resource-limited regions, informal caregivers can be trained
as lay health workers or care extenders. Even in developed
nations, caregivers can be active contributors in supporting
patients with post-discharge recommendations for therapy,
self-care, and medication management.
This symposium will discuss three approaches to caregiver
involvement in care with examples from ongoing research
around the globe. First, we will present an academic-clini-
cal-community collaborative model designed to educate and
train caregivers to provide in-home support for older adults
transitioning home from the hospital. Second, we will pre-
sent the assessments used to assess caregiver capacity in a
pragmatic trial and the electronic care plan used to facilitate
an integrated care model. Third, we present the role of infor-
mal caregiving in low and middle income countries and the
models of care being tested in different regions to address
the lack of healthcare providers. The variation in activities
caregivers are engaged with demonstrates great potential for
CAREGIVER SUPPORT AFTER HOSPITAL
DISCHARGE: THE DUKE ELDER FAMILY CAREGIVER
TRAINING (DEFT) PROGRAM
C.C.Hendrix, 1. Duke University, Durham, North
Carolina, 2. Durham Veterans Affairs Medical Center,
Durham, North Carolina
The decline in functional reserves and comorbidities
complicate the recovery of older adults following a hospi-
tal discharge. Consequently, the assistance of family and
friends (caregivers) while convalescing at home is particu-
larly needed. The Duke Elder Family Caregiver Training
(DEFT) Center offers a model for an academic-medical-
community partnership for integrated caregiver support
after hospital discharge. Under the leadership of the Duke
School of Nursing, caregivers referred by Duke Hospital
providers receive education and training in home care from
Duke learners in Nursing, Medicine, Physical Therapy pro-
grams. Video technology is used for real-time observation of
skills and communication at home. The DEFT collaborates
with community-based agencies for resources and activation
of lay volunteers for instrumental support. The DEFT aims
to increase caregiver preparation for home care reduce pre-
ventable health care utilization among patients, and increase
competence among learners in interprofessional care and
care transitions. Preliminary data will be discussed in the
presentation.
66
CAREGIVER ROLE IN COMPREHENSIVE POST-
ACUTE CARE STROKE SERVICES
B.Lutz1, C.Bushnell2, P.Duncan2, S.Gesell2, M.Boynton2,
A.Kucharska-Newton3, S.Jones3, J.Freburger4, 1. bisexual and transgender (LGBT) people have very diverse
University of North Carolina - Wilmington, Wilmington,
North Carolina, 2. Wake Forest Baptists Medical Center,
Winston-Salem, North Carolina, 3. University of North
Carolina, Chapel Hill, Chapel Hill, North Carolina, 4.
University of Pittsurgh, Pittsburgh, Pennsylvania
Comprehensive Post-Acute Care Stroke Services
(COMPASS) is an ongoing pragmatic cluster-randomized
controlled trial comparing the effectiveness of a post-acute,
transitional care intervention with usual care for stroke
patients discharged from hospitals across North Carolina.
The innovative intervention combines services from post-
acute care coordinators and advanced practice provid-
ers with linkages to community-based services to enhance
continuity and coordination of stroke post-acute care. The
COMPASS intervention is unique in its focus on addressing
post-discharge needs of both patients and family caregivers.
Assessments of the patients functional and social status and
related post-acute care needs, and the caregivers capacity
for assisting the patient provide the basis for an individual-
ized electronic care plan addressing specific needs; linking
patients and caregivers to relevant community-based ser-
vices (e.g. caregiver support, medication management) and
follow-up care. Examples of the COMPASS assessments, and
methods for real-time electronic care plan generation and
immediate links to community resources will be discussed.
CAREGIVERS AS THE PRIMARY RESOURCE FOR
POST-HOSPITAL CARE IN LOW-AND MIDDLE-
INCOME COUNTRIES
J.Prvu Bettger, Duke University, Durham, North Carolina
Low and middle income countries face numerous chal-
lenges in providing efficient and appropriate care to patients
after hospital discharge including lack of available com-
munity-based providers; healthcare professionals without
expertise to address post-acute needs; inability to connect
patients to available community-based services; poor pro-
vider-to-patient communication, education and training; and
inadequate policies for health care access and community
reintegration. The ATTEND trial in India and RECOVER
trial in China are both completing enrollment in 2016 for
studies of models that provide caregiver training in the hos-
pital on key therapeutic areas for stroke patients to support
continued therapy at home. ATTEND leverages physiothera-
pists as the trainers and RECOVER uses nurses. Hospitals in
Eastern Africa unable to spare any in-hospital resources for
training are adapting manuals and videos to use on the gen-
eral wards for discharge teaching. Challenges to implemen-
tation and measurement and broader applicability of these
models will be discussed.
SESSION 275 (SYMPOSIUM)
THE IMPACTS OF LESBIAN, GAY, BISEXUAL AND
TRANS (LGBT) LIFE COURSES AND IDENTITIES IN
LATER LIFE
Chair: K.Almack, University of Nottingham, Nottingham,
United Kingdom
Innovation in Aging, 2017, Vol. 1, No. S1
Co-Chair: G.M.Gutman, Simon Fraser University,
Vancouver, British Columbia, Canada
Previous research has shown that older lesbian, gay,
life courses. Some have lived outwardly conventional lives
while others have lived more unconventional ones. It has
also been shown that older LGBT people use (and do not
use) sexual and gender identity labels very differently in dif-
ferent historical, cultural and geographical locations and at
different stages of their lives. The papers in this symposium
explore some of the impacts of these diverse life courses and
identities in later life, in order to contribute to more nuanced
and less homogenised ways of understanding LGBT older
peoples experiences and needs.
Fredriksen-Goldsens paper is a systematic review and
narrative analysis LGBT ageing studies spanning 25 years,
showing the tension between individualized and intercon-
nected identities for LGBT ageing. Kongs paper explores
some of the ways in which the identities and lives of older
gay men living in Hong Kong were affected by participa-
tion in a research project, demonstrating how this become
a site for the construction of new collective identities. Kings
paper examines how the housing experiences, concerns and
preferences of older LGBT people are intersected and com-
plicated by questions of identity with significant implications
for policy and practice. Meanwhile, Jones paper compares
the experiences of older people with bisexual relationship
histories who do and do not identify as bisexual, in order
to add to our understanding of the contextually specific way
in which identities are used, and the effects this may have in
later life.
RESEARCH ON LGBTQ AGING ACROSS THE LIFE
COURSE: DECADE IN REVIEW
K.I.Fredriksen-Goldsen, University of Washington, Seattle,
Washington
Given shifting demographics, the global population of
LGBTQ (lesbian, gay, bisexual, transgender, queer) midlife
and older adults is rapidly growing. Given increasing research
on LGBTQ aging, this paper assesses the existing literature
to identify key themes, trends and gaps in the knowledge
base. Building upon a previous 25-year review, we use a nar-
rative analysis across more than 60 studies published from
2005 to 2014. Key components of equity and life course the-
ory (Fredriksen-Goldsen etal., 2014)are applied to examine
structural, psychological, social, and other factors associ-
ated with aging and well-being in later life in these histori-
cally disadvantaged communities. The findings highlight the
diversity in LGBTQ aging experiences, intersectional consid-
erations in identity and development, and the ways in which
lives are both individualized and interconnected across social
relationships, communities, and social structures. Next steps
for the future of LGBTQ research in later life are identified.
QUEERING PARTICIPATORY ACTION RESEARCH
T.S.Kong, The University of Hong Kong, Hong Kong,
Hong Kong
This article examines the ways in which a research project
transformed into participatory action research (PAR) with
the outcome of setting up a self-help group for older (60+)
gay men in Hong Kong. The self-help group offers two types
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of service: community building and public education. The
overall process witnessed a change in the level of participa-
tion by both the researcher and researched, as well as the
social transformation of the participants and production of
local knowledge on Chinese homosexuality. By bridging the
gap between gay and lesbian/queer (GL/Q) studies and PAR,
this research examines how the groups establishment has
transformed individual identities into collective ones which
reunites the gay community that queer research has tended
to fragment. This article concludes with a critical reflection
on the role and significance of the notion of community in
contemporary gay life.
A COMPARISON OF THE AGEING EXPERIENCES
OF OLDER PEOPLE WHO DO AND DO NOT CLAIM
BISEXUAL IDENTITIES
R.L.Jones1, K.Almack2, R.Scicluna3, 1. School of Health, should respond to these challenges. The varying realities of
Wellbeing and Social Care, The Open University, Milton
Keynes, United Kingdom, 2. University of Hertfordshire,
Hatfield, United Kingdom, 3. University of Kent,
Canterbury, United Kingdom
Older bisexual people are widely acknowledged to consti-
tute a particularly hard-to-reach group within LGBT+ ageing
research. One reason for this lies in differences in the claim-
ability of bisexual identities compared to lesbian and gay
identities. This means that reliance on claimed sexual iden-
tities to recruit participants has significant analytic effects.
The Looking Both Ways study therefore recruited a sample
composed half of older people who did identify as bisexual
and half of those who did not but acknowledged a history of
relationships with more than one gender (n=12, ages 5183,
mean 64). Life history interviews enabled nuanced explora-
tion of sexual and gender histories and imagined futures.
Comparison between the two groups suggests ways in which
life course events and historical cohort influence the claiming
of particular sexual identities in earlier and later life, which
then have implications for ageing futures.
IDENTITY MATTERS? THE HOUSING CONCERNS,
EXPERIENCES, AND PREFERENCES OF OLDER LGBT
PEOPLE IN THE UK
A.D.King, Sociology, University of Surrey, Guildford,
Surrey, United Kingdom
Research has documented the unique experiences and
characteristics of older LGBT adults. Yet in the UK there
has been a gap in knowledge about older LGBT people
and housing. This presentation outlines findings from the
SAFE Housing Project, drawing on data from five focus
groups with 28 older LGBT people age 50 plus, as well as
an extensive online survey completed by 175 older LGBT
people in in two areas of England (Greater London and
Shropshire). Results showed that housing concerns, prefer-
ences and experiences were strongly related to identity, in
terms of gender, gender identity and sexuality, as well as
geographical location and other social factors. Hence, the
research challenges the view that housing for older LGBT
people can be perceived of in terms of an individualistic
choice and demonstrates why a more nuanced, identity-
based understanding of older LGBT peoples housing needs
to be considered.
IAGG 2017 World Congress
67
SESSION 280 (SYMPOSIUM)
LONG-TERM CARE: INTERNATIONAL IMPERATIVES,
LOCAL RESPONSES
Chair: C.Roles, Age International, London, United
Kingdom
The demographic changes taking place globally mean
that long-term care is becoming a policy imperative in every
region of the world. There are many challenges that policy-
makers and practitioners have to confront: the determinants
of demand; the cost of care; who is responsible for provision
of care (the state, family or individual); the role of the pri-
vate sector; and the agency and voice of older people them-
selves. Global frameworks such as the WHOs Global Action
Plan on Ageing and Health and the Sustainable Development
Goals help make visible how governments and civil society
wealthier countries, lower-income and middle-income coun-
tries requires different responses at national and local levels,
but there are also commonalities that bridge these differences
and allow us to learn from each other. This symposium will
examine long-term care challenges across diverse interna-
tional economic and social contexts and stimulate dialogue
on how best to respond.
THE INTERNATIONAL POLICY CONTEXT FOR
ACTION ON LONG-TERM CARE
J.Beard1-3, 1. World Health Organisation, Geneva,
Switzerland, 2. University of Sydney, Sydney, New South
Wales, Australia, 3. Southern Cross University, Sydney, New
South Wales, Australia
The World Health Organization has identified ageing as
a priority issue and released the first World report on ageing
and health in 2015. This was followed by the adoption in
2016 of the Global strategy and action plan on ageing and
health by the World Health Assembly. The report and strat-
egy provide a clear public health framework for action on
ageing in 4 strategic areas: developing age-friendly environ-
ments; aligning health systems to older populations; build-
ing systems of long term care; and improving measurement,
monitoring and research. These objectives are framed around
a significant reconceptualization of Healthy Ageing that is
relevant even for those older people who have experienced
significant losses of capacity and who require on-going care
and support. The World report makes clear that in the 21st
Century, there is no country that can afford not to have a
system that supports long-term care.
LONG-TERM CARE SYSTEMS AND THE
IMPORTANCE OF BUILDING THE PAID AND UNPAID
WORKFORCE
A.Pot, World Health Organisation, Geneva, Switzerland
Building a sustainable paid and unpaid workforce is
essential for the development and improvement of long-term
care systems worldwide, including care at home, in the com-
munity and in institutions. This paper will examine the chal-
lenges facing the establishment of long-term care systems,
with special attention given to building a sustainable work-
force. Questions to be addressed include: What is needed for
caregivers like family members, volunteers, peers, migrants,
68
nursing assistants and others to provide care in the next dec-
ades in different parts of the world? How to share the bur-
den of care? The consequences for policy-makers, researchers
and service providers will also be discussed.
DEVELOPMENT OF COMPETENCIES IN THE CARE
OF OLDER PERSONS: COMPARATIVE PERSPECTIVES
P.Conboy, HelpAge International, London, United
Kingdom
More people are ageing and, as they age, their health and
care needs become more complex. Many are living with more
than one long-term condition and single disease approaches
to care are failing to meet their needs. One of the keys to
the effective care of older people is the assurance that those
working for them doctors, nurses, primary and community
care workers, care attendants have the right knowledge,
training, skills and values to deliver the right type of care. In
middle and low income countries, access to specialist geriat-
ric care is limited and the challenge is to establish innovative
models for the development of competencies in the care of
older persons for a range of professional groups and sectors.
This presentation will explore the issues and challenges of
developing such models by sharing experiences from selected
low and middle income countries.
GLOBAL CHALLENGES TO FAMILY CARE
K.Glaser, Kings College London, London, United Kingdom
Families are undergoing rapid transformations that are
affecting intergenerational care and support around the
Globe. While families have proved remarkably adaptable in
the face of such change, the ability of families to provide
care and support is at risk. Not only are care demands likely
to increase given projected rises in complex multi-morbid-
ities and challenging health conditions such as dementia,
but social changes such as womens increasing engagement
in paid work and migration are influencing care and sup-
port within families. Moreover, changes in family behaviour
are not distributed uniformly across social groups. This has
raised concerns that the need for family assistance among
all generations of the already disadvantaged may increase,
potentially exacerbating social disparities in intergenera-
tional care and support. This paper will examine evidence
on the extent of such disparities around the globe and their
consequences for the health and wellbeing of older people
and their families.
SESSION 285 (SYMPOSIUM)
THE EFFECT OF FAMILY CAREGIVING ON THE
WELL-BEING OF OLDER ADULTS AS CAREGIVERS
OR CARE RECIPIENTS
Chair: M.Kim, Daegu University, Korea (the Republic of)
Co-Chair: L.Park, University of Wisconsin-Madison,
Madison, Wisconsin, Afghanistan
Depending on the situation, older adults can be caregivers
or care recipients. Also depending on the situation the effect
can positively or negatively affect the older adults well-
being. This session focuses on family caregiving on the well-
being of older adults in Korean families. The purpose of this
session is to highlight different caregiving styles involving
older adults in Korea and in the U.S. Two studies from Korea
Innovation in Aging, 2017, Vol. 1, No. S1
focus on the well-being of older adults as the caregiver. The
first study explores the potential use of narrative therapy to
alleviate caregiving burden stemming from stigma and feel-
ings of guilt that older parents struggle with from having an
adult child with developmental disabilities. The second study
examines the well-being of grandparents helping raise their
grandchildren as the nuclear family system changes with an
increase in working mothers. The other two studies, using
datasets from the US, focus on older adults as recipients of
caregiving. The first study using the Wisconsin Longitudinal
Study examines whether co-residence of an adult child has
a positive or negative effect on the quality of life for their
older parents. The second study using a national dataset on
Medicare beneficiaries and their caregivers examines various
caregiver and care recipient factors influencing the likelihood
of older adults, who are vulnerable to chronic illness and
dementia, to remain in the community and avoid nursing
home placement. Implications of these studies on family car-
egiving suggest that the status of the older adult as caregiver
or care recipient may have differing effects.
RE-AUTHORING THE NARRATIVES OF THE OLDER
CAREGIVING MOTHERS
J.Ko1, S.Lee2, J.Park2, 1. Kyung Hee Cyber University,
Seoul, Korea (the Republic of), 2. Chung-Ang University,
Seoul, Seoul, Korea (the Republic of)
This presentation is to illustrate the potential use of nar-
rative therapy (NT) for alleviating caregiving burdens of the
older parents, whose adult children have developmental dis-
abilities (DDs). Five sessions of group narrative therapy were
conducted on participants. As sessions progressed, meanings
of their children were changed into something that gives
them reason to live; the unilateral nature of their relation-
ship was later described as interdependent. Participants
identity as mothers shifted from an imperfect one to some-
one striving to improve the situation. The authors pointed
out that NT is an effective approach in the Korean cultural
context for addressing the multiple hardships of the older
mothers, including the image as a sinful daughter-in-law who
gave birth to an imperfect child and the lonely journey as
a caregiver during a time when resources for children with
DDs and their families were limited in Korea. Creating alter-
native meanings allows them to experience empowerment in
their lives.
THE EFFECT OF GRANDPARENTS CAREGIVING OF
GRANDCHILDREN ON WELL-BEING
M.Kim1,3, L.Park2, 1. Daegu University, Daegu, Korea (the
Republic of), 2. University of Wisconsin-Madison, Madison,
Wisconsin, 3. The Institute of Aging Society, Daegu
University, Daegu, Korea (the Republic of)
The changing nuclear family system has created seri-
ous child caring issues in Korea. In Korea, half of working
mothers children were taken care of by their grandparents.
This study used Pearlin et al.(1990)s stress process model
to analyze grandparents well-being while caregiving grand-
children. The model consists of primary stressors, secondary
stressors and coping resources. This study used the 5th and
5th addition wave of KReIS (Korean Retirement and Income
Studies) which were collected in 2013 and 2014 respectively.
The sample size of this study was 174 who took care of their
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
grandchildren. As a well-being measure, life satisfaction and
subjective health were used. Hierarchical multiple regression
was used for data analysis. Caregiving location had a signifi-
cant effect on both life satisfaction and subjective health. The
age of grandchildren had a negative significant effect on sub-
jective health. Emotional and instrumental support affected
life satisfaction, and coping affected subjective health.
IS IT BENEFICIAL OR DETRIMENTAL TO WELL-
BEING?: CO-RESIDENCE WITH AN ADULT CHILD IN
OLD AGE
E.Namkung, University of Wisconsin-Madison, Madison,
Wisconsin
Increased life expectancy in parent generation and pro-
longed period of financial instability in child generation have
made it more likely for aging parents to live with their adult
children. However, little has been known about whether
co-residing with an adult child has a positive or negative
effect on parental well-being in old age. Using the Wisconsin
Longitudinal study, this study examined (1) how co-residence
affects well-being of aging parents aged 65 or older (n=6,537,
Mage=71), and (2) whether the effects are moderated by limita-
tions in Activities in Daily Living (ADL) and marital status of
parents. Co-residence predicted greater depressive symptoms
and poorer psychological well-being, and these deleterious
effects of co-residence in later life were significant regard-
less of parents marital status and ADL limitations. Given the
strong effects of co-residence status on parental well-being,
practitioners should assess whether or not this living situation
is optimal for the well-being of the elders.
FACTORS THAT CONTRIBUTE TO REMAINING IN
THE COMMUNITY AMONG OLDER ADULTS
H.Moon, S.Rote, University of Louisville, Louisville,
Kentucky
The combination of a longer life expectancy and high
rates of chronic illness and dementia will lead to a rise in
the number of older adults in need of informal or formal
care. The majority of older adults, however, prefer to age in
place in their community. Using national data on Medicare
beneficiaries and their caregivers, we investigated 772 car-
egiver (CG) and care recipients (CR) factors that influence
the likelihood of remaining in the community and avoiding
nursing home placement over a 3-year period. The only CG
factor (higher CGs education) and CR factors race (being
non-White), lower levels of ADL disability, dementia sta-
tus (no probable or possible dementia), and CRs sense of
community was a significant predictor of remaining in the
community. Our findings highlight the need to enable CRs
to maintain relationships with their neighbors or community
members to avoid nursing home placement.
SESSION 290 (SYMPOSIUM)
CHANGE AGENTS: ASSESSING THE HEALTH
TRANSITIONAL CARE NEEDS FOR VULNERABLE
OLDER ADULTS
Chair: I.C.Williams, University of Virginia, Charlottesville,
Virginia
Co-Chair: K.M.Rose, University of Virginia School of
Nursing
IAGG 2017 World Congress
69
Discussant: A.Perez, University of Pennsylvania,
Philadelphia, Pennsylvania
Racial disparities in health care are well documented,
and eliminating them is a national priority. Similarly, the
unique needs of sexual and gender minorities are increas-
ingly becoming a high priority. Among older adults, health
care transitions, such as a discharge from hospital to home,
are one of the most vulnerable times placing patients at risk
for poor outcomes. As the proportion of ethnic/racial and
sexual/gender minority older adult grows, it is increasingly
important to design health care services and tailored inter-
ventions that are responsive to this population and their car-
egivers to ultimately avoid unnecessary re-hospitalizations
and reduce poor health outcomes.
This Change AGEnt qualitative study represents an initial
step in developing responsive transitional care services and
was designed to identify strategies for navigating transitions
in healthcare for ethnic, racial, sexual and gender minorities.
This symposium will present findings and recommendations
from focus groups, individual interviews, and discussion
forum data collected through a Change AGEnt action com-
munity. Results from three papers will focus on (1) the state
of the science for transitional care for older adults and the
method of the Change AGEnt action community, (2) unique
transitional care needs of older adult racial/ethnic minori-
ties, and (3) the shortages of tailored transitional care ser-
vices available for older sexual/gender minorities. Findings
from these studies are central to understanding the gaps for
practice, research, and education for transitional care among
vulnerable older adults.
STATE OF SCIENCE: TRANSITIONAL CARE AMONG
OLDER VULNERABLE ADULTS
K.M.Rose1, K.B.Hirschman2, A.Perez2, R.A.Jablonski-
Jaudon3, L.Eastham1, J.Anderson1, I.C.Williams1,
1. University of Virginia, Charlottesville, Virginia, 2.
University of Pennsylvania, Philadelphia, Pennsylvania, 3.
University of Alabama, Birmingham, Alabama
Improving transitions of care among chronically ill older
adults and their family caregivers, especially for our most
vulnerable populations who have been historically stigma-
tized resulting in poorly managed transitions and likely
poorer health outcomes and increased health care costs, is
essential. The purpose of this paper is to describe the Change
AGEnt funded project to better understand the state of the
science in transitions of care for older adults and their family
caregivers with a specific focus on our most vulnerable popu-
lations defined as racial/ethnic and sexual/gender minorities.
We will describe the methods used for this project which
include the assembly of groups of experts in both transitions
and vulnerable populations to learn more about disparities.
We will summarize the need for practice change and how
transition of care services may help better meet the unique
medical, emotional, and psychosocial needs of older adults
from vulnerable and underserved populations.
EXPLORING TRANSITIONAL CARE CHALLENGES
AMONG OLDER RACIAL/ETHNIC MINORITIES
I.C.Williams1, A.Perez2, L.Eastham1, K.B.Hirschman2,
R.A.Jablonski-Jaudon3, J.Anderson4, K.M.Rose4, 1. School
of Nursing, University of Virginia, Charlottesville, Virginia,
70
2. University of Pennsylvania, Philadelphia, Pennsylvania,
3. University of Alabama, Birmingham, Alabama, 4.
University of Tennessee at Knoxville College of Nursing,
Knoxville, Tennessee
For minority older adults and their families, being stig-
matized has historically resulted in poorly managed transi-
tions and likely poorer health outcomes and increased health
care costs. Vulnerable older adult patients and their fami-
lies are possibly being missed or are not taking advantage of
resources available because of their own sense of stigmatiza-
tion and lack of trust of their health care providers. Our goal
was to address these disparate gaps and explore established
evidence-based transitional care models to identify the gaps
and needs of racial/ethnic older adults and their family mem-
bers. Results suggest that trust and communication between
team members and families, empowerment of patients and
families, and culturally tailored coaching will make transi-
tions smoother. The context in which vulnerable families
understand the model of care must be developed more effec-
tively, ultimately saving money and improving quality of
care. Recommendations for research, education, and practice
based on analyses will be discussed.
TRANSITIONS IN CARE FOR SEXUAL AND GENDER
MINORITIES: RECOMMENDATIONS FOR RESEARCH
AND PRACTICE
J.Anderson1, R.A.Jablonski-Jaudon2, K.B.Hirschman3, outcomes (safety and/or comfort benefits of technologies).
A.Perez3, L.Eastham1, I.C.Williams1, K.M.Rose1, 1.
School of Nursing, University of Virginia, Charlottesville,
Virginia, 2. University of Alabama, Birmingham, Alabama,
3. University of Pennsylvania, Philadelphia, Pennsylvania
The estimated 2 million U.S.older adults who self-iden-
tify as members of the LGBTQ community will increase
exponentially over the next several years to more than 4 mil-
lion by 2030. A recent Institute of Medicine report stated
that the existing evidence and knowledge regarding the
health of LGBT individuals is lacking and requires further
research. Consequently, there is a shortage of services that
reflect knowledge and understanding on the well-being of
LGBT older adults, particularly related to transitions in care.
The purpose of this study was to foster discussion among
health care professionals and health sciences research to
understand the unique medical, emotional, and psychoso-
cial needs of LGBTQ older adults in terms of transitions in
care. Focus group and discussion forum data were collected
and analyzed using content analysis. Recommendations for
research, education, and practice based on the analysis will
be discussed.
SESSION 295 (SYMPOSIUM)
INNOVATIVE USES OF TECHNOLOGY FOR
TRANSPORTATION AND DRIVING NEEDS OF
OLDER PERSONS
Chair: C.C.Quinn, University of Maryland School of
Medicine, Baltimore, Maryland
The purpose of this symposium is to present how inno-
vative technologies are enabling older persons maintain
independence in transportation services and adapt vehicles
for older drivers. Previous studies confirm the relationship
Innovation in Aging, 2017, Vol. 1, No. S1
of transportation to socialization, loneliness, housing, and
access to health care. While 20% of older adults do not
drive, 78% of caregivers and friends transport older persons,
and driving safety are major issues, focus on older adults has
been limited. Using technology to improve the simplicity, effi-
ciency and safety could have a major impact on the use of
on demand transportation services and capabilities of older
adult drivers.
In this symposium Dr. Charlene Quinn, will provide an
overview of the translation of technology to transportation
and driving capability of older persons.
Dan Trigub, will describe Lyft Companys curb to curb
transportation for older adults, including driver training,
impact on increasing access to health appointments, develop-
ment of services for older persons without smart phones and
Lyfts national and international health, housing and non-
profit senior programs.
Victoria Kline will discuss on-demand transportation
pilot and demonstration programs of the national Village to
Village Network, including Sequoia Village, whose members
help each other to age in place by providing access to support
services and community activities.
Dr. David Eby, Transportation Institute Research of the
University of Michigan will discuss advanced in-vehicle tech-
nologies, focusing on: use (how older drivers use technolo-
gies), perception (what they think about technologies), and
LYFT: USING TECHNOLOGY TO CONNECT AGING
PERSONS WITH TRANSPORTATION ON-DEMAND
D.Trigub, Lyft, San Francisco, California
Technology applications in the on-demand economy are
a novel way to reach older persons. Annually, 3.6 million
Americans miss or delay medical care because they lack
appropriate transportation. Lyft has created a new mobility
option for older adults and caregivers that help make trans-
portation on-demand and accessible. Lyft operates in 200+
cities across the U.S.with over 400,000 drivers giving 3 mil-
lion rides per week. Lyft and its international partners cover
51% of the worlds population. Lyft has developed a plat-
form called Dispatch which allows any third party includ-
ing hospitals, home care providers, Medicaid transportation
brokers and others to request rides on behalf of a senior. No
smartphones required. A requester simply inputs the pas-
sengers name and pickup and drop-off location, and a Lyft
driver is matched instantly. Today there are over 25,000 rides
being booked by Dispatch each week with 500,000+ rides
completed in just the past few months.
OLDER DRIVERS AND ADVANCED IN-VEHICLE
TECHNOLOGIES
D.W.Eby1, L.J.Molnar2, L.Zhang3, R.St. Louis2,
N.Zanier2, L.P.Kostyniuk2, 1. Transportation Research
Institute, University of Michigan, Ann Arbor, Michigan, 2.
Transportation Research Institute, University of Michigan,
Ann Arbor, Michigan, 3. Tsingua University, Beijing, China
Driving is a complex task that involves psychomotor,
visual, and cognitive functional abilities. As people age they
may experience declines in driving abilities as a result of age-
related medical conditions and the medications used to treat
these conditions. This study was a detailed synthesis of the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
literature that addressed 16 advanced in-vehicle technolo-
gies. This synthesis focused on how older drivers use these
technologies, what they think about them, and safety and/
or comfort benefits of these technologies. This presentation
will also report on training, education, and research needs in
technology applications for driving.
VILLAGE TO VILLAGE NETWORKS: ACCESSING
MOBILE TRANSPORTATION SERVICES TO HELP AGE
IN PLACE
V.Kline, Sequoia Village, San Carlos, California
Village to Village Network (VtV) is a national peer to peer
network to help establish and continuously improve man-
agement of their own villages whether in large metropolitan
areas, rural towns or suburban settings. The mission of VtV
is to enable communities to establish and effectively manage
aging in community organizations initiated and inspired by
volunteer members. Approximately 190 Villages are operat-
ing in the US, Australia and the Netherlands with 185 addi-
tional Villages in development. Villages in San Francisco and
the Bay Peninsula, both members of VtV, have developed as
backups to their existing core of volunteer drivers, an on-
demand transportation services meeting a major need of
older adults to age in place. This presentation provides use
cases and older adult testimonials on use and impact of on-
demand transportation services for Village members.
THE RESPECT SHOE INSOLE TO MONITOR FRAILTY
PARAMETERS
A.Piau1, Y.Charlon2, E.Campo2, F.Nourhashemi1,
B.Vellas1, 1. Grontople, Toulouse University Hospital,
Toulouse, France, 2. CNRS, LAAS, Toulouse, France
Frailty detection and evaluation is not routinely done
when older adults receive health care or social services.
Standardized research measures of frailty are available.
However, seamless follow-up of frailty parameters or access
to information on adherence to lifestyle recommendations
from evaluations may prevent or delay frailty. Our European
consortium is evaluating a removable shoe insole to measure
dynamic characteristics of gait (speed, distance). The insole
transmits wireless data to be available for distance consulta-
tions by users (i.e., patients or physicians). The first phase of
the study determined end user evaluation (technical, clini-
cal, social, ergonomic, and economic), at the Blagnac smart
house (n=10). The second evaluation phase involves 60 frail
community-dwelling subjects, with 30 of them which will use
the smart insoles for 3months. Comprehensive assessments
determined the feasibility, acceptability, interoperability, inte-
gration in a healthcare network, and clinical relevance of the
technological device in comparison to usual care.
SESSION 300 (SYMPOSIUM)
MEDIA AND AGEISM
Chair: M.Wilinska, Jnkping University, Jnkping,
Sweden
Co-Chair: S.Mosberg Iversen, University of Southern
Denmark, Odense, Denmark
It is widely recognized that how we approach old age is
conditioned upon culture. Media is undoubtedly the largest
cultural arena in which societal images and attitudes towards
IAGG 2017 World Congress
71
old age and older people are formed. The existing research
usually discusses the process of underrepresentation and mis-
representation of old age and older people. However, media
as an important part of everyday realities among older peo-
ple are also about creation and active use of media and their
content.
It is therefore pertinent to the study of ageism to not only
understand how different types of online and offline media
represent ageing and old age, but also how people of dif-
ferent ages access and use those media and what types of
knowledge about media and old age dominate. The main
objective of this symposium is to address these concerns by
specifically focusing on a) the processes of knowledge pro-
duction about media and via media with regards to old age,
and b) the ways in which older peoples use various types of
online and offline media.
The symposium brings together ageing and media studies
researchers from several European countries who are active
in research promoting anti-ageist knowledge that reflects the
growing diversity of people of different ages who are com-
monly referred to as old.
MEDIA AND HEALTH INFORMATION LITERACY
AMONG SENIOR CITIZENS IN ICELAND
.Plsdttir, University of Iceland, Reykjavk, Iceland
The paper explores various aspects of media and health
literacy among senior citizens in Iceland by comparing two
age groups, those who are 60 to 67years old and those who
are 68years and older. Health literacy refers to the cognitive
and social skills which determine the motivation and ability
of individuals to gain access to, understand and use informa-
tion in ways which promote and maintain good health. It is
closely related to a joint definition by UNESCO and of media
and information literacy, which allows individuals to
access, retrieve, understand, evaluate and use, create, as well
as share information and media content in all formats The
term media and health information literacy combines these
two concepts. Thus, competency in media and health infor-
mation literacy is important as a tool for lifelong learning,
which provides people with better opportunities to fight age
discrimination and make informed decisions.
AGE DISCRIMINATION IN BIG DATA ANALYSIS: THE
CASE OF AGE-PREDICTIVE SYSTEMS
A.Rosales, M.Fernndez-Ardvol, the Universitat Oberta
de Catalunya, Barcelona, Spain
Digital communication systems opened the door for
tracking everyday activities. Terabytes of data created by real
life users in their daily activities on digital devices. Big data
are used among others, to understand human behavior and
to model statically to predict human behavior.
However, big data analyses are limited by assumptions,
values, and biases. Concretely, older people often constitute a
minority group in digital media, both in terms of the number
of users and in terms of activities. Also, tracked data often
do not have demographic information, do not include older
people, or do not make a generational analysis. Thus pre-
sumably, big data analysis provide conclusions and influence
decisions without taking into account the nuances related to
older people, their particular interests and habits leading to
structural discrimination.
72
The paper analyzes this topic within the area of intelligent
systems to predict the age of users in social network sites.
FIGHTING AGEISM: OLDER PEOPLE SELF-
DEPRECATING HUMOR IN EVERYDAY ONLINE
CONVERSATIONS
L.Ivan, I.Schiau, National University of Political Studies
and Public Administration, Bucharest, Romania
By the means of netnographic techniques we investigate
the use of humor in an online community of grandparents
from Romania, departing from the distinction between self-
deprecating humor and other -deprecated humor (James
& Olson, 2000). The two types of humor are described as
commonly used regardless the cultural contexts, holding
adaptive value in conversations. Our data support the idea
found in the literature that self-deprecated humor is used
particularly on sexual conversational topics, also when we
talk about older peoples online conversations. Furthermore,
we found that self-deprecating humor is used by participants
in approaching other less comfortable topics in connection
to ageist discourse, for example the use of technology, the
frailty and cognitive impartment. The findings suggest the
idea that self-deprecated humor could be seen as an adaptive
way to fight ageist everyday practices.
SESSION 305 (SYMPOSIUM)
THE BENEFITS OF THE HUMANITIES AND ARTS
FOR OLDER ADULTS
Chair: M.Ardelt, University of Florida, Gainesville, Florida
This symposium draws on diverse research approaches
across different disciplines to demonstrate the wide range of
benefits of the humanities and arts for older adults.
Using data of 242 older wise and creative nominees and
controls, the first presentation shows that emphatic con-
cerns for others partially mediated the positive relations of
wise and creative nominees on life satisfaction, indicating
possible benefits of programs, which encourage growth in
wisdom and/or creativity. The second presentation discusses
the role of Vital Involvement (VI) in behavioral interven-
tions that engage older adults in arts participation to foster
health and psychosocial growth and help heal the multiple
losses and deteriorations of old age. The third presentation
analyzes the impact of arts participation on the quality of
life of frail older adults by providing a systematic review of
the international literature, interviews with older adults and
family caregivers, and focus group discussions with health
and art professionals, researchers, and policy makers. The
fourth presentation draws on interview, focus group, and
video data from four qualitative arts-based research pro-
jects to demonstrate the power of the arts in addressing rela-
tional and social justice issues and reducing the suffering
experienced by persons with dementia. The final presenta-
tion explores the value of reading novels and short stories
for older adults based on a meta-analysis of publications on
literature and aging.
Overall, the presentations suggest that the humanities and
arts should not be overlooked in models of aging well and
might be particularly beneficial for older adults most margin-
alized in our communities.
Innovation in Aging, 2017, Vol. 1, No. S1
WISDOM AND CREATIVITY AS TWO ROUTES TO
SATISFACTION IN LATER LIFE: APERSONAL TRAITS
MODEL
W.Shi1, M.Ardelt1, L.Orwoll2, 1. Sociology and
Criminology & Law, University of Florida, Gainesville,
Florida, 2. Ann Arbor, Michigan
Wise and creative older people are considered exemplars
of successful aging. Indeed, our study of 66 wisdom nomi-
nees, 84 nominated visual artists, and 92 controls between
the ages of 53 and 92 (M=71.3, SD=8.97) showed that both
wise and creative nominees reported higher life satisfaction
than controls, particularly after controlling for subjective
health, suggesting that wisdom and creativity are two routes
to greater satisfaction in later life. There was no significant
difference in stated life satisfaction between wise and crea-
tive older nominees. The positive relations of wise and crea-
tive nominees on life satisfaction was partially mediated by
respondents emphatic personality traits, assessed by items
from the California Personality Inventory. It appears that
both wisdom and creativity foster empathic concerns for
others, which further contributes to life satisfaction in old
age. Hence, older adults are likely to benefit from programs
that encourage growth in wisdom and/or creativity.
VITAL INVOLVEMENT IN INTEGRATING
HUMANITIES AND ARTS INTO OLDER ADULTHOOD
H.Q.Kivnick, School of Social Work, University of
Minnesota, St. Paul, Minnesota
The arts and humanities contribute to knowledge through
ways of knowing that transcend the verbal, linear, and meas-
urable. This presentation discusses the role of the Vital
Involvement (VI) construct in behavioral engagement of
elders in H&A activities. Practitioners implement interven-
tions that engage older adults in arts participation, and eval-
uate individual participation impact in terms of validated
outcome variables. The VI construct contextualizes elder arts
participation within lifelong psychosocial development. As
VI is fundamental to earlier-life healthy development, and
arts participation exemplifies the dynamic, reciprocal VI pro-
cess, so arts participation can help to catalyze the ongoing
development that underlies old age as a period of growth and
possibility. Such ongoing growth and health promotion have
been shown to be healing for multiple losses and deteriora-
tions of old age, as well as health promoting for elders who
still focus far more on living a good life than on compen-
sating for problems.
LIBERATING THE ARTS FROM THE THERAPY
CULTURE IN DEMENTIA CARE
S.L.Dupuis1, P.Kontos3, G.Mitchell2, C.Jonas-Simpson2,
J.Gray4, 1. Recreation and Leisure Studies, University of
Waterloo, Waterloo, Ontario, Canada, 2. York University,
Toronto, Ontario, Canada, 3. Toronto Rehabilitation
Institute, Toronto, Ontario, Canada, 4. University of
Toronto, Toronto, Ontario, Canada
Influenced by biomedical/behavioural models, the arts
within dementia care are valued primarily as therapy; arts-
based interventions are provided as non-pharmacological
means to improve functioning of patients and treat mis-
understood behaviours. Informed by theorizing within
liberation arts and critical theory, this presentation aims to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
liberate the arts in dementia care from the therapy culture
and demonstrate the power of the arts to address broader
relational and social justice issues connected to aging and
elder care. We draw on interview, focus group, and video
data from four qualitative research projects using theatre,
visual arts, an arts-based learning academy, and elder clown-
ing. Findings demonstrate how the arts: challenge dominant
discourses and problematize oppressive policies and prac-
tices; ignite personal discovery, growth, and transformation;
and nurture relational citizenship. The arts create transform-
ative spaces for relational flourishing and prompt the social
change needed to reduce the harm and suffering experienced
by older adults living with dementia.
READING NOVELS AND SHORT STORIES: BENEFITS
FOR OLDER ADULTS
P.Derkx, University of Humanistic Studies, Utrecht,
Netherlands
Alain de Botton & John Armstrong argue in Art as
Therapy (2013) that art has seven functions referred to as
remembering, hope, sorrow, rebalancing, self-understand-
ing, growth and appreciation. Rita Felski in her Uses of
Literature (2008) analyzes the spectrum of reader responses
to literature in terms of recognition, enchantment, knowl-
edge and shock. Using these lenses and focusing on nov-
els and short stories this paper will give the results of a
meta-analysis of the scattered publications on literature and
aging since the first conference on humanities and aging,
which took place in Cleveland, Ohio in November 1975.
The conclusion will present a carefully considered judg-
ment on what the main value of reading novels and short
stories can be for older adults
SESSION 310 (SYMPOSIUM)
SUPPORTING OPTIMAL AGING OF OLDER PERSONS
WITH MULTIPLE CHRONIC CONDITIONS AND
THEIR FAMILIES
Chair: M.Markle-Reid, McMaster University, Ontario,
Canada
Co-Chair: J.Ploeg, McMaster University
Discussant: V.Boscart, Conestoga College, Bright, Ontario,
Canada
The prevalence of multiple chronic conditions (MCC)
among older persons is increasing worldwide and is asso-
ciated with poor health status and high rates of healthcare
utilization and associated costs. Current health and social
services are not addressing the complex needs of this group
or their family caregivers who are largely responsible for
their care in the community. There is uncertainty in the litera-
ture on the effectiveness of interventions for individuals who
have MCC. The purpose of this symposium is to describe
four studies, funded by the Canadian Institutes of Health
Research Signature Initiative on Community Based Primary
Healthcare, that contribute to our understanding of future
directions for interventions to support optimal aging of older
persons with MCC and their families.
The first paper describes the results of a qualitative study
of the experiences of managing MCC from the perspec-
tives of 130 older adults with MCC, their caregivers and
IAGG 2017 World Congress
73
healthcare providers. The second study examined the pat-
terns of health services use and associated costs among older
adults with MCC using multiple linked administrative data-
bases. The results of these two studies informed the design
of two intervention studies. The third paper describes the
results of a pragmatic randomized controlled trial of an inter-
professional community-based health promotion program
to address the needs of older adults with MCC and Type 2
Diabetes Mellitus. The final paper describes the results of a
pragmatic randomized controlled trial of an online interven-
tion for family caregivers of older persons with MCC and
dementia.
MANAGING MULTIPLE CHRONIC CONDITIONS:
EXPERIENCES OF OLDER ADULTS, CAREGIVERS,
AND CARE PROVIDERS
J.Ploeg1, N.Matthew-Maich2, K.Fraser3, S.Dufour1,
C.A.McAiney1, S.Kaasalainen1, M.Markle-Reid1,
R.Upshur4, 1. McMaster University, Hamilton, Ontario,
Canada, 2. Mohawk College, Hamilton, Ontario, Canada,
3. University of Alberta, Edmonton, Alberta, Canada, 4.
University of Toronto, Toronto, Ontario, Canada
The purpose of this study was to explore the experience
of managing multiple chronic conditions (MCC) in the com-
munity from the perspectives of older adults with MCC,
caregivers and healthcare providers. Semi-structured quali-
tative interviews (n=130) were conducted in two Canadian
provinces with 41 community-living older adults (65 years
and older) with 3 or more chronic conditions, 47 caregivers
and 42 healthcare providers working in community settings.
Participants described the experience of managing MCC as:
(a) overwhelming, draining and complicated, (b) organizing
pills and appointments, (c) being split into pieces, (d) doing
what the doctor says, (e) relying on family and friends, and
(f) having difficulty getting outside help. The experience of
managing MCC was highly complex and significant gaps
existed between the perceived needs of older adults and car-
egivers and the ability of health and social care systems to
meet those needs. Study results informed the design of inter-
vention studies.
MY TOOLS 4 CARE: AN ONLINE INTERVENTION
SUPPORTING CAREGIVERS OF OLDER PERSONS
WITH DEMENTIA
W.Duggleby1, J.Ploeg2, C.A.McAiney2, S.Ghosh3,
S.Peacock4, K.Fisher2, 1. Unversity of Alberta, Edmonton,
Ontario, Canada, 2. McMaster University, Hamilton,
Ontario, Canada, 3. Faculty of Medicine and Dentistry
University of Alberta, Edmonton, Alberta, Canada, 4.
College of Nursing University of Saskatchewan, Saskatoon,
Saskatchewan, Canada
Based on Transition theory an online intervention was
developed for family caregivers of older persons with demen-
tia with multiple chronic conditions living at home (My
Tools 4 Care). The purpose of the study was to evaluate the
impact of My Tools 4 Care on caregiver self-efficacy, hope,
and quality of life. Amixed methods pragmatic randomized
control trial was conducted with 185 participants randomly
assigned to a treatment or a control group. Study results indi-
cate that participants perceived My Tools 4 Care helped them
74
to reflect on their caregiving journey, how far theyve come,
and what supports they have available to them. Participants
appreciated that My Tools 4 Care provided information and
education for the caregiver. Some participants also noted that
My Tools 4 Care helped them to reflect on the importance of
self-care.
ACHRUCOMMUNITY PARTNERSHIP PROGRAM
FOR OLDER ADULTS WITH DIABETES AND
MULTIMORBIDITY
M.Markle-Reid1, J.Ploeg1, K.Fraser2, K.Fisher1,
N.Akhtar-Danesh1, A.Bartholomew1, A.Gafni1, 1.
McMaster University, Hamilton, Ontario, Canada, 2.
University of Alberta, Edmonton, Ontario, Canada
In response to the complex needs of older adults with
Type 2 Diabetes Mellitus and multimorbidity, an inter-
professional community-based health promotion program
was developed. A pragmatic randomized controlled trial
study design was used to conduct the 6-month program
comprised of in-home visits, monthly group sessions, and
nurse-led coordination of care delivered by Registered
Nurses, Dietitians, and fitness leaders from the YMCA or
community centre. Compared with the usual care group
(n=79), the intervention group (n=80) showed statistically
significant and clinically important improvements in the
mean SF-12 measured mental health (3.69, p=0.02, 95%
CI: 0.60, 6.78), vitality (3.68, p=0.02, 95% CI: 0.57, 6.80)
and general health scores (3.56, p=0.02, 95% CI: 0.65,
6.46). These benefits were achieved at no additional cost
compared to usual primary care. The results support the
effectiveness of the program in improving health related
quality of life in older adults with Type 2 Diabetes in com-
munity settings.
SIMILARITIES IN SERVICE USE AND COMORBIDITY
IN OLDER ADULTS WITH DEMENTIA, DIABETES, OR
STROKE
L.Griffith1, A.Grunier2, K.Fisher1, A.Gafni1, C.Patterson1, and dementia in adults followed between 45 and 85years.
M.Markle-Reid1, J.Ploeg1, 1. McMaster University,
Hamilton, Ontario, Canada, 2. University of Alberta,
Edmonton, Alberta, Canada
This study describes the striking similarities seen across
three studies examining health service use and associated
costs among community-living older adults with comorbid-
ity and one of dementia, diabetes, or stroke, using linked
administrative databases from Ontario, Canada.
We identified 376,434 persons with diabetes, 95,399
with dementia, and 29,671 with stroke (2008). Comorbidity
prevalence differed, with 75% of the stroke cohort having
3+ comorbidities, compared to 50% for dementia and 46%
for diabetes. However, in all three, hypertension and arthri-
tis were most common with a frequency over 75%. Overall
utilization increased with comorbidity for the three index
conditions. Although per-patient costs differed (highest for
stroke, then dementia and diabetes), the relative pattern of
costs over time was similar. In each cohort, total service costs
increased with comorbidity, with acute care services increas-
ing the most. Although intensity of comorbidity differed
among the cohorts, we found similar relationships between
comorbidity, utilization and costs.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 315 (SYMPOSIUM)
IMPORTANCE OF TRAJECTORY ANALYSIS FOR
RESEARCH ON COGNITIVE DECLINE, DISABILITY,
AND DEMENTIA
Chair: A.Singh-Manoux, INSERM U1018, Paris, France
Co-Chair: A.Elbaz, INSERM U1018, Paris, France
Populations across the world are becoming older, with
the over-65 age group fast approaching one third of the
population of rich countries. Prevention efforts to address
this unprecedented societal challenge are hindered by lack
of knowledge on the principal risk factors for age-related
functional decline, disability, and dementia. Much of evi-
dence comes from studies were risk factor levels are meas-
ured once, making it difficult to establish their importance
for ageing outcomes such as cognitive decline, dementia,
and disability. This symposium will present and discuss our
research using longitudinal data from the British Whitehall II
study and the French Three Cities Study. Specifically, we will
show the impact of duration of exposure to atrial fibrillation
on cognitive decline and risk of dementia; the importance
of hormonal status on functional decline and disability; we
will compare the importance of walking speed assessed once
and decline in walking speed for dementia; the importance
of adverse health behaviours for the risk of disability in two
cohorts; and finally the importance of assessment of physical
activity and BMI for dementia by modelling their trajectories
over 28years before dementia onset. The underlying theme
of this symposium is the use of longitudinal data on risk fac-
tors and functional outcomes in identifying trajectories of
risk factors for ageing outcomes.
ATRIAL FIBRILLATION AS ARISK FACTOR FOR
COGNITIVE DECLINE AND DEMENTIA
A.Singh-Manoux, A.Fayosse, A.Dugravot, INSERM
U1018, Paris, France
We assessed associations of AF with cognitive decline
Atotal of 737 incident AF and 323 incident dementia were
identified. In analysis adjusted for sociodemographic covari-
ates, AF was associated with an increased risk of dementia
(hazard ratio=1.78; 95% CI: 1.28, 2.48). By age 60 years,
participants with AF at age 50 and 55 years, compared to
AF-free participants, had an excess decline in cognitive func-
tioning corresponding to an age effect of 3.2 and 1.8years.
By age 85, participants with AF at ages 70, 75, and 80years
had an excess decline in cognitive function corresponding to
an age effect of 7.0, 4.6, and 2.4years, respectively. In adults
aged 4585 years AF is associated with accelerated cogni-
tive decline and higher risk of dementia even at ages when
AF incidence is low; overt stroke explained only part of the
association.
LIFETIME ENDOGENOUS ESTROGEN EXPOSURE
AND DECLINE OF GAIT SPEED IN ELDERLY WOMEN
M.Canonico, F.Artaud, A.Singh-Manoux, A.Elbaz,
INSERM U1018, Paris, France
There is increasing evidence of a role of vascular risk
factors and disease in decline of physical function. Lifetime
estrogen exposure is associated with cardiovascular disease
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
among postmenopausal women. Whether reproductive his-
tory is related to motor decline remains poorly investigated.
Analyses are based on elderly women from the Three-City
Study followed over 10y. We examined the cross-sectional
and longitudinal associations of age at menopause, oopho-
rectomy, and parity with gait speed (GS, cm/s) and dis-
ability. One-year older age at menopause was associated
with faster baseline GS (beta: 0.21; 95% CI: 0.01;0.42)
and lower disability hazard over the follow-up (HR=0.98;
95%CI:0.97;0.99). Oophorectomy was associated with
slower baseline GS (beta:-5.07; 95%CI:-9.07;-1.07). There
was no association of parity with GS and disability. Higher
endogenous estrogen exposure during reproductive life may
be protective for motor function in the elderly. These results
are consistent with the hypothesis of a cardiovascular com-
ponent of motor function.
GAIT SPEED AND DECLINE IN GAIT SPEED AS
PREDICTORS OF INCIDENT DEMENTIA
A.Elbaz1, F.Artaud1, A.Singh-Manoux1, J.Dumurgier2,
1. INSERM 1018, Paris, France, 2. INSERM U942 and
Memory Clinical Center, Saint LouisLariboisiereFernand
Widal Hospital, Paris, France
Previous studies showed that baseline slow gait speed
(GS) is associated with an increased risk of incident demen-
tia. It is unknown what is the added the value of measur-
ing GS repeatedly in order to identify those at higher risk.
We examined the relationship between baseline GS, change
in GS, and the hazard of incident dementia in community-
dwelling elderly people (N=3,663) dementia-free at baseline
(mean age, 73.5y) and followed over 9y, from the prospec-
tive French Three-City study cohort. 296 participants devel-
oped dementia during the follow-up. Gait was slower up to
7years prior to the clinical dementia onset. GS decline was
more accelerated in those who later developed dementia.
Independently of baseline gait speed, those who experienced
a steeper decline over the follow-up had an increased demen-
tia risk. Our findings highlight the benefit of using repeated
measures in order to identify those with a steeper GS decline
and higher dementia risk.
TRAJECTORIES OF UNHEALTHY BEHAVIORS IN
MIDLIFE AND RISK OF DISABILITY AT OLDER AGES
F.Artaud1, S.Sabia1,2, A.Dugravot1, M.Kivimaki2,
A.Singh-Manoux1,2, A.Elbaz1, 1. INSERM U1018, Paris,
France, 2. Department of Epidemiology and Public Health,
University College London, London, United Kingdom
Most evidence on the association between unhealthy
behaviors and disability comes from studies in the elderly,
where reverse causation and selection bias may distort asso-
ciations. We examined associations of trajectories of four
health behaviors (physical activity, diet, smoking, alcohol),
starting in midlife and over 20y, with subsequent disability
(range=54-84y) in the Whitehall II cohort study. Disability
was assessed three times over 8y, and behavior trajectories
were defined using group-based trajectory models. GEE
models were used to examine their independent associations
with disability. Of 6,825 participants, 19.2% were disabled
at least once. Participants with persistent inactivity or declin-
ing physical activity, recent ex- or current-smokers, and per-
sistent/recent abstainers or persistent heavy alcohol drinkers
IAGG 2017 World Congress
75
had higher disability risk; fruit/vegetable consumption was
not associated with disability. Disability risk increased with
the number of unhealthy behaviors trajectories. Unhealthy
behavior trajectories in midlife are associated with greater
disability risk later in life.
RISK FACTORS TRAJECTORIES PRIOR TO
DEMENTIA DIAGNOSIS: BMI AND PHYSICAL
ACTIVITY
S.Sabia, A.Dugravot, A.Elbaz, A.Singh-Manoux,
INSERM U1018, Paris, France
Dementia is preceded by a preclinical period that unfolds
over several years, and affects various processes, including
risk factors levels. Thus, the risk factor-dementia association
drawn from studies based on older adults may be subject to
reverse causation biases. We aim to present trajectories of
two risk factors, physical activity and BMI, for which asso-
ciations with dementia remain unclear, in the 28-year period
preceding dementia diagnosis. We will present results from
the Whitehall II study where risk factors were assessed up to
7 times over 28years among 329 dementia cases, assessed via
electronic health records, and 1974 controls. We will show
that both BMI and physical activity trajectories are modified
over the course of 28years, particularly in the decade preced-
ing dementia. Thus, when these risk factors are measured in
the 10years before diagnosis their associations with demen-
tia are different to that when they are assessed in midlife.
SESSION 320 (PAPER)
PHYSIOLOGICAL FACTORS AND HEALTH
OUTCOMES
HIV INFECTION AND OLDER ADULTS IN SOUTH
AFRICA
I.L.Butler3,4, W.B.McLeod1,2, B.N.Tipping3,4, S.Coetzer3,4,
1. Health Economics and Epidemiology Research Unit,
Department of Internal Medicine, School of Clinical
Medicine, Faculty of Health Sciences, University of the
Witwatersrand., Johannesburg, Gauteng, South Africa,
2. Center for Global Health and Development, Boston
University School of Public Health., Boston, Massachusetts,
3. Division of Geriatrics, Department of Internal Medicine,
School of Clinical Medicine, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, Gauteng,
South Africa, 4. Wits University Donald Gordon Medical
Centre, Johannesburg, Gauteng, South Africa
The number of Human Immunodeficiency Virus (HIV)
infected adults aged over 50years in South Africa is increas-
ing. There is limited knowledge about how this population
differs from younger HIV positive adults and whether there
are different treatment outcomes.
The study objective was to explore dissimilarities between
younger and older HIV positive adults at initiation of
Antiretroviral Therapy (ART) with regard to their baseline
demographic, clinical and laboratory variables and then
compare 12-month ART outcomes.
We did a retrospective record review of a large single site
and included treatment-nave HIV positive adult patients at
initiation of ART. Patients aged 1840years (n=10726) were
76
compared to patients aged 50+ years (n=1635). Baseline vari-
ables and 12-month outcomes in the two groups were com-
pared using log-binomial regression.
The older cohort had significant differences in baseline
demographic, clinical and laboratory data compared to the
younger cohort. These included: gender ratios, education and
employment levels and BMI and CD4+ count categories. At
12-months of treatment a higher proportion were dead (PR
1.52, 95% CI 1.301.76), a lower proportion had a favour-
able treatment outcome namely viral load suppression and
CD4+ increase of >100cells/m3 (PR 0.84, 95% CI 0.80
0.90) but there was no difference in treatment complications
between the two groups (PR 1.01, 95% CI 0.961.07).
HIV positive South African adults aged over 50 years
are a unique population. Despite better baseline clinical and
laboratory variables, the 12-month outcomes were worse.
Contrary to first world studies, there was no difference in
treatment complications in our sample.
CALPAIN ACTIVITY MAINTAINS GOOD HEALTH
OF CENTENARIAN T CELLS; SUMMARY OF THE
CALPACENT PROJECT
J.M.Witkowski1, A.Mikosik1, E.Bryl1, J.Foerster1,
T.Flp2, C.Caruso3, 1. Pathophysiology, Medical
University of Gdansk, Gdansk, Poland, 2. University of
Sherbrooke, Sherbrooke, Quebec, Canada, 3. University of
Palermo, Palermo, Italy
Causes of aging-associated deterioration of human
immunity, and the reasons why the immune system of the
oldest old individuals (centenarians) is relatively robust,
remain moot. Intracellular proteolysis system of two
proteases - and m-calpain and their inhibitor cal-
pastatin (the calpain-calpastatin system (CCS)) - is active
in resting human peripheral blood T cells, participating in
maintenance of their readiness to proliferate and secrete
cytokines in response to stimulation. The amounts of the
CCS proteins decrease in resting T lymphocytes of healthy
elderly, only to return in the centenarians to those levels
seen in the young individuals. We compared the calpain
activities and the levels of transcription of the CCS genes
in the resting and stimulated peripheral blood T lympho-
cyte populations of young, elderly and centenarians, and
correlated these activities with the strength of proliferative
and cytokine secretion responses to a polyclonal stimula-
tion. Calpain activities significantly decrease in the resting T
cells of the elderly compared to the young, and rise again in
centenarian lymphocytes, in parallel to the relatively higher
proliferative and secretory dynamics and CCS genes tran-
scription in the centenarian than in elderly T cells. Calpain
activity seems to increase the levels of phosphorylation of
chosen signal transduction molecules. Concluding, we pro-
pose that the CCS activity is essential for the maintenance
of adequate level of the T cell responses, that its decrease in
the elderly is one of the reasons for the immunosenescence,
while its relative preservation may facilitate relative robust-
ness of T cell responses in the centenarians.
PERIPHERAL FATIGUE DOES NOT INFLUENCE THE
ONSET OF FATIGUE IN OLDER ADULTS
J.Yentes1, A.Rosen1, T.Grindstaff2, Z.Starks1,3, 1.
University of Nebraska Omaha, Omaha, Nebraska, 2.
Innovation in Aging, 2017, Vol. 1, No. S1
Creighton University, Omaha, Nebraska, 3. A.T. Still
University, Kirksville, Missouri
Muscular fatigue is the decline in ability of a muscle group
to produce force following a contraction. Although older
adults are less susceptible to fatigue, they have decreased mus-
cle mass, strength, and contractile ability. Peripheral fatigue
is attributed to metabolic buildup, while central fatigue is
linked to down-regulation of motor unit firing. Decreased
oxygen in the tissue and brain is linked to peripheral and
central fatigue, respectively. The purpose of this study was to
evaluate the onset of fatigue in older adults and assess altera-
tions in oxygenation within the soleus muscle and prefron-
tal cortex following a plantar-flexor fatigue protocol. Eleven
participants (56.37.6 years, 169.56.5cm, 75.36.7kg)
were assessed before and after a fatigue protocol consisting
of repeated maximal concentric contractions completed until
<50% of isometric one-repetition maximum was reached.
Peripheral fatigue was assessed via resting twitch (RT) and
central fatigue was assessed via electromyography (rEMG)
and percent of voluntary muscle activation (ITT). Soleus
muscle oxygenation (StO2) was recorded with an oximeter
and central oxygenation (HbO) of the prefrontal cortex was
measured via functional near infrared spectroscopy (fNIRS).
Significant decreases were found for ITT (p<0.01), rEMG
(p=0.03), StO2 (p<0.01), and prefrontal cortex oxygena-
tion (p=0.04). The results indicated that central fatigue was
the primary contributor to the observed fatigue. Fewer type
II muscle fibers in older adults would cause less metabolic
buildup and less peripheral fatigue. Adecrease in oxygena-
tion in either the prefrontal cortex or muscular tissue may
be related to the faster onset of fatigue in populations with
disease.
CARDIAC TISSUE GLYCATION AND SKIN
AUTOFLUORESCENCE IN CORONARY ARTERY
DISEASE PATIENTS
A.Simm, K.Jacobs, A.Navarrete Santos, A.Wienke,
H.Treede, B.Hofmann, Clinic for Heart Surgery, Martin-
Luther-University Halle-Wittenberg, Halle (Saale), Germany
Aim: During ageing, advanced glycation end products
(AGEs) accumulate in extracellular matrix proteins like col-
lagen and contribute to a decline in organ function. As skin
autofluorescence (sAF) can assess subcutaneous accumula-
tion of fluorescent AGEs, this study aimed to investigate the
relationship between AGE-modified cardiac tissue collagen
and AGE related sAF in coronary artery bypass surgery
patients.
Methods: Between January 2011 and January 2012,
data from 72 consecutive male patients undergoing isolated
CABG were prospectively recorded. Collagen fractions were
isolated from the right atrial auricle of these patients by
proteolysis and collagenase digestion. Collagen was quanti-
fied by hydroxyproline assay and AGEs by the AGE related
intrinsic fluorescence. Skin autofluorescence was measured
using an autofluorescence reader.
Results: The biochemical analysis showed that the insolu-
ble cardiac collagen fraction contained the highest amounts
of accumulated AGEs; the AGE related intrinsic fluorescence
of this fraction increased with age (p=0.0001), blood glucose
level (p=0.002), HbA1c level (p=0.01) and the skin autofluo-
rescence (p=0.008).
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Conclusion: This study confirmed for the first time a
relationship between cardiac tissue glycation and the AGE
related skin autofluorescence. In addition, cardiac tissue
glycation was associated with age, blood glucose levels and
long-term glucose values of the assessed CAD patients.
IMPACT OF TELEMEDICINE ON CARE
IMPROVEMENT IN NURSING HOMES
N.Salles, A.Lafargue, M.Barateau, C.Caubet, M.Dupuy, in differing national and educational settings to shape the
A.Prigent, K.Libert, University Hospital, Bordeaux, France
Even if challenges of telemedicine are great in geriatrics,
particularly in the monitoring of elderly patients with chronic
diseases requiring repeated hospitalizations, literature data
concerning the benefits of telemedicine remains poor.
The aim of this study was to describe the impact of tel-
econsultations on care improvement in nursing homes.
Methods: This study was based on teleconsultations
organized by an expert team in the department of clinical
gerontology, Bordeaux, France. After obtaining patient and
general practitioner (GP) consent, the nursing home care
team connected to a virtual room with the expert center.
Following each teleconsultation, a report was written and
sent via a secure messaging system to the GP.
Results: a total 312 teleconsultations were analyzed and
concerned residents with a mean age of 85.28.2years; mean
ADL (Katz) score: 2.11.1; mean MMSE score: 15.76.5; Denmark, 2. Aarhus University Hospital, Aarhus, Denmark
mean CIRS-G score: 14 .45.2; and mean drugs intake per
day: 8.13.5. Reasons for teleconsultations were mainly
behavioral problems related to dementia (25.3%); com-
plex chronic ulcers (38.8%), psychiatric disorders (16.3%),
and chronic spasticity (11.3%). Teleconsultations permit-
ted the avoidance of specialized consultations in 62.2% of
cases; programmed hospitalizations (9.3%), and emergency
admission (2.5%). Teleconsultations permitted to avoid the
renouncement of care for 81 (26%) nursing home residents.
Ninety four (30.1%) therapeutic optimizations were realized
and permitted to stop neuroleptic treatment in 36.2% of
cases, anticholinergic treatment (23.4%), and psychotropic
treatments (18.1%).
In conclusion, global geriatric assessment remains essen-
tial during teleconsultations and should permit to decrease
return trips to the hospital for nursing home residents.
SESSION 325 (SYMPOSIUM)
GLOBAL TRENDS IN INTERPROFESSIONAL
EDUCATION IN AGING AND HEALTH: PROGRAM
DEVELOPMENT AND EVALUATION
Chair: P.G.Clark, University of Rhode Island, Kingston,
Rhode Island
Discussant: M.Formosa, International Institute on Ageing,
Msida, Malta
Major forces shaping the global development of the
health care and social services workforce are: (1) the need
for interprofessional education (IPE) and practice (IPP), and
(2) the impacts of aging, chronic disease, and disability on
healthcare systems. The WHO (2010) Framework for Action
on Interprofessional Education and Collaborative Practice
highlighted the growing importance of health care and social
services students and professionals learning how to work
together. The WHO (2015) World Report on Ageing and
IAGG 2017 World Congress
77
Health called for international action to address the global
implications of aging for health care. These two forces merge
in the development of educational programs to train students
and professionals to work together collaboratively to pro-
mote health in older adults. This symposium both (1) reviews
the interprofessional health and aging program development
and evaluation strategies used in different country contexts,
and (2) assesses the factors and forces that have emerged
course of academic programs linked to practice contexts in
aging and health. Papers include a discussion of programs
developed and evaluated in the Nordic countries, the UK,
and the US. Methods of program impact assessment of both
interprofessional learning outcomes and knowledge and
skills related to practice with older adults will be presented,
and the analyses and interpretation of data will be reviewed
and critically assessed. Implications for developing program-
matic strategies and evaluations will be explored, and recom-
mendations for how to respond to the dual WHO calls for
action will be presented.
INTERPROFESSIONAL GERIATRICS EDUCATION
IN DENMARK: CLINICAL SUPERVISOR PRACTICAL
COMPETENCE PROFILE
T.Kramer1,2, 1. University of Copenhagen, Copenhagen,
InBetween was a pilot project to use the development of a
patient pathway through the healthcare system to strengthen
patient-centred, interprofessional collaboration skills for
health professions students from medicine, nursing, physi-
otherapy, and occupational therapy. The program evaluation
utilized ethnographic studies of interprofessional practice
orientation in real learning contexts and investigated clinical
supervisors practical competence profile in geriatrics. The
evaluation framework was multi-site ethnography involv-
ing a mixed methods approach, including participant obser-
vations, interviews, videos, audio logbooks, and documents.
Major findings of the evaluation were: (1) interprofessional
collaboration improves patient-centred practice, (2) clinical
supervisors profession sets the agenda for interprofessional
conferences, and (3) professions preconceptions seem to be
maintained by clinical supervisors. Discussion will focus on
the continued refinement and dissemination of this model
program in both educational and practice settings. Forces
supporting and opposing its implementation in the Danish
context will be explored.
NORWEGIAN DEMENTIA EDUCATIONAL
PROGRAM: DEVELOPING STAFF COMPETENCE IN
PERSON-CENTRED DEMENTIA CARE
A.Rokstad1,2, B.Dble1, J.Stordalen1, K.Krohne1,
K.Kristiansen1, 1. Norwegian National Advisory Unit on
Ageing and Health, Tnsberg, Norway, 2. Molde University
College, Molde, Norway
The Dementia ABC Educational Program was initiated by
the Norwegian Dementia Plan in 2015. It offered high qual-
ity, interprofessional, easily available training for care staff
in all municipalities. Program evaluation assessed impact
on participants person-centred care competence and job
satisfaction level. The program consisted of written book-
lets and interprofessional reflection groups and workshops.
78
A longitudinal evaluation followed 1,795 participants
from 90 municipalities over a period of 24months, with a
6-month follow-up after completion. The Person-Centred
Care Assessment Tool (P-CAT) evaluated person-centered-
ness. Asignificant increase in the mean P-CAT sub-score of
person-centred practice and the P-CAT total score was found
at 12, 24, and 30months compared to baseline. Asignificant
increase in satisfaction with workload, personal and profes-
sional development, demands balanced with qualifications,
and variation in job tasks was reported. Results indicate that
the interprofessonal, multicomponent training positively
impacted the development of person-centred care practice
and staff job satisfaction.
INTERPROFESSIONAL GERIATRICS EDUCATION:
IMPLEMENTATION AND EVALUATION OF NOVEL
SIMULATION DAY IN THE UK
T.McGowan1, P.Ehilawa1, A.Blundell1, A.Gordon2, the networking and interdisciplinary ambitions of these pro-
J.Pattinson1, N.Woodier1, M.Fores1, 1. Nottingham grams, but they also display challenges inherent in motivating
University Hospitals NHS Trust, Nottingham, United
Kingdom, 2. Royal Derby Hospital, Derby, United Kingdom
Following the introduction of an Advanced Nurse
Practitioner Programme in Geriatric Medicine at a large UK
teaching hospital, a pilot regional interprofessional simula-
tion day with medical registrars was designed and held four
times over four months. The format included five scenarios
involving simulated patients, covering topics on delirium,
elder abuse, falls, end of life communication, and polyphar-
macy. Structured debriefs were held after each scenario with
an interprofessional faculty. Ninety percent of the 39 par-
ticipants would recommend the day to colleagues and stated
it was pitched at an appropriate level. Following the day,
participants scored 1.1 marks higher on a 10-point knowl-
edge test (P<0.001) and 2.5 points higher on the Readiness
for Interprofessional Learning Scale (P<0.003). Discussion
will explore impact on clinical practice two months after
the simulation and qualitative data from post-simulation
focus groups reflecting on the interprofessional learning.
Implications for interprofessional education in the UK will
be discussed.
EVALUATING AN INTERPROFESSIONAL COURSE IN
GERIATRICS TEAMWORK: IMPLICATIONS FOR THE
U.S. CONTEXT
P.G.Clark1, R.Filinson2, 1. Gerontology, University of
Rhode Island, Kingston, Rhode Island, 2. Rhode Island
College, Providence, Rhode Island
Supported by a federal Health Resources and Services
Administration (HRSA) grant, the University of Rhode Island
offers a service-learning course on inteprofessional team-
work in aging and health for health professions students.
Novel adaptations of two validated questionnaires were used
to evaluate the courses impacts on attitudes and skills rele-
vant to interprofessional teamwork with older adults: (1) the
Attitudes Toward Interdisciplinary Teams, ATIT, Scale and
(2) the Team Skills Scale, TSS. Findings showed statistically
significant improvement with regard to a positive orientation
towards interprofessional teams on 10 of the 21 attitudinal
items and on all 17 skills items. All 3 of the ATIT compos-
ite subscales showed an increase in support for the tenets
of interprofessional training. Implications of this evaluative
Innovation in Aging, 2017, Vol. 1, No. S1
methodology will be discussed. The unique educational and
practice contexts of the US for developing and evaluating
such academic courses will be explored, including the forces
supporting and opposing such programs.
GRADUATE EDUCATION INITIATIVES FOR
INTERDISCIPLINARY RESEARCH ON AGING AND
HEALTH IN SWEDEN
S.Iwarsson, M.Haak, A.Fange, T.Svensson, M.H.Nilsson,
G.Ahlstrm, C.Lofqvist, Lund University, Lund, Sweden
Sparked by the development of a Nordic Masters
Program in Gerontology, and followed by the establishment
of graduate schools integrated with national aging research
centers in Sweden, a national Graduate School for Ageing
and Health (SWEAH) was established. SWEAH is a part-
ner of the International Summer School on Ageing (ISSA).
Program evaluation results show that students appreciate
students to get seriously involved in activities requiring that
they leave their disciplinary comfort zones. Based on expe-
riences and evaluation results gained from these programs
over the years, we describe and problematize requirements
for efficient capacity-building in a national and international
context. Spin-off effects in terms of international engagement
and collaboration in supervision teams and examination
committees serve to strengthen the interdisciplinary com-
petence and capacity for international collaboration of the
management teams and teachers involved.
SESSION 330 (SYMPOSIUM)
PRESIDENTIAL SYMPOSIUM: DEVELOPING ACUTE
CARE SERVICES FOR OLDER PEOPLE: GLOBAL
PERSPECTIVES FOR THE NEXT DECADE
Chair: R.Y.Wong, University of British Columbia,
Vancouver, British Columbia, Canada
The development of responsive and efficient acute care
services for older people remains a high-priority focus
around the world and into the next decade. This symposium
showcases expertise from North America, Europe, Southeast
Asia and Asia to review the latest evidence and experiences
that improve the care for older people in hospitals globally,
and provide an interactive opportunity for participants to
share strategies from their local jurisdictions.
After attending this session, participants will be able to:
(a) list the steps of developing a geriatric program that is
aligned with innovations (such as personalized medicine and
big data analytics) in the future hospital; (b) describe how
quality improvement can drive better frailty care; (c) give
examples of how to improve delirium care; and (d) identify
the characteristics of effective post-acute care services.
The symposium speakers are recognized leaders in
Geriatrics globally and locally, hence providing their glocal
perspectives. All have solid track records of implementing
system-based improvements on acute care services for older
people.
At the symposium, we will present cutting-edge, evidence-
informed findings and experiences that will influence acute
care services in the next decade. We plan to tailor to partici-
pants needs in identifying local improvement opportunities
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and sharing with them lessons leanred during knowledge-to-
practice translation.
GERIATRIC PROGRAM DEVELOPMENT IN THE
FUTURE HOSPITAL
R.Y.Wong, Medicine, University of British Columbia,
Vancouver, British Columbia, Canada
The steps of developing a specialized geriatric program
in the future hospital include initiating a high-level analysis,
conducting an environmental scan, designing an operational
plan, developing an inter-professional staffing model, imple-
menting strategies to optimize servce, and evaluating the
program. During this process, the program logic model, ser-
vice-patient matrix, and patient segmentation matrix can be
helpful tools. An inter-professional model of geriatric service
is critical for program sustainability. The strategies to opti-
mize patient-centred care must be feasible and aligned with
paradigm-shifting innovations, such as personalized medi-
cine (with integrated genomics and microbiomes platform)
and big data analytics (health informatics). The geriatric pro-
gram that is developed must be nimble enough for broader
adaptation and dissemination, both within the hosptial and
across the health system.
DEVELOPING ACUTE FRAILTY MODELS IN UK
HEALTH SYSTEMS
D.Oliver, Royal College of Physicians of London, London,
United Kingdom
Increasingly the core and system-critical business of acute
care systems in the UK is older people with complex co-mor-
bidities, dementia and frailty.
We are fortunate in having Geriatric Medicine as the larg-
est General Internal Medical Speciality, with a strong presence
at the urgent hospital front door in Emergency Departments,
Acute Medical Units and Rapid Access Ambulatory Clinics
and managing a large bed base in deeper wards.
Geriatricians increasingly work in interface roles across
the acute and community boundary. And there is a growing
focus on new models of care outside hospital such as inte-
grated rapid response teams.
I will discuss the development of national quality improve-
ment drives and key resources and clinical networks such as
the Acute Frailty Network and Older People in Acute Care
Programme (Scotland), the progress we have made in urgent
and emergency care for frail older people and the very real
challenges we still face.
ACUTE CARE INNOVATIONS IN DELIRIUM
MANAGEMENT
W.Lim, Tan Tock Seng Hospital, Singapore, Singapore
Delirium is an acute decline in cognitive functioning
that is a common, under-recognized, serious, and costly dis-
order that affects as much as 50% of hospitalized elderly.
Increasingly used as an indicator of health-care quality for
hospitalized elderly, delirium provides a target for system-
wide process improvement to prevent downstream complica-
tions and costs.
Multi-component non-pharmacological risk factor
approaches are the most effective strategy for delirium pre-
vention. Pharmacological prevention or treatment has been
largely disappointing, prompting the shift towards process,
IAGG 2017 World Congress
79
staff and environmental approaches beyond the treatment of
reversible patient factors.
Care innovations include the Hospital Elder Life Program
(HELP), general medical units with best practice in delirium,
and the Delirium Room. We will share our experience and
related outcomes in setting up the Geriatric Monitoring Unit,
a designated unit for systematic, specialized, and restraint-
free management of acute delirium care. Challenges such as
upscaling, demonstrating value, sustainability, and further
research will be discussed.
INNOVATIONS IN TRANSITIONAL AND
COMMUNITY CARE POST-ACUTE SERVICES
T.Chan, Kwong Wah Hospital, Hong Kong, China
An aging population has led to an increasing need of acute
care for elderly people. Anumber of geriatrician-led transi-
tional care services were established in Hong Kong over last
20 years to support elderly patients who were discharged
from acute setting. Community Geriatric Assessment Teams
provide post-discharge support and long term follow up to
residents in old age homes. Avalidated risk assessment score,
HARRPE, was developed to identify hospitalized elderly
patients who were at risk of unplanned readmission in
28days. At-risk patients will receive comprehensive assess-
ment. Those with complex needs are provided with home
visit by case-managers, domiciliary rehabilitation as well
home support services from Non-Government Organizations
(NGO). Multi-disciplinary rehabilitation is also provided at
Geriatric Day Hospitals for elderly patients with various dis-
abilities. Patient Support Call Center offers telephone fol-
low up for discharged patients with high HARRPE score.
Outcomes of patients were shown to be improved.
SESSION 335 (SYMPOSIUM)
NOVEL APPROACHES TO IMPROVING PRESCRIBING
FOR VULNERABLE OLDER ADULTS
Chair: M.Steinman, University of California, San Francisco
School of Medicine, San Francisco, California
Medication misadventures are common in older adults,
and have a major impact on quality of life and mortality for
this population. Unfortunately, existing efforts to improve
prescribing quality have fallen short, and new approaches are
needed. This symposium will address this critical gap by dis-
cussing several new strategies to conceptualize and improve
prescribing quality in older adults. There will be four presen-
tations of original research on these topics by experts from
the United States, Italy and Israel. These will include three
presentations on clinical trials of interventions to improve
pharmaceutical care and medication safety in older adults,
and one presentation on novel ways of conceptualizing the
scope and impact of drug-drug interactions in older adults.
Each of these presentations will include a traditional pres-
entation of original research findings, plus a brief discussion
about how the research fits into a larger understanding of
how to conceptualize and improve pharmaceutical care qual-
ity in older adults. The last third of the symposium will con-
sist of a moderated discussion with the presenters, including
questions from the audience. The focus of this moderated
discussion will be commonalties and lessons learned from
research in the areas discussed, and how health systems and
80
clinicians can use these findings to improve pharmaceutical
care for the older adults they serve.
REDUCING PSYCHOACTIVE MEDICATION USE IN
OLDER ADULTS WITH DELIRIUM SUPERIMPOSED
ON DEMENTIA
D.M.Fick1, A.M.Kolanowski1, L.C.Mion2, J.McDowell1, based primary care intervention on medication outcomes in
J.Waller3, 1. Penn State University, University Park,
Pennsylvania, 2. Vanderbilt University, Nashville, Tennessee,
3. Georgia Regents University, Augusta, Georgia
Delirium is often misdiagnosed in dementia and mis-
treated with medications that may be continued even after
hospital discharge. This paper will present results from
the Early Nurse Detection of Delirium Superimposed on
Dementia (END- DSD) NIH funded cluster randomized trial.
We hypothesized that subjects on the END-DSD units would
receive fewer psychoactive medications compared to sub-
jects on control units. Participants (n=391; Mage=84; 71% the role of nurse-based interventions in improving pharma-
female; 95% Caucasian) were enrolled at the time of admis-
sion. The intervention group had significantly lower number
of medications given PRN than the control group. The num-
ber of unique Beers medications given PRN was lower in
the intervention group. And the number of PRN medications
with an anticholinergic burden score of 3 was significantly
lower. These drugs negatively impact older adults and should
be avoided. Nurses play an integral role in decreasing the use
of PRN and psychoactive medications in older adults.
IMPROVING MEDICATION SAFETY AND TRAINING
FOR OLDER ADULTS WITH DEMENTIA
N.Brandt, University of Maryland at Baltimore, Baltimore,
Maryland
The intent of this session is to highlight the work of an
interprofessional team and tactics to improve medication
safety for older adults and their caregivers. Interprofessional
health care providers at the Baltimore Veterans Affairs
Medical Clinic, namely medicine, pharmacy, nursing, neu-
ropsychology & social work, have been actively involved in
various clinical and educational initiatives. One of these ini-
tiatives is the DEMO: Dementia Evaluation, Management
and Outreach program. This program aims to extend
dementia evaluations to regional community-based outpa-
tient clinics, which serve people in more rural regions, and
to improve management and follow-up of these patients,
including medication coordination and adherence monitor-
ing. Additionally, the team has created and evaluated online
interprofessional training focusing on medications and other
needs of older adults with dementia, looking at knowledge,
skills and attitudes. Results and resources will be shared with
conference attendees that can be useful for their clinical care
settings.
IMPACT OF ANURSE-BASED INTERVENTION ON
MEDICATION OUTCOMES IN OLDER ADULTS: THE
CC-MAP STUDY
E.Shadmi2,3, M.Low3, R.Balicer3,4, M.Steinman1, 1. time. The Atherosclerosis Risk in Communities (ARIC) Study
Division of Geriatrics, Department of Medicine, University
of California, San Francisco School of Medicine, San
Francisco, California, 2. University of Haifa, Haifa, Israel,
3. Clalit Research Institute, Tel Aviv, Israel, 4. Ben Gurion
University of the Negev, Beersheva, Israel
Innovation in Aging, 2017, Vol. 1, No. S1
Medication-related problems are common in older adults
with multiple chronic conditions. Holistic, patient-centered
approaches may be particularly well-suited to addressing
the complex and disease-crossing nature of these problems.
In this presentation, we will present results of a cluster-con-
trolled clinical trial that evaluated the impact of a nurse-
1,218 high-risk older Israeli adults. Our primary outcome
was the number of changes to patients medication regi-
mens, a marker of attention to patient-centered prescribing.
After 9months of follow-up, intervention subjects had more
changes to their medication regimen than control subjects
(mean 4.04 vs. 3.62 medication changes; adjusted difference
0.55, P=0.001). Similarly, intervention subjects had more
changes to their symptomatic medications (mean 1.38 vs.
1.26 changes, adjusted difference 0.20, P=0.003). We will
discuss how our findings inform a broader understanding of
ceutical care for vulnerable older adults.
DRUG INTERACTIONS AND THE NEED FOR
ACOMPREHENSIVE APPROACH TO PRESCRIBING
G.Onder1, D.Vetrano1,2, 1. Universit Cattolica del Sacro
Cuore, Rome, Italy, 2. Karolinska Institutet, Stockholm,
Sweden
One of the biggest challenges in preventing drug interac-
tions in older adults is the substantial gap that exists between
theory and clinical practice. Drugs have a network of effects
that go well beyond a single specific drug target. Moreover,
the spectrum of possible drug interactions goes well beyond
the traditional drug-drug and drug-disease dyads, for exam-
ple by impairing immune response and therefore decreasing
the effectiveness of vaccination. In this presentation, origi-
nal data on the possible interaction of statins and PPIs on
the effect of influenza vaccination will be shown. Similarly,
drugs can contribute to the onset of several geriatric syn-
dromes or worsen cognitive status, but such interactions are
rarely considered as factors limiting their use. This presen-
tation will also include original data from nursing homes,
home care, and acute care hospitals showing the relation-
ship between drug interactions and geriatric syndromes and
cognition.
SESSION 340 (SYMPOSIUM)
MIDLIFE VASCULAR FACTORS, LATE-LIFE HEARING
LOSS AND FUNCTIONAL DECLINE: INSIGHTS FROM
THE ARIC STUDY
Chair: J.A.Deal, Johns Hopkins University, Baltimore,
Maryland
Discussant: K.J.Bandeen-Roche, Johns Hopkins University
Strategies for the prevention of late-life decline in cogni-
tive and physical function are informed by methodologically-
sound observational studies that can identify factors which
influence health processes occurring over long periods of
is an ongoing, prospective observational study of 15,792
men and women (27% African American) aged 4564 at
baseline (19871989) from four U.S.communities. Initially
designed to investigate the epidemiology, causes and clini-
cal consequences of atherosclerosis, ARIC is now in its 6th
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
round of data collection. With rich data on midlife vascular
factors and markers, audiometric hearing assessment at Visit
6 (201617), over 20years of cognitive testing, and exten-
sive late-life testing of neurocognitive and physical function,
ARIC is uniquely suited to evaluate the role of midlife vas-
cular determinants and late-life hearing impairment on func-
tional decline in older adults.
In this symposium, we will discuss solutions to meth-
odological challenges of long-term observational follow-
up of functional outcomes from mid- to late-life, including
harmonization of different cognitive measures across study
visits and informative attrition over time, and present recent
results that contribute to our understanding of the relation-
ship of midlife glucose peaks and cognitive decline in older
age, mid- to late-life body mass index trajectories and gait
speed in late-life, and midlife cardiovascular health with late-
life frailty. We will also present observational results of the
relationship between hearing impairment and cognitive func-
tion, and discuss the design of ACHIEVE, a best practices
hearing intervention vs. successful aging randomized trial,
nested within the ARIC study.
GLUCOSE PEAKS AND COGNITIVE DECLINE:
ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC)
STUDY
A.Rawlings1, A.Sharrett1, T.H.Mosley2, S.Ballew1,
J.A.Deal1, E.Selvin1, 1. Johns Hopkins University,
Baltimore, Maryland, 2. University of Mississippi Medical
Center, Jackson, Mississippi
Diabetes and HbA1c are associated with cognitive
decline, but the role of glucose peaks is unclear. We exam-
ined the association of glucose peaks in midlife, measured
by 1,5-anhydroglucitol(1,5-AG) at baseline(19901992) and
20-year cognitive decline, in 12996 ARIC participants(mean
age 57, 13% with diabetes). Cognition was assessed using
three neuropsychological tests at three time points from
19902013(summarized as Z-score). Low 1,5-AG(<10 g/
mL, indicating hyperglycemic peaks) was examined within
clinical categories of HbA1c using adjusted mixed models.
We found no association between glucose peaks and cog-
nitive decline in persons without diabetes. In persons with
diabetes and Hb1c<7%, those with glucose peaks had 0.19
greater Z-score decline over 20-years compared to per-
sons without peaks(p-value=0.162). In persons with dia-
betes and HbA1c7%, those with glucose peaks had 0.38
greater Z-score decline compared to persons without glucose
peaks(p-value=<0.001). More research is needed to deter-
mine if targeting glucose peaks among persons with diabetes
can reduce cognitive decline.
THE RELATIONSHIP OF MID-TO-LATE-LIFE BODY
MASS INDEX TRAJECTORIES WITH LATE-LIFE GAIT
SPEED
B.Windham1, M.E.Griswold1, W.Wang1, A.Kucharska-
Newton2, L.A.Pompeii3, S.B.Kritchevsky4, T.H.Mosley1,
1. Medicine/Geriatrics, University of Mississippi Medical
Center, Jackson, Mississippi, 2. University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, 3.
University of Texas Health Science Center, Houston, Texas,
4. Wake Forest School of Medicine, Winston-Salem, North
Carolina
IAGG 2017 World Congress
81
Prior studies suggest being overweight in late-life may
protect against poor function. Relations of BMI trajectories
over 26years at five visits (19872013, baseline n=15,720,
aged 45-64yrs; 55% women; 27% black) to late-life gait
speed at the fifth visit (aged 65yrs, n=6,229) were exam-
ined using linear mixed models, adjusting for demographics
and comorbidities. Late-life gait speed was 94.3, 89.6 and
82.1cm/sec for participants with mid-life normal BMI (25),
overweight (25BMI30) and obese (BMI30) (p0.001).
Late-life gait speed was 96.9, 88.8 and 81.3cm/s for par-
ticipants who maintained normal, overweight and obese
BMI across 26years (p0.01). A1%/year BMI increase for
a participant with a baseline BMI=22.5 (final BMI 28.5) was
associated with a 4.6cm/s (95% CI: -7.0, -1.8) slower late-
life gait speed than a participant who maintained a baseline
BMI=22.5. Maintaining a normal BMI in mid- and late-life
may help preserve late-life mobility.
AMERICAN HEART ASSOCIATIONS LIFES SIMPLE 7
IN MIDLIFE AND FRAILTY IN LATE LIFE: THE ARIC
STUDY
P.Palta1, A.Kucharska-Newton1, S.Lirette2, J.L.Lund1,
A.Folsom3, R.Foraker4, K.J.Bandeen-Roche5,
B.Windham2, 1. University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, 2. University
of Mississippi Medical Center, Jackson, Mississippi, 3.
University of Minnesota, Minneapolis, Minnesota, 4. The
Ohio State University College of Public Health, Columbus,
Ohio, 5. Johns Hopkins University, Baltimore, Maryland
The etiology of frailty remains poorly understood, yet
is not completely explained by comorbidity and disability.
We tested the hypothesis that ideal cardiovascular health, as
measured by AHAs Lifes Simple 7 (LS7) in mid-life (1987
1989), is associated with a lower prevalence of frailty in late-
life (20112013). The LS7 cardiovascular health score (014
points) is a summary of 7 health behaviors/factors scored as
ideal (2 points), intermediate (1 point), or poor (0 points).
Participants were classified as frail, pre-frail or robust
using established criteria. Each 1-point higher LS7 score was
associated with a 19% (95%CI: 16%, 22%) higher preva-
lence of being classified as robust versus pre-frail, and a 34%
(95%CI: 27%, 41%) higher prevalence of being classified as
robust versus frail in late-life. Among the LS7 components,
ideal levels of body mass index, physical activity, blood pres-
sure, and glucose in mid-life were most strongly associated
with prevention of frailty in late-life.
HEARING LOSS AND COGNITIVE DECLINE
OBSERVATIONAL RESULTS AND EMBEDDING OF
ARANDOMIZED TRIAL IN ARIC
F.Lin1, J.A.Deal1, T.Chisolm2, N.W.Glynn4, S.Davis3,
T.H.Mosley5, J.Coresh1, 1. Johns Hopkins University,
Baltimore, Maryland, 2. University of South Florida,
Tampa, Florida, 3. University of North Carolina, Chapel
Hill, North Carolina, 4. University of Pittsburgh,
Pittsburgh, Pennsylvania, 5. University of Mississippi,
Jackson, Mississippi
Hearing loss (HL) is independently associated with accel-
erated cognitive decline and an increased risk of incident
dementia. The Aging, Cognition, and Hearing Evaluation
in Elders (ACHIEVE) randomized trial is being planned to
82
determine if hearing loss treatment versus a successful aging
control intervention can reduce the risk of cognitive decline
in older adults. This trial will be nested within ARIC, and a
pilot study was recently completed that established trial fea-
sibility and intervention efficacy. In this 6-month pilot study
of 40 individuals aged 7084years, the hearing intervention
demonstrated a clear efficacy signal on communication and
social functioning (domains hypothesized to mediate down-
stream effects of HL on cognitive decline). Estimated changes
in standardized (z-score) outcomes were qualitatively differ-
ent by intervention assignment for all measures, including
perceived handicap due to hearing loss (HHIE, p<0.0001),
loneliness, number of contacts (p= 0.007) and diversity of
social network, and social, mental, and physical function.
APPLICATION OF LATENT VARIABLE METHODS TO
THE STUDY OF COGNITIVE DECLINE WHEN TESTS
CHANGE OVER TIME
A.Gross1,2, S.Burgard3, S.Davis3, J.A.Deal1,2, T.H.Mosley4,
J.Coresh1, A.Sharrett1, 1. Department of Epidemiology,
Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, 2. Johns Hopkins University Center
on Aging and Health, Baltimore, Maryland, 3. Department
of Biostatistics, UNC Gillings School of Global Public
Health, Chapel Hill, North Carolina, 4. Department of
Medicine, University of Mississippi Medical Center, Jackson,
Mississippi
We demonstrated the use of factor analysis to link dif-
fering cognitive batteries over ARIC-NCS visits to common
metrics representing general and domain-specific cognition.
We used 23 years of data from the Atherosclerosis Risk in
Communities Study (ARIC-NCS) (N=14,252). Using gen-
eralized estimating equations, we compared associations of
diabetes with cognitive change using general and domain-
specific factor scores vs. z- scores. Factor scores provided
stronger associations with diabetes at the expense of greater
variability around estimates (e.g., for executive functioning,
-0.065 SD units/year, SE=0.015, vs -0.057 SD units/year,
SE=0.013), suggesting factor scores more explicitly address
error in measured traits. We calibrated general and domain-
specific cognitive performance across study visits in which
different but overlapping cognitive tests were administered
at each visit. Factor analysis facilitates use of all available
data when measures change over time. We further demon-
strate how to estimate factor scores during real-time data
collection to enable selection into further screening.
SESSION 345 (PAPER)
MULTI-MORBIDITY AND ENVIRONMENTAL
FACTORS AFFECTING GAIT AND FUNCTION
MULTI-MORBIDITY PATTERNS AND DISABLEMENT
SEVERITY AMONG MOBILITY LIMITED OLDER
ADULTS
M.E.Jacob1,2,3, P.Ni1, E.Leritz2,3, J.Driver2,3, S.G.Leveille4,
A.M.Jette1, J.F.Bean2,3, 1. Health and Disability Research
Institute, Boston University, Brookline, Massachusetts, 2.
New England GRECC, VA Boston Healthcare System,
Boston, Massachusetts, 3. Harvard Medical School, Boston,
Innovation in Aging, 2017, Vol. 1, No. S1
Massachusetts, 4. University of Massachusetts Boston,
Boston, Massachusetts
Multi-morbidity contributes to functional decline among
older adults. However, it is not evident whether specific pat-
terns of multi-morbidity are associated with worse disable-
ment outcomes. We analyzed baseline data from the Boston
RISE study, a cohort of older primary care patients with
mobility limitations, to examine the association between
multi-morbidity patterns and neuromuscular impairments
and function. Participants(n=425) self-reported 13 major
chronic conditions and underwent assessment of impair-
ments (leg strength, leg velocity, trunk extensor endurance,
leg range of motion, sensation) and function (400 m walk
test, Short Physical Performance Battery (SPPB), Late Life
Function and Disability Instrument (LLFDI)). We conducted
Latent Class Analysis among the chronic conditions and
examined impairments and functional status among different
latent classes. LCA identified a high multi-morbidity group
with high prevalence of cardiovascular, metabolic and mus-
culoskeletal diseases (Class 1), a low multi-morbidity group
(Class 2)and a musculoskeletal group with high prevalence
of arthritis, back pain and osteoporosis, but few other condi-
tions (Class 3). After adjusting for age and gender, Class 1
had significantly lower strength, range of motion, SPPB score,
gait speed and LLFDI scores compared to Class 2.However,
Class 3 demonstrated less range of motion impairment and
similar SPPB, gait speed and LLFDI scores compared to Class
2 but similar pain levels to Class 1.Among mobility limited
older adults, a sub group with predominantly musculoskel-
etal conditions did not have worse neuromuscular impair-
ments or function than a healthier sub-group; the sub-group
with co-occurring musculoskeletal conditions and other co-
morbidities had the worst impairments and function.
IS NEURAL CONTROL OF WALKING IMPORTANT
BEYOND GAIT SPEED?
J.M.Van Swearingen, C.Smith, L.Coffman, S.Perera,
J.Brach, University of Pittsburgh, Pittsburgh, Pennsylvania
Gait speed is a robust index of walking and functioning,
but may not represent neural control of walking. Integrating
spatial and temporal aspects of gait, the walk ratio (WR, step
length/step rate) is a measure of neural control and is associ-
ated with energy expenditure. We explored the WR in rela-
tion to mobility-related endurance (6-minute walk. 6MWD)
and walking confidence (modified Gait Efficacy Scale) in
older adult participants in a community-based trial (n=391;
mean age, 80.57.7years). Gait speed was 0.920.21 m/s
and WR 0.00480.0008 m/steps/min. Adjusting for gait
speed, a 0.001 m/steps/min difference in WR was associated
with 15 meters in 6MWD and 2.5 points in confidence (both
p<0.005). A clear gradient of mobility-related performance
across WR quartiles was observed within quartiles of gait
speed. Those who walked within the narrow gait speed range
of 0.770.90 m/s, 6MWD ranged 237281 meters and confi-
dence ranged 71.177.1 points across WR quartiles. Among
those with gait speed>1.04 m/s, 6MWD ranged 317369
meters and confidence 75.884.1 points across WR quar-
tiles. Good and poor neural control of walking are possible
at both slower and faster gait speed, and is associated with
endurance and confidence independent of gait speed. Neural
control of walking is an important aspect of gait and should
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
be considered in assessment and intervention in community-
dwelling elderly.
AGE-ASSOCIATED FACTORS CONTRIBUTING TO
OBSTACLE NEGOTIATION ABILITIES: NOT ALL IS AS
EXPECTED
S.Eyal2,4, I.Kurz1,4, A.Mirelman4,6, I.Maidan4, N.Gil nity-dwelling adults age 75 identifying predictors of mobil-
adi5,6,3, J.M.Hausdorff4,2,3, 1. Department of Physical
Therapy, Faculty of Health Sciences, Ben-Gurion University
of the Negev, Beer-Sheva, Israel, 2. Department of Physical
Therapy, Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel, 3. Sagol School of Neuroscience, Tel Aviv
University, Tel Aviv, Israel, 4. Center for the Study of
Movement, Cognition, and Mobility, Tel Aviv Sourasky
Medical Center, Tel Aviv, Israel, 5. Neurological Institute,
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, 6.
Department of Neurology, Tel Aviv University, Tel Aviv, Isr
ael
Tripping over an obstacle is one of the most common
causes of falls among older adults. Using an innovative, com-
puter controlled, obstacle course, we evaluated age-associ-
ated changes in the ability to negotiate obstacles and the
role of obstacle parameters (e.g., expected vs. unexpected,
height and available response time (ART), and subject
characteristics (e.g., executive function, gait and balance).
Twenty healthy older adults (77.73.4years; 50% women)
and 20 healthy young adults (29.33.8years; 50% women)
underwent cognitive, gait and balance testing before negoti-
ating the computer controlled obstacle course. The primary
outcome measure was the ability to successfully negotiate
the obstacles (without touching); independent variables
included the obstacle height and ART. As hypothesized,
the success rate (SR) for all subjects was higher when the
obstacle was expected (99.02.8%; compared to unex-
pected 66.020.2%; p<0.001). With an obstacle height of
25mm and an ART of 225msec, SR was lower (p<0.001)
among older adults (50.040.4%), as compared to young
adults (1000.0%). For all subjects, the effect of unex-
pected obstacle height on SR was opposite to our hypothe-
sis; surprisingly, SR was lower when the obstacle height was
higher (p<0.001). For young adults, SR was related to ART
(p=0.02), however, for the older adults, SR was not related
to ART. Among the older adults, SR was correlated with
stride length (rs=0.42, p=0.039) and Trail Making Test B
(rs=-0.38, p=0.055). These findings provide new insights into
the ability of older adults to successfully negotiate obstacles
and help to better understand the mechanisms that underlie
this everyday skill.
LIFE-SPACE PREDICTS HEALTHCARE UTILIZATION
IN COMMUNITY-DWELLING OLDER ADULTS
R.E.Kennedy1, C.Williams1, P.Sawyer1, A.Lo3,
K.Connelly2, A.Nassel4, C.Brown1, 1. Gerontology,
Geriatrics, and Palliative Care, The University of Alabama
at Birmingham, Birmingham, Alabama, 2. Indiana
University, Bloomington, Indiana, 3. Emergency Medicine,
The University of Alabama at Birmingham, Birmingham,
Alabama, 4. School of Public Health, The University of
Alabama at Birmingham, Birmingham, Alabama
The UAB Life-Space Assessment (LSA) is a validated
patient-reported outcome to measure community mobility
IAGG 2017 World Congress
83
and social participation. We have previously shown that LSA
predicts adverse health outcomes including mortality, nurs-
ing home admission, and cognitive decline, but the role of
life-space in healthcare utilization among older adults in gen-
eral is not known. Participants (N=400) were drawn from
the UAB Study of Aging II, a longitudinal study of commu-
ity decline. LSA scores at each monthly follow-up interview
were used to predict emergency department (ED) visits and
hospitalizations over the next 30days using generalized esti-
mating equations, adjusting for baseline age, race, gender,
education, Charlson comorbidity score, physician visits in
the last month, and living alone. Over 35-months of follow-
up, 55.8% of participants reported at least one ED visit or
hospitalization. In multivariable models, a 10-point lower
life-space was associated with a 12% increase in healthcare
utilization (p<.0001). Further investigation is warranted on
the utility of life-space scores for predicting unnecessary
healthcare utilization and identifying conditions that can be
managed in a less intense setting.
FROM HEAD TO TOE, FREQUENCY OF COGNITIVE
ACTIVITIES IS ASSOCIATED WITH SHORTER FOOT
REACTION TIME
Y.Cai1, S.G.Leveille1,2,3, J.M.Hausdorff4, J.F.Bean3,5,
B.Manor3,6, T.You1, 1. University of Massachusetts Boston,
Boston, Massachusetts, 2. Beth Israel Deaconess Medical
Center, Boston, Massachusetts, 3. Harvard Medical School,
Boston, Massachusetts, 4. Tel Aviv University, Tel Aviv,
Israel, 5. Veterans Administration Boston Health System,
Boston, Massachusetts, 6. Hebrew SeniorLife, Boston,
Massachusetts
Cognitively stimulating activities can improve both
cognitive and physical function. Foot reaction time, a test
of neuromotor performance and a possible risk factor for
falls in older adults, might be influenced by participation
in cognitively stimulating activities. The aim of this cross-
sectional study was to examine the association between cog-
nitive leisure activities and foot reaction time. We studied
310 community-dwelling older adults aged 71 to 101years
(mean=84.0y), in the MOBILIZE Boston Study II. Simple
foot reaction time (SRT) and choice foot reaction time (CRT)
were measured as time to initiation of movement in response
to an intermittent light stimulus, seated with feet placed on
a gait mat (CIR Systems, Inc., Franklin, NJ). The Cognitive
Activity Scale (CAS), assessed frequency of participation in
17 cognitive leisure activities. SRT and CRT ranged from
0.17 to 0.55ms (mean=0.250.06ms), and 0.21 to 0.72ms
(mean=0.320.08ms), respectively. Average SRT and CRT
were shorter according to higher CAS scores. In multivariable
models adjusted for age, sex, race, education, mobility diffi-
culty, peripheral arterial disease, and number of joint pain
sites, CAS scores were associated with shorter SRT (p=0.02)
and CRT (p=0.01). The association persisted but was weaker
after further adjusting for gait speed (SRT, p=0.05; CRT,
p=0.03). Adjustment for vision impairment did not alter the
relationship between CAS and reaction time. These results
show that participation in cognitively stimulating activities is
associated with shorter foot reaction time. Further research
is needed to determine whether participation in cognitive
activities could reduce fall risk in older adults.
84
SESSION 350 (SYMPOSIUM)
BIOMARKERS AND LONGITUDINAL TRAJECTORIES
OF STRESS AND NEUROCOGNITIVE DISORDERS
Chair: C.E.Gould, VA Palo Alto Health Care System,
California
Discussant: R.OHara, Stanford University School of
Medicine, Stanford, California
Longitudinal studies provide insight into the development
and course of stressors, anxiety, and neurocognitive disorders
across the lifespan. The presenters in this symposium will
consider the effect of genetic risk factors, combined genetic
and environmental influences, and environmental stressors on
physical and cognitive health trajectories. Presenters will dis-
cuss data from four unique longitudinal studies conducted in
three countries: Brazil, Sweden, and the United States. These
longitudinal studies utilize self-report, neuropsychological
and biological measures to characterize aging processes as the
presenters will describe. The first presenter, Dr. Lee, will con-
sider the differential impact of major life stressors compared
with daily stressors on physical health in the VA Normative
Aging study. Second, Dr. Castro Costa will discuss the impact
of genomic ancestry on depressive symptoms in a population-
based cohort. Third, Dr. Petkus will describe the trajectories
of anxiety and cognitive performance across the lifespan and
the extent to which genetic and environmental influences
explain these associations. Finally, Dr. Hirst will consider spe-
cific genetic risk factors for declines in list recall, a very sensi-
tive predictor of cognitive decline. Dr. Ruth OHara will serve
as the discussant and will guide the audience in considering
how these findings from the influential multinational longi-
tudinal studies may inform the development and course for
physical and neurocognitive problems in late life.
STRESS AND HEALTH IN LATER LIFE:
ACOMPARISON OF MAJOR LIFE EVENTS AND
DAILY STRESSORS
L.O.Lee, A.Spiro, Psychiatry, Boston University School of
Medicine, Arlington, Massachusetts
Major life events (LEs) and daily stressors (DSs) have
been linked independently to morbidity and mortality. This
study compared how LEs and DSs were related to 3 health
outcomes: change in health conditions and BMI, and all-
cause mortality. We used longitudinal and daily diary data
from 173 older adults in the VA Normative Aging Study. Self-
reported LEs and DSs were assessed in 20023, and health
conditions in 20023 and 20045. BMI was measured in
triennial examinations. Mortality information was available
through 3/2014. Separate regression models were used for
each outcome, adjusting for age, sex, smoking, and drinking.
Those with more LEs, but not DSs, showed an increase in
health conditions over time. In contrast, more DSs, but fewer
LEs, were associated with increase in BMI. In Cox regression
models, neither LEs nor DSs predicted all-cause mortality.
Findings demonstrate that the effects of stress on health vary
across outcome and stressor type.
GENOMIC ANCESTRY AND THE RISK OF
DEPRESSIVE SYMPTOMS IN OLD ADULTS
E.Castro-Costa, Centro de Pesquisas Ren Rachou
(CPqRR), Belo Horizonte, Brazil
Innovation in Aging, 2017, Vol. 1, No. S1
Genomic ancestry is well-known moderator factor of
several chronic health conditions in general population.
However, there are few evidences about the impact of
genomic ancestry on depressive symptoms, particularly, in
older adults. The aim of this longitudinal analysis is to evalu-
ate the relationship between genomic ancestry and depres-
sive symptoms in older adults from population-based cohort.
We found that highest proportion of African ancestry was
associated with depressive symptoms after controlling for
potential confounders.
LONGITUDINAL ASSOCIATION OF ANXIETY
AND COGNITIVE PERFORMANCE: GENETIC AND
ENVIRONMENTAL INFLUENCES
A.Petkus1, C.A.Reynolds2, M.Gatz1, 1. University of
Southern California, Los Angeles, California, 2. University
of California, Riverside, Riverside, California
The extent to which genetic and environmental influ-
ences explain longitudinal associations between anxiety
symptoms and worse cognitive performance in later life
is unknown. This study sample included 778 twins from
the Swedish Adoption/Twin Study of Aging who completed
at least one of seven assessments of anxiety and cognition
over a 26-year period. Multi-level random coefficients mod-
els were fit to examine average trajectories of anxiety and
cognitive performance over age. Multivariate Cholesky-
ACE models were fit to decompose the variance and covari-
ance between the estimated age 65 score (intercept) and
estimated age effects (linear and quadratic) of anxiety and
each cognitive test. Higher estimated anxiety was associ-
ated with worse processing speed, nonverbal memory, and
visuospatial ability at age 65. Overlap in genetic influences
between anxiety and cognitive performance contributed to
these associations. Shared environmental contributions on
level of anxiety and linear age changes in processing speed
tests were also found.
GENETIC VARIATIONS IN 5-HTTLPR GENE AFFECT
MEMORY PERFORMANCE IN OLDER ADULTS:
ALONGITUDINAL STUDY
R.Hirst1, R.OHara2, 1. Palo Alto University, Palo Alto,
California, 2. Stanford University School of Medicine,
Stanford, California
The SS allele of the 5-HTTLPR serotonin transporter gene
has been linked with greater risk for anxiety, depression,
and cognitive impairment, particularly in memory, in older
adults. However, no longitudinal studies have examined this
association. Community-dwelling older adults (n = 157;
mean age=71.45years, SDage=9.02) completed baseline
genetic, cognitive, and psychological testing as part of a lon-
gitudinal study at our laboratory, with repeat cognitive and
psychological testing at 12-month and 24-month follow-up.
Conditional growth modeling revealed that, after controlling
for depression (BDI-2 score), SS allele carriers performed
worse than LL and LS carriers at baseline on delayed ver-
bal recall (Rey Auditory Verbal Learning Test). However, SS
carriers memory performance was stable over the two-year
period, while LL and LS allele carriers experienced decline.
At two years, recall performances of the three groups were
indistinguishable. Findings suggest an interactive effect of
genetic status on memory over time.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 355 (PAPER)
THE ROLE OF FITNESS TRAINING IN IMPROVING
HEALTH OUTCOMES
THE PROBALANCE RANDOMIZED CONTROLLED
TRIAL: FOCUS ON STRENGTH AND GAIT OF OLDER
ADULTS
B.R.Gouveia1,2,3, E.R.Gouveia2,5, A.Ihle2,8, H.G.Jardim6,
M.M.Martins4, D.L.Freitas5, J.A.Maia7, M.Kliegel2,8, 1.
Saint Joseph of Cluny Higher School of Nursing, Funchal,
Portugal, 2. Center for the Interdisciplinary Study of
Gerontology and Vulnerability - University of Geneva,
Geneva, Switzerland, 3. Institute of Biomedical Sciences
Abel Salazar, University of Porto, Porto, Portugal, 4. Higher
School of Nursing of Porto, Porto, Portugal, 5. Department
of Physical Education and Sports, University of Madeira,
Funchal, Portugal, 6. Higher School of Health, University
of Madeira, Funchal, Portugal, 7. CIFID, Faculty of Sport,
University of Porto, Porto, Portugal, 8. Department of
Psychology, University of Geneva, Geneva, Switzerland
This study aimed to assess the effect of the ProBalance
rehabilitation program on strength and gait of community-
dwelling older adults with balance impairments, aged 6585.
In this single-blind randomized controlled trial, the interven-
tion included gait, balance, functional training, strengthening
and endurance, flexibility, and 3D training. It was delivered
by one rehabilitation nurse on a group basis (90-min ses-
sions, twice/ week, for 12 weeks). Controls maintained usual
activities. Strength was assessed by chair stand and arm curl
tests. Gait velocity, stride length, and cadence were derived
from the 30-foot walk-test. Assessments were at 0 (pretest),
12 (posttest), and 24 weeks (follow-up). Statistical analysis
included descriptive and t-test statistics and mixed-ANOVAs.
Of 177 participants assessed, 52 were randomized (IG, n=27;
CG, n=25).
No significant differences were seen in the CG across
time. The IG showed significant improvements in strength at
posttest, for the lower and upper body [2.42(1.70), p<0.001;
2.23(2.55), p<0.001, respectively]. At follow-up, a signifi-
cant decrease was seen [-1.15(1.76), p=0.003; 1.73(1.97),
p<0.001, respectively]. A mixed-ANOVA (physical activ-
ity and age as covariate) detected a large interaction effect
for strength tests. For gait parameters, there were only sig-
nificant increases in gait velocity and cadence at maximal
speed, at posttest [0.21(0.20); p<0.001; 0.22(0.31); p=0.002,
respectively], with a large effect size for group in velocity and
large interaction effect in cadence. Increases in strength, gait
velocity and cadence (at maximal speed) can be attributed to
the intervention. At follow up, a detraining effect in strength
reinforces the indication of to maintain specific intervention.
Registration: ACTRN12612000301864.
TRANSLATING RESEARCH INTO PRACTICE USING
PATIENT-CENTRED VIDEOS: DEVELOPMENT AND
ANALYSIS OF UPTAKE
L.Giangregorio1,2,3, C.Ziebart1, C.McArthur1,
A.Cheung2,4, J.Laprade4, R.Jain5, L.Lee6,
A.Papaioannou6,3, 1. Kinesiology, University of Waterloo,
Waterloo, Ontario, Canada, 2. University Health Network,
Toronto, Ontario, Canada, 3. Geriatric Education and
IAGG 2017 World Congress
85
Research in Aging Sciences Centre, Hamilton, Ontario,
Canada, 4. University of Toronto, Toronto, Ontario,
Canada, 5. Osteoporosis Canada, Toronto, Ontario,
Canada, 6. McMaster University, Hamilton, Ontario,
Canada
Purpose: We used patients input and behaviour change
theory to design a video series on the Too Fit To Fracture
physical activity recommendations. The aim of this work is
to describe series development and report on uptake.
Methods: Focus groups and interviews were conducted
with older adults across Ontario, with purposeful sampling
by gender and urban/rural location. Two researchers coded
data and identified emerging themes, categorized as repre-
senting capability, opportunity and motivation in accord-
ance with the Behaviour Change Wheel. Themes informed
a 13-part video series featuring patient stories, answers to
common questions, and functions: modeling, persuasion,
training, incentivisation, education and enablement. Videos
featured cases of variable age and gender, and addressed
noted barriers or patient questions. Media communications
were the primary delivery method. Uptake over 7 months
was estimated as views in total and by region.
Results: Since their release in November 2015, videos
were shared by the Canadian Society for Exercise Physiology,
Osteoporosis Canada, American Society for Bone and
Mineral Research and the International Osteoporosis
Foundation, and in traditional and social media. Videos were
viewed 20,800 times in 86 countries. Audiences were primar-
ily in Canada (16898 views, 81% of total) and the United
States (2060 views, 10% of total) and other English-speaking
countries (744 views, 4% of total). Average duration of
views in English-speaking countries was 78% compared to
60% elsewhere. Within Canada, rural residents accounted
for 22% of the viewership, slightly above the proportion of
rural Canadians (19%). Nearly half of views were within the
month of release when promotion was active. Another spike
came after traditional media articles about the work of one
of the authors and cited the videos.
Conclusions: Partnering with knowledge users to cre-
ate patient-centred, theory-informed, educational tools and
delivery strategies resulted in broad uptake.
EFFECTS OF TAI CHI ON MULTISITE PAIN AND
PHYSICAL FUNCTION IN OLDER ADULTS
E.Ogawa1, T.You1, S.Thapa1, Y.Cai1, G.Yeh2,3, P.Wayne3,
L.Shi1, S.G.Leveille1, 1. University of Massachusetts
Boston, Boston, Massachusetts, 2. Beth Israel Deaconess
Medical Center, Boston, Massachusetts, 3. Harvard Medical
School, Boston, Massachusetts
Chronic pain is associated with a decline in physical
function and an increased risk of falls in older adults. This
study examined the effects of Tai Chi on pain severity, pain
interference and physical function in older adults with mul-
tisite pain. Fifty-four community-dwelling older adults with
multisite pain who reported falling in the past year or cur-
rently used an assisted device were randomized into a light
exercise program or a Tai Chi program offered twice a week
for 12 weeks. Pain severity and pain interference were meas-
ured using subscales of the Brief Pain Inventory, and physical
function was measured by the Short Physical Performance
Battery (SPPB). Paired t-tests were used to assess changes
86
within each group, and independent t-tests were used to
assess differences between groups. Twenty-three participants
in the light exercise group and twenty-two participants in
the Tai Chi group completed the study. There were signifi-
cant improvements only in the Tai Chi group in pain severity
score (p=0.01) and pain interference score (p=0.04); how-
ever, there were no significant group differences in changes
of pain scores. There were no significant improvements in
SPPB scores in either group. Therefore, pain severity and
pain interference were improved after a 12-week Tai Chi
intervention in older adults with multisite pain; however,
no between-group differences were detected, likely due to a
small sample size. Alarger study with longer term is required
to examine the effectiveness of Tai Chi on multisite pain and
physical function in older adults. (Supported by NIH Grant
R21 AG043883)
THE EFFECT OF KINECT-BASED TAI-CHI
EXERGAMING PROGRAM ON OLDER ADULTS WITH
MILD DEMENTIA
P.Lin1,2,3, C.Hsieh1, Y.Wei1, Y.Hsu1, Y.Huang1, 1. actively struggle against being invisible to staff. Campbell
Department of Physical Therapy & Graduate Institute of
Rehabilitation Science, College of Medicine, Chang Gung
University, Taoyuan, Taiwan, 2. Healthy Aging Research
Center, Chang Gung University, Taoyuan, Taiwan, 3. Dept
of Internal & Geriatric Medicine, Chang Gung Memorial
Hospital, Linkou Branch, Taoyuan, Taiwan
Studies have shown Tai-Chis beneficial effects, but evi-
dence in those whom with cognitive impairment is limited.
There are growing applications of the interactive game-
Kinect in health promotion and rehabilitation to enhance
motivation and participation of the clients.
The purpose of this study is to investigate the effect of a
6-month kinect-based tai-chi program on physical and cog-
nitive function in mild demented older adults.
A convenient sample of older adults aged over 60 in day-
care centers were recruited and clustered randomized (by
center) to 6-month kinect-based tai chi exercise, 45min/
session, 2 times/week(N=20) or control groups(N=20).
Cognitive function (Cognitive Abilities Screening Instrument
(CASI)), physical fitness tests (grip strength, knee extension
strength, 30sec sit-to-stand, arm-curl test, timed up and go,
5-meter walking time, 6 minute walking distance(6-MWT),
functional reach(FR), chair sit-and-reach, and reaction time),
Geriatric Depression Scale and proxy reported quality of
life, MPBC behavior measure and Zarits caregiver burden
scale (ZCBS) were measured at baseline and after interven-
tion. Two-way (group time) repeated measure ANOVA was
adapted for analysis.
There were no significant differences of basic character-
istics between 2 groups. Significant interaction effects were
found in FR, 6-MWT, MPBC and ZCBS. For CASI score, the
interaction did not reach significance, but with the Tai-chi
group revealed relative maintenance and the control signifi-
cantly decline after 6month.
A 6-month kinect-based tai chi exercise program is fea-
sible, fun and effectiveness for the mild demented OAs in
improving balance, endurance and behavior problems,
reducing care burdens, and at least maintaining cognitive
function.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 360 (SYMPOSIUM)
WE ARE NOW THEY: OLD GERONTOLOGISTS
LIVING IN AGE-SEGREGATED HOUSING
Chair: M.S.Moss, Arcadia University
Co-Chair: H.Q.Kivnick, University of Minnesota, St. Paul,
Minnesota
Discussant: T.Sodei, Ochanomizu University, Tokyo, Japan
This symposium uses personal narratives to explore
the perspectives of four retired, long term gerontological
researchers (ages 70+ - 90+) on their current lives in some
form of senior housing community. Each presenter narrates
particular elements of her/his experience of living in an age-
segregated community as each one mediates personal expe-
rience on the basis of lifelong professional research, theory,
practice, and developing wisdom. Like most of us confer-
ence attendees, these presenters have all spent their careers
studying and writing about diverse aspects of aging adults
(Them). Now the presenters are also Them. Wyatt-
Brown describes living in a CCRC, where residents must
examines multiple aspects identity when living, suddenly,
in CCRC in a wholly new city. Moss and Moss focus more
explicitly on using particular gerontological theories to
meet the challenges of living in a retirement commmunity.
Co-chair/discussant Kivnick suggests additional gerontologi-
cal theories as relevant to these three sets of experience. She
also identifies common themes and unique issues for poten-
tial study, and highlights contributions that these and other
path breaking gerontologists can make to our fields under-
standing and societys optimal structuring of this part of the
experience of later life. Discussant Sodei broadens the session
by looking at the presentations and their issues through the
lens of Japanese gerontological practice and policy.
LIFE IN ACCRC: ON NOT BEING INVISIBLE
A.M.Wyatt-Brown, Program in Linguistics, University of
Florida, Baltimore, Maryland
In Aging in the Right Place, Stephen Golant (2015) argues
that CCRC residents must be able to trust the managers to
treat them empathically when residents need more advanced
care. True, but empathy is also necessary other times. When
managers at my CCRC forced out a beloved employee
for unexplained reasons, I began to resent my loss of the
autonomy that I had traded for long-term care. Managers
must understand, as Atul Gawande learned, (Being Mortal,
2014), that they cannot provide a supportive environment
unless they make residents feel understood and respected.
Surprisingly, when some of the hiring mistakes were cor-
rected, Ifound that a weight had been lifted. During the tur-
moil, Ilearned that Irelied on the comfort of my residential
friends. Unlike some people who make elders feel invisible
(Angell, 2014), fellow residents understand our dilemma. Yet
the staff in CCRCs should provide emotional support as well.
AGING OUT OF PLACE
R.Campbell, Turner Geriatric, University of Michigan, Ann
Arbor, Michigan
In December 2015, after ten years in Tokyo, and 35years
before that in Ann Arbor, Michigan, my husband and Imoved
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Innovation in Aging, 2017, Vol. 1, No. S1
to Piedmont Gardens, a CCRC in Oakland, California. As a
geriatric social worker, I had mixed feelings about moving
at age 77 to age segregated housing. Novels reinforced the
negative aspects of assisted living (Schine, 2016)although an
early study of retirement communities (Ross, 1977) found
many beneficial aspects. But the aging in place assumptions
about staying put (Scharlach, 2012)did not fit with my ideas
on continuity and change. My discoveries so far: 1)Moving
in as a couple facilitates adjustment; 2)My young grandchil-
dren enjoy frequent visits; 3)Living with ninety year olds has
deepened my understanding of aging; 4)Sharing my geron-
tological expertise is challenging; a low profile seems best;
5)The surprising sense of community with many unexpected
connections
ADAPTATION TO LIVING IN ARETIREMENT
COMMUNITY
M.S.Moss, S.Z.Moss, Arcadia University, Glenside,
Pennsylvania
For over one year, we have been residents of a very well
designed town house in a retirement community, that empha-
sizes independence over dependency. We are living the expe-
rience of old age, after studying it for decades. We are now
they. Thoughts of increasing frailty and death are in the air.
Our multiple challenges include: (1) maintaining and modi-
fying our social roles and outside ties to allow continuity
of our individual sense of personal identity (Atchley, 1971).
(2) Recognizing personal and societal themes of ageism,
(Calasanti, 2003), both inside and outside our retirement
community; and (3) adapting to and resisting the structures
of community living, to maximize our sense of residential
comfort and residential mastery (Golant, 2015). We discuss
how our gerontological perspectives are reflected in our
experience of living in an age-segregated community.
SESSION 365 (SYMPOSIUM)
THE GENETICS OF HUMAN AGING: RESULTS FROM
AWORLD-WIDE COLLABORATION
Chair: J.Murabito, Boston University School of Medicine,
Massachusetts
Co-Chair: D.Melzer, University of Exeter, Exeter, Devon,
United Kingdom
Most observational studies of human aging suffer from
confounding, but establishing links between inherited genetic
variation and human aging can provide robust insights.
Genetic evidence can help identify both biological path-
ways and also help prove the importance of environmental
and behavioral risks. In this symposium, we will present
work from a near global collaboration across the Cohorts
for Heart and Aging Research in Genomic Epidemiology
(CHARGE) consortium, the European Longevity consor-
tium, and the Chinese Longitudinal Healthy Longevity Study
as well as data from the UK Biobank investigating large
human samples and unique aging phenotypes to facilitate
gene discovery and uncover insights into aging biology. Dr.
Joris Deelen will present a 1000 Genome meta-analysis of
a novel longevity phenotype defined using age, gender and
country specific survival thresholds. Drs. Luke Pilling and
Janice Atkins will present data from analyses of parental
age at death in nearly 500,000 middle-aged offspring. Novel
IAGG 2017 World Congress
87
variants including one in the DNA repair pathway were
identified and follow-up analyses to explore mechanisms
underlying human aging will be presented. Dr. Daniel Evans
will present the Longevity Genomics project and website,
a resource to develop translational strategies to promote
longevity. The overall project approach is to use longevity
associated variants identified from GWAS, gene expression
studies and evidence from animal models to identify longev-
ity genes. Mendelian Randomization approaches will be used
to evaluate the impact of longevity genes on outcomes and as
potential targets for therapeutics.
WORLDWIDE GENOME-WIDE ASSOCIATION STUDY
OF LONGEVITY
J.Deelen2, D.Evans3, P.E.Slagboom4, J.Murabito1,
1. Boston University School of Medicine, Boston,
Massachusetts, 2. Max Planck Institute for the Biology of
Ageing, Cologne, Germany, 3. California Pacific Medical
Center Research Institute, San Francisco, California, 4.
Leiden University Medical Center, Leiden, Netherlands
Genome-wide association studies of survival to advanced
ages (i.e. above 90 or 100 years) have thus far identified a
limited number of longevity loci, i.e. TOMM40/APOE/
APOC1, FOXO3A and chromosome 5q33.3. To comprehen-
sively explore the genetic architecture of human longevity,
we initiated the largest international GWAS meta-analysis of
longevity to date, including studies from the U.S., Europe and
China. Genotypes were imputed using the 1000 Genomes
Phase 1 reference panel. We defined longevity using country,
gender, and birth cohort specific survival percentile cut-off
points, where cases were defined as individuals whose age
was above the 90th survival percentile and controls as those
whose age was below the 60th survival percentile at last cen-
soring. We currently have included over 10,000 cases and
20,000 controls and we expect the study size to increase even
further with additional collaborators. The results of the 1000
Genomes meta-analysis of longevity will be presented during
the meeting.
GENETIC VARIANTS FOR AGING WELL SUGGEST
POTENTIAL FOR INTERVENTION
L.C.Pilling, J.Atkins, D.Melzer, University of Exeter
Medical School, Exeter, United Kingdom
The UK Biobank is a cohort of 500,000 European origin
volunteers. In our preliminary analysis of participants aged
5570 against parental age at death, we identified several
novel variants including one in a DNA repair pathway. We
also found strong associations with known genetic variant
counts for many common conditions and traits, especially
for smoking, high blood pressure and cholesterol levels, obe-
sity linked variants and others. We will present results for all
500,000 European origin subjects plus an overview of results
from similar studies of Asian, African and other groups. In
addition to promising new mechanistic insights, the results
underline the importance of preventable risk pathways in
human aging.
CAN GENETICS CLARIFY THE RISK PARADOXES OF
LATER LIFE?
J.Atkins, L.C.Pilling, D.Melzer, K.Bowman, University of
Exeter Medical School, Exeter, United Kingdom
88
Observational studies of aging cohorts often produce par-
adoxical associations between known risk factors (such as
obesity) and later life outcomes. These paradoxes may be due
to confounding from mixing together fit and frail groups,
and from the impact of sub-clinical pathology on behaviors
and exposures. In this presentation we will explore the role
of genetics in clarifying these paradoxes.
Associations between germline genetic variants and phe-
notypes cant be confounded by the usual behavioral and
social factors. Therefore so-called Mendelian Randomization
analyses provide robust evidence for causal influences and
pathways involved in health outcomes. We will provide an
overview of the accumulating evidence from genetics to sup-
port the role of key risk factors and clarify claimed para-
doxes. We will also present our own analyses, for example
showing that body mass index related genetic variation does
not support a paradoxical protective effect of being over-
weight or obese in later life.
TRANSLATIONAL STRATEGIES TO PROMOTE
HEALTHY AGING: LONGEVITY GENOMICS
RESEARCH GROUP
D.Evans1, K.Bhutani5, G.J.Tranah1, T.Girke2,
N.J.Schork3, S.Melov4, S.R.Cummings1, 1. California
Pacific Medical Center Research Institute, San Francisco,
California, 2. University of California Riverside, Riverside,
California, 3. J. Craig Venter Institute, La Jolla, California,
4. Buck Institute for Research on Aging, Novato, California,
5. University of California San Diego, San Diego, California
The Longevity Genomics Research Project is designed
to create a publicly-available research resource available
through its website (www.longevitygenomics.org) to ena-
ble scientists to develop translational strategies to promote
human longevity and healthy aging. Our resource will con-
sist of software tools as R packages, curated datasets, and
project results. We will identify Longevity-Associated Genes
(LAGs) from Longevity-Associated Variants (LAVs), gene
expression studies of aging, and evidence from model organ-
isms. Mendelian Randomization using cohort studies with
genetic data and longitudinal measures of aging-related traits
will be used to evaluate the potential impact of modulating
LAGs on longevity. Candidate Longevity-Associated Drugs
(LADs) that target LAG activity are then identified. Using
sets of genes whose expression changes with age, we will
report associations between genetically predicted expression
of these genes and human survival, followed by connectiv-
ity map analysis to identify compounds that could target the
expression of these genes.
SESSION 370 (SYMPOSIUM)
MANIFESTATIONS OF WISDOM IN REAL-LIFE
EXPERIENCES
Chair: N.M.Weststrate, University of Toronto, Toronto,
Ontario, Canada
Discussant: C.M.Aldwin, Oregon State University,
Corvallis, Oregon
In the last 30 years, the scientific study of wisdom has
flourished. Significant advancements have been made in
terms of the definition and measurement of wisdom. Less
work, however, has examined how wisdom manifests in, and
Innovation in Aging, 2017, Vol. 1, No. S1
develops from, real-life experiences. This is a noteworthy gap
in the literature, given that wisdom is a highly contextual
phenomenon that is intimately connected to real-life situa-
tions, such as the management of difficult life events.
This symposium examines wisdom in relation to real-life
experiences using a diverse range of ecologically rich method-
ologies that draw on research from North America, Europe,
and the Middle East. These studies define real-life experience
in a variety of ways, ranging from relatively mundane daily
hassles to momentous and life-changing events.
Using a daily-diary methodology, Beichler and Glck
report on how wise and less wise individuals experience
everyday hassles and uplifts, with a focus on individuals
emotional appraisals of these relatively common events. At
the level of momentous life experiences, two presentations
address the role of wisdom in positive and negative relation-
ship experiences. Farjam, Asadi, and Abadi present on differ-
ences in wisdom across groups of divorced and non-divorced
women. Auer-Spath and Glck report on the role of wisdom
and wisdom-related resources (e.g., empathy), in shaping
peoples views of the good marriage and their relationship
satisfaction. Finally, Weststrate, Ferrari, and Fournier pre-
sent on event content and self-reflective processing in midlife
adults autobiographical memories of wisdom-fostering life
experiences.
Carolyn Aldwin will discuss these presentations in relation
to the broader science of wisdom and optimal development.
WISDOM AND EVERYDAY REGULATION OF HASSLES
AND UPLIFTS
E.M.Beichler, Department of Developmental Psychology,
University of Klagenfurt, Klagenfurt, Krnten, Austria
Are wiser individuals happier than others, due to their
superior emotion-regulation skills, or even less happy
because of their awareness of the negative sides of life?
Recent resilience research suggests that being able to savor
the good things in life may be as important to living a good
life as being able to manage the difficult things. This study
investigates how wise and less wise individuals experience
and deal with daily hassles and uplifts.
Using a daily-diary method, 52 participants recorded
positive and negative experiences and their emotional reac-
tions twice a day for one week. They completed several self-
report and performance measures of wisdom in an earlier
study. Wiser participants reported the same number of daily
uplifts but fewer daily hassles and more low-arousal positive
emotions than less wise participants. Thus, wiser individuals
seem to be better able than others to savor daily uplifts and
deal constructively with daily hassles.
WISDOM AND THE GOOD MARRIAGE
I.Auer-Spath, Developental Psychology, University of
Klagenfurt, Klagenfurt, Austria, Austria
The development of human beings takes place in close
interaction with other people. Thus, it seems likely that rela-
tionships to others influence the development of wisdom.
Especially in the context of long-term relationships and the life
events that couples go through together, individuals personal
development may be closely linked to that of their partners.
As a first step toward investigating the role of relation-
ships in the development of wisdom, this study analyzed
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Innovation in Aging, 2017, Vol. 1, No. S1
relationships between participants levels of wisdom and
their views of a good relationship. Asample of 120 partici-
pants were interviewed about their views of a good relation-
ship. Wisdom, wisdom-relevant resources, and relationship
satisfaction were assessed using self-report and performance
measures.
The results showed significant relationships between
aspects of wisdom, especially those related to empathy, and
relationship satisfaction. In their accounts of a good relation-
ship, wiser individuals were more likely to emphasize accept-
ance of the other persons individuality.
DO DIVORCED AND NON-DIVORCED FEMALES
DIFFER IN WISDOM?
S.Asadi1, E.Farjam1, H.Zareei Mahmoudabadi1,
J.Glueck2, 1. Yazd University, Yazd, Yazd, Iran (the Islamic
Republic of), 2. Alpen-Adria University, Klagenfurt, Austria
According to the MORE Life Experience Model, the
experience of challenging life events, such as divorce or ill-
ness, interacts with personal resources to support the devel-
opment of wisdom. To investigate this empirically the current
study examined general and personal wisdom in divorced
and non-divorced Iranian females. Twenty divorced women
were recruited using a targeted sampling method and 20
non- divorced women were selected randomly. Participants
completed interview - based measures of the Berlin and
Bremen Wisdom Paradigms (Staudinger, 1994; Mickler &
Staudinger, 2008), which were transcribed and rated for the
five wisdom-related criteria. Intragroup results revealed that
divorced females scored higher in personal wisdom than
general wisdom, but there was no significant difference in
levels of personal and general wisdom among non-divorced
females. Moreover, intergroup comparisons failed to detect
a significant difference between the two groups for either
measure of wisdom. We conclude that divorce may provide
an opportunity for the development of personal wisdom, but
not general wisdom, and that increases in personal wisdom
after divorce may influence females ability to optimally man-
age their future lives.
WHAT THE FISHERWOMAN SAID TO THE BOY:
NARRATIVE CHARACTERISTICS OF WISDOM-
FOSTERING EVENT MEMORIES
N.M.Weststrate, M.Ferrari, M.A.Fournier, Applied
Psychology & Human Development, University of Toronto,
Toronto, Ontario, Canada
Despite the importance of wisdom to human flourishing,
little is known about how it is cultivated in people. Laypersons
and experts believe that wisdom develops through life expe-
rience, yet this assumption has lacked empirical scrutiny. To
address this, 502 midlife adults provided a written autobio-
graphical narrative about an event in their life where they
felt they grew in wisdom. A team of trained raters scored
these wisdom-fostering event memories for narrative content
(event type, cultural normativity, fundamentality, average
event valence), structure (narrative coherence), and process
(meaning-making and personal growth). Participants com-
pleted self-report and performance measures of general and
personal wisdom. In general, results suggest that negative,
fundamental, and culturally non-normative life events are
IAGG 2017 World Congress
89
especially important to wisdom development and that par-
ticular styles of self-reflection may be central to the active
construction of wisdom from adversity. In terms of event
types, mortality events (e.g., premature death) and relation-
ship events (e.g., divorce) were most commonly reported as
wisdom-fostering.
SESSION 375 (SYMPOSIUM)
SOCIAL EXCLUSION IN LATER LIFE:
UNDERSTANDING THE INTERACTIVE NATURE OF
EXCLUSION PATHWAYS
Chair: G.Windle, IMSCaR, Bangor University, United
Kingdom
Social exclusion is a complex multidimensional process,
which although not directly measureable is evident by the
presence of associated indicators. The choice of indicators
however can be problematic, often overlapping with vari-
ables considered drivers or outcomes of social exclusion,
obscuring our understanding of the process and mechanisms
through which it occurs. This symposium highlights the need
to disentangle these pathways and move beyond descriptive
accounts of social exclusion, presenting a new working frame-
work that allows direct hypothesis testing of these between
domain relationships. Whilst this working framework can
be applied to any population we focus on older adults. Life
events that can drive social exclusion such as bereavement
and changes in health are more likely to occur in later life,
and occur more frequently, increasing the risk of social exclu-
sion for this population. Using both quantitative and quali-
tative methods this symposium will begin to explore some
of these framework pathways, modelling the relationship
between environmental press and ageing in place on social
exclusion; and exploring the relationship between social
exclusion and health as both an indicator of exclusion and,
whilst controlling for prior health, as an outcome. Possible
protective factors that moderate the impact of poor health on
social exclusion, such as technology use, will also be exam-
ined, and older adults experiences of using technology and
the barriers they face will be discussed. Through detailed
examination of the complex pathways through which social
exclusion exists we gain a clearer understanding of this phe-
nomenon, and identify possible target areas for intervention.
MEASURING SOCIAL EXCLUSION IN OLDER AGE:
DEVELOPING AWORKING FRAMEWORK FOR
HYPOTHESIS TESTING
C.A.MacLeod1, A.Ross2, A.Sacker2, G.Netuveli2,3,
G.Windle1, 1. Dementia Services Development Centre
Wales, Bangor University, Bangor, Gwynedd, United
Kingdom, 2. University College London, London, United
Kingdom, 3. University of East London, London, United
Kingdom
Social exclusion is widely acknowledged to be a dynamic,
multidimensional process; however, each dimension has
the potential to be a determinant, indicator, or outcome of
social exclusion, making it difficult to disentangle the path-
ways through which social exclusion exists. We constructed
a working framework of individual social exclusion from
which to directly examine some of these relationships. To
90
enable hypothesis testing it is important to separate out
determinants from indicators of exclusion and to this end
we conceptualised social exclusion as reflecting the three
domains of service provision and access; social relations
and resources; and civic participation. Rooted in this new
working framework we constructed later life social exclusion
measures for use with Understanding Society - the United
Kingdom Household Longitudinal Study. This new working
framework and developed social exclusion measures provide
a platform from which to explore the complex relationships
between domains of social exclusion.
HEALTH AND SOCIAL EXCLUSION IN OLDER
AGE: RESULTS FROM THE UK HOUSEHOLD
LONGITUDINAL STUDY (UKHLS)
A.Sacker1, A.Ross1, C.A.MacLeod2, G.Netuveli3,
G.Windle2, 1. Epidemiology and Public Health, University
College London, London, United Kingdom, 2. Bangor
University, Bangor, United Kingdom, 3. University of East
London, London, United Kingdom
We investigated longitudinal associations between health
and social exclusion with data from 4 waves of UKHLS.
Adults 65years in Wave 3 participating in Waves 14 with
complete data (N=4169) were used. We modeled the rela-
tionship between a social exclusion index (SEI) and prior
health and the relationship between SEI and subsequent
health, conditional on baseline health and control variables.
Poor self-rated health (SRH), limiting long-standing illness
(LLTI) and psychological distress predicted SEI (b = 1.04
95%CI 0.88, 1.22; 0.94 95%CI 0.73, 1.15; 0.79 95%CI
0.59, 0.98, respectively). Mobile phone, car and internet
use moderated associations. Higher SEI was associated with
poorer health outcomes (OR SRH 1.17 95%CI 1.11, 1.23;
LLTI 1.07 95%CI 1.02, 1.12; distress 1.10 95%CI 1.04,
1.16). Internet and technology use protected older adults in
poor health from social exclusion, suggesting age-friendly
hardware and software design might have public health
benefits.
THE ENVIRONMENTAL EFFECTS ON SOCIAL
EXCLUSION IN OLDER AGES
G.Netuveli1,2,4, A.Ross2, C.A.MacLeod3, G.Windle3,
A.Sacker2, 1. Institute for Health and Human
Development, University of East London, London, United
Kingdom, 2. University College London, London, United
Kingdom, 3. Bangor University, Bangor, United Kingdom,
4. Imperial College London, London, United Kingdom
The role of unsupportive environments as a barrier for
active life style and social participation has been noted. We
investigated the effects of environmental press and ageing in
place, as indicators of environmental support, on social exclu-
sion with data from 3 waves of UKHLS. Environmental press
was operationalised with three characteristics: the neigh-
bourhood: disruptions, problems and insecurities. Ageing in
place was operationalised as the length of residence in the
neighbourhood and whether the participant would stay in
the same neighbourhood. Social exclusion was measured
using a social exclusion index (SEI). Neighbourhood prob-
lems (0.657, 95%CI 0.279, 1.036) and disruptions (1.988,
95%CI 1.569, 2.407) increased social exclusion significantly
while being a stayer reduced social exclusion significantly
Innovation in Aging, 2017, Vol. 1, No. S1
(-0.502, 95% CI-0.664, -0.341). There were no differences
between men and women in these results. Policies that
will improve neighbourhood quality and make places age-
friendly can reduce social exclusion.
USING TECHNOLOGY IN LATER LIFE: QUALITATIVE
INSIGHTS INTO ACTUAL AND PERCEIVED BARRIERS
C.A.MacLeod1, K.Canvin2, A.Sacker2, G.Netuveli2,3,
G.Windle1, 1. Dementia Services Development Centre
Wales, Bangor University, Bangor, Gwynedd, United
Kingdom, 2. University College London, London, United
Kingdom, 3. University of East London, London, United
Kingdom
Poor health is known to predict social exclusion in later
life, however this relationship is moderated by internet and
technology use. Peoples approach to technology varies and
older adults are known to engage less with technology and
its associated applications than younger age groups. We
conducted qualitative interviews with 40 participants aged
65 years and over, asking people about their access to ser-
vices and use of technology. Focusing on information and
communication technology (ICT), we found varying levels of
engagement amongst this group and identified four catego-
ries of use: proficient, basic/learner, proxy and avoider. We
explored peoples experiences of ICT and revealed a num-
ber of actual and perceived barriers, including hardware,
software and social factors that inhibit people from fully
engaging with technology. Technology use has the potential
to protect older adults in poor health from exclusion, but
first people need to overcome barriers preventing them from
engaging with technology.
SESSION 380 (SYMPOSIUM)
BEST PRACTICES OF FOUR GLOBAL INNOVATION
CENTERS TO IMPROVE THE LIVES OF OLDER
ADULTS
Chair: J.G.DAmbrosio, University of Louisville, Louisville,
Kentucky
Co-Chair: A.Faul, Institute for Sustainable Health and
Optimal Aging
This symposium brings together innovation centers from
Canada, Ireland, the US and China who will share best prac-
tices for improving the lives of older adults by advancing the
development and translation of technology in both clinical
and community based settings. The Schlegel-UW Research
Institute for Aging, Waterloo, Canada has developed a
Centre for learning, research and innovation in long-term
care through research-informed practice change and inno-
vation in workforce preparedness. Their campus includes
a long term care center, a workforce teaching and research
facility that houses living classrooms and research labs. The
Ireland Smart Ageing Exchange (ISAX), Ireland has estab-
lished an independent network of businesses, academic insti-
tutions, government agencies and NGOs collaborating to
fast-track research, development and commercialization of
solutions for the global smart ageing economy. The Thrive
Center, Louisville, Kentucky is an innovation center that
partners closely with the Institute for Sustainable Health &
Optimal Aging, University of Louisville to promote life-long
wellness in order to transform the quality of life and care for
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
the global aging population. It acts as a hub for older adults,
academia and industry to experience and create innovative
products, services and education that will promote sustaina-
ble health and optimal aging. The Genesis Innovation Center
housed within the Qinhuangdao Taisheng GRS International
Rehabilitation Center is a state-of-the-art facility designed
to bring the best care to the people of China. Genesis has
been designed for guests to interact with some of the newest
technologies created to improve healthy living and maximize
independence.
THE THRIVE CENTER, AN INNOVATION HUB
DESIGNED TO CARE FOR THE GLOBAL AGING
POPULATION
J.G.DAmbrosio1, A.Faul1, S.Rose2, J.Reinhart2, 1. School S.Thomas, The Genesis innovation Center, Qinhuangdao
of Medicine, University of Louisville, Louisville, Kentucky,
2. The Thrive Center, Louisville, Kentucky
The Thrive Center, Louisville, Kentucky is an innovation
organization, with a mission to promote life-long wellness by
transforming the quality of life and care for the global aging
population. The Center is a hub for older adults, academia
and industry to experience and create ground-breaking prod-
ucts, services and education that promotes sustainable health
and optimal aging. The Center includes interactive exhibits
and cutting edge state of the art technology and products
that can be used in the older adult market to promote qual-
ity of life and care. The exhibits rotate between stakeholders
in the market and are open to exploration by older adults
and caregivers. The Thrive Center is also an educational and
evidence based service facility for academia, industry and the
community. The Center partners closely with the Institute
for Sustainable Health & Optimal Aging at the University of
Louisville, and is located within the universitys innovation
research campus.
ENHANCING LIFE AND CARE OF OLDER ADULTS
THROUGH PARTNERSHIPS IN RESEARCH,
EDUCATION AND PRACTICE.
M.Sharratt, J.DAvernas, Schlegel-UW Research Institute
for Aging, Waterloo, Ontario, Canada
The Schlegel-UW Research Institute for Aging (RIA),
Waterloo, Canada, has a distributed network across Ontario
of 16 continuum of care Villages housing over 3,000 residents.
Emphasis is placed on learning, research, and innovation in
long-term care and retirement through research-informed
practice change and innovation in workforce preparedness.
The newest Village is contiguous with a 30,000 sq.ft. research
building (RIA) as part of a unique Centre of Excellence. The
magic of this infrastructure is that it brings potential front-
line workers in contact with university students, researchers,
and labs, and provides an opportunity to mingle with the res-
idents of the Village (Living Classroom). In response to the
aging demographic and a resource-limited system, the RIA is
a catalyst for the development and spread of innovation that
enhances the quality of life and care for older adults.
ISAX BRINGING BUSINESSES, ACADEMIA,
GOVERNMENT, AND NGOS TOGETHER TO
ADDRESS AGING
A.Connolly, ISAX, Arthurs Quay, Limerick, Ireland
IAGG 2017 World Congress
91
The Ireland Smart Ageing Exchange (ISAX), Ireland has
established an independent network of businesses, academic
institutions, government agencies and NGOs collaborating
to fast-track research, development and commercialization
of solutions for the global smart ageing economy. ISAX has
developed Start Your Own Business programs for smart age-
ing and for mature entrepreneurs aged 55+, developed a
Smart Ageing Community (panel of 55+ age cohort inter-
ested in sharing their life experience to help design better
products and services and is forging themed clusters among
its members to pursue new business opportunities.
THE GENESIS INNOVATION CENTER ADDRESSING
THE NEEDS OF CHINAS OLDER ADULTS
Taisheng, China
The Genesis Innovation Center, China provides new tech-
nology interaction to improve healthy living and maximize
independence, including smart-home technology, and global
innovative products such as sensors, digital applications,
virtual and augmented reality, mobile health platforms, arti-
ficial intelligence, and 3D printing. Participants experience
innovative designs from prototype to products ready for pur-
chase. The Center has a startup in residence program for
entrepreneurs and collaborates with engineers, startups and
investors to accelerate design development. It has fully inte-
grated tech-enabled care delivery utilizing robotics to access
world class clinicians and resources, virtual rehabilitation
and motion trainer tools to create and monitor compliance,
performance and clinical outcomes. The Centers high-tech
devices and switches improve environmental access, increase
independence, and assist with cognitive or mobility impair-
ments. Remote controlled appliances, sleep monitors, video
capture technology, smart design features with biometric
monitoring and clinician or caregiver alerting mechanisms
are all built into the design of the center.
SESSION 385 (SYMPOSIUM)
OLDER MEN LIVING ALONE: ROBERT
RUBINSTEINS SINGULAR PATHS REVISITED
Chair: M.Leontowitsch, Goethe-University Frankfurt am
Main, Frankfurt am Main, Hessen, Germany
Discussant: E.H.Thompson, College of the Holy Cross,
Broadview Heights, Ohio
Due to demographic changes the number of men who live
up to old age is steadily increasing and the gap in life expec-
tancy between men and women is closing. Across a vari-
ety of circumstances (e.g. widowhood, divorce, singledom,
living apart together) a growing number of men are living
on their own in later life. However, this group has received
relatively little attention. Some social and evironmental ger-
ontological as well as medical work have considered older
men living alone to be an at risk group, with higher scores of
deprivation, suicide and mental health problems compared
to older women living alone. Social anthropologist Robert
Rubinsteins important publication Singular Paths in 1986
provided a novel account of how and why some older men
live on their own, which suggested that this group was more
emotionally and socially stable than previously expected. In
92
light of significant changes to aging this symposium aims to
look at how our knowledge of this group has evolved over the
past 30years. Presentations will provide accounts of mens
lives from different geographical areas as well as social set-
tings. They will look at how perceptions and performances of
masculinities are shaped by widowhood and other life events
that have lead men to live on their own after the age of 60.
WIDOWERS AS REAL MEN: THE EVERYDAY LIVES OF
WIDOWERS IN NEW BRUNSWICK, CANADA
D.K.van den Hoonaard, Gerontology, St. Thomas
University, Fredericton, New Brunswick, Canada
This paper explores the everyday lives of older widow-
ers who live in New Brunswick, a relatively rural province
of Canada. It is based on an in-depth interview study, from
a symbolic-interactionist perspective, with widowers over
the age of 60 whose wives had died within the previous ten
years. The thematic analysis showed that the widowers used
impression management to present their everyday lives as
masculine. They minimized their ability to carry out house-
hold work, emphasized their relationships with women, and
focused on masculine leisure activities. Using quotations
from the interview transcripts, the paper argues that losing
two pillars of masculinity, work and being in a heterosex-
ual couple relationship, was threatening to the widowers
sense of masculinity. They framed their everyday activities to
remind the female interviewer that they were still real men.
OLDER MEN LIVING ALONEINSIGHTS FROM
AGERMAN PILOT STUDY
M.Leontowitsch1, I.Fooken1, F.Oswald1, N.Kramer2,
1. Faculty of Educational Sciences, Goethe-University
Frankfurt am Main, Frankfurt am Main, Hessen, Germany,
2. Institute of Historical Studies, Goethe-University
Frankfurt am Main, Hessen, Germany
This paper explores the lives of older men living alone
in Frankfurt/Main, a medium-sized German city. The data is
based on in-depth interviews with men aged 60+ who lived
on their own for a variety of reasons and structured inter-
views with stake holders in social care, adult education and
international cultural programmes. The inductive thematic
analysis of the interviews with the men links their life events
that led them to live alone in later life with social and histori-
cal changes that accompanied those experiences. In doing so
the paper will argue that the way men live alone in later life
needs to be understood in the context of their biography. The
analysis of the stake holder interviews shows that a deficit
orientated view of older men living alone does not match
the heterogeneity of the group and the potential risks and
resources these men have accumulated over the life course.
DEPRESSION, MASCULINITY, AND LIVING ALONE IN
AMILITARY RETIREMENT COMMUNITY
K.de Medeiros, Miami University, Oxford, Ohio
Everyday concepts of depression are often associated
with feminine traits such as sadness and uncontrollable cry-
ing. Such gendered traits can consequently pose challenges to
constructions of masculinity in older men. This paper draws
upon interviews from a unique sampleeight older men who
reside alone in a military-sponsored retirement community
and explores how masculinity is performed and defended in
Innovation in Aging, 2017, Vol. 1, No. S1
light of age- and person-based threats such as depression.
Findings point to the importance of the lifelong identity as
a military serviceman as an important site through which to
negotiate, process, or deny change with age.
SESSION 390 (PAPER)
SOCIAL AND ECONOMIC DETERMINANTS OF
ADULT HEALTH
CONCEPTUALIZING PATHWAYS BETWEEN
NEIGHBORHOOD ENVIRONMENTS AND RISK OF
CARDIOVASCULAR DISEASE
A.J.Lehning2, C.Mair3, S.Waldstein3, E.Onukwugha2,
M.K.Evans1, A.Zonderman1, 1. National Institute on
Aging, Baltimore, Maryland, 2. University of Maryland,
Baltimore, Baltimore, Maryland, 3. University of Maryland,
Baltimore County, Baltimore, Maryland
Using cardiovascular disease (CVD) risk as an example,
this paper discusses conceptual and methodological devel-
opments to advance research about neighborhood effects
on health across the life course. CVD is a leading cause of
morbidity and mortality, and modifying the neighborhood
physical and social environment is a promising strategy for
reducing racial and income disparities in CVD risk. However,
empirical evidence of the specific pathways through which
environments influence CVD risk is limited because previ-
ous studies: 1)measure only a few neighborhood character-
istics rather than multiple indicators, 2)assess cardiovascular
health primarily through self-reported measures or mortality
rather than clinical biomarkers of risk, 3) do not consider
intermediary pathways, and 4)analyze predominantly white
samples.
We present an adapted version of the Social Determinants
of Health and Environmental Health Promotion model
(Shultz & Northridge, 2004), which conceptualizes the mul-
tiple pathways through which neighborhood environments
influence individual and population health. We illustrate
the potential of this conceptual model for reducing cardio-
vascular health disparities by demonstrating an approach
for combining data from multiple sources at multiple lev-
els. Specifically, we link household- and neighborhood-
level data from administrative sources to Healthy Aging in
Neighborhoods of Diversity across the Life Span dataset
(HANDLS), a 20-year epidemiological study examining
health disparities among socioeconomically diverse African
American and white adults in Baltimore City, USA. We dis-
cuss the implications of our conceptual model and analytic
approach as a means of leveraging community data to inform
the design of multilevel interventions to reduce cardiovascu-
lar health disparities in an urban adult population.
THE EFFECT OF NEIGHBORHOOD CONTEXT
ON COGNITIVE FUNCTION IN INDIVIDUALS
APPROACHING MIDLIFE
E.Munoz1, R.Corley2, S.J.Wadsworth2, C.A.Reynolds1, 1.
University of California, Riverside, Riverside, California, 2.
University of Colorado Boulder, Boulder, Colorado
The context in which individuals develop plays an impor-
tant role in determining function in old age. We examined
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Innovation in Aging, 2017, Vol. 1, No. S1
the role of neighborhood context in cognitive function in
a sample of adults approaching middle-age (3045 years)
taking part in the ongoing Colorado Adoption/Twin Study
of Lifespan behavioral development and cognitive aging
(CATSLife), a longitudinal follow-up of individuals from
the Colorado Adoption Project and Longitudinal Twin
Study. We conducted an initial analysis of the adoptive sub-
set of participants who underwent cognitive assessments at
age 3035 (n = 266; mean age = 31.86 (SD = 1.28); 52% DETERMINANTS OF HEALTH IN OLD AGE
female) and completed a neighborhood demographics ques-
tionnaire in which they reported on the prevalence of prob-
lems in their neighborhoods (e.g., crime, transportation,
corruption). Results from multilevel models to account for
family clustering showed that those who reported greater
neighborhood problems, performed more poorly on WAIS
performance tasks (Cohens d = -.37) compared to WAIS
verbal tasks (Cohens d=-.19). Across the whole cognitive
battery, including the WAIS subtests and specific cognitive
ability tasks, effect sizes were larger for episodic memory (-
.34) and spatial/fluid tasks (-.31), than for verbal (-.22) or
perceptual speed tasks (-.07). However, effect sizes ranged
within and across domain from large to small (range=-.78
to .15; median=-.21). We will extend analyses to incorpo-
rate a larger sample size with additional waves and compare
results to international samples from the UK, Netherlands,
and Germany. These findings suggest that the demands of
dealing with stressful neighborhood environments may
diminish cognitive function in adulthood.
LOW MOOD AND 9-YEAR INCIDENCE OF
DEMENTIA: THE ROLE OF MARITAL STATUS AND
LIVING SITUATION
L.Sjberg1, L.Fratiglioni1,2, H.Wang1, 1. Aging Research life; differences were small. Income was independently and
Center (ARC), Department of Neurobiology, Care Sciences
and Society (NVS), Karolinska Institutet and Stockholm
University, Stockholm, Sweden, 2. Stockholm Gerontology
Research Center, Stockholm, Sweden
This study aims to examine whether low mood was
related to an increased risk of dementia (DSM-III-R), and
whether marital status and living situation can modify this
association. To examine this, the Kungsholmen Project was
used where 1203 cognitively healthy community-dwellers
aged 75+ years were followed for 9 years. Low mood at
baseline was associated with an increased dementia risk
over a 9-year period (HR: 1.36, 95% CI: 1.091.69).
Stratified analyses by marital status revealed that the effect
of low mood on the risk of dementia was only observed
in individuals who were single (HR: 1.50, 95% CI: 1.18
1.90), but not in those who were married (HR: 0.83, 95%
CI: 0.481.42). A similar pattern was observed in strati-
fied analyses by living situation; individuals with low mood
were at a higher risk of developing dementia only if they
were living alone (HR: 1.49, 95% CI: 1.171.91), but not
if living with someone (HR: 0.96, 95% CI: 0.591.57).
These associations could not be explained by socio-demo-
graphics or health status of the participants, and remained
unchanged after excluding those who developed dementia
during the first 3-years of follow-up. Overall, dementia risk
was elevated among older adults who have low mood, but
the risk exists only in individuals who were single or living
IAGG 2017 World Congress
93
alone. This study emphasizes the importance of social inter-
action when experiencing low mood. Thus, specific atten-
tion should be directed towards the health care of older
adults who are experiencing low mood and are single or
living alone.
DIFFERENT INDICATORS OF SOCIOECONOMIC
POSITION AND THEIR RELATIVE IMPORTANCE AS
A.Darin Mattsson1, S.Fors1, I.P.Kreholt1,2, 1. Aging
Research Center (ARC), Karolinska Institutet & Stockholm
University, Stockholm, Sweden, 2. School of Health
Sciences, Aging Research Network-Jnkping (ARN-J),
Jnkping University, Jnkping, Sweden
Socioeconomic position is most commonly operation-
alised as education, social class, or income. Socioeconomic
position can also be operationalised as occupational com-
plexity. Studies of health inequalities in the general popu-
lation show that the choice of indicators influences the
results. However, less is known about the influence of indi-
cator choice in older populations. We explored whether the
strength of the association between socioeconomic position
and health in old age (6988) varied by the indicator of soci-
oeconomic position used.
Data from two nationally representative Swedish surveys
(LNU and SWEOLD) were combined, providing 20years of
follow-up. Average marginal effects were analysed to com-
pare the association between the indicators of socioeconomic
position (education, social class, occupational complexity
and income) and two late-life outcomes: mobility limitations
and psychological distress.
All indicators were associated with both outcomes in late-
most strongly associated with both outcomes and contrib-
uted the most to model fit. Social classcontributed the least
to both outcomes. The results indicated that occupational
complexity was at least as strongly associated to health in
old age as social class and education.
If the primary objective of including an indicator of socio-
economic position is to adjust the model for socioeconomic
differences rather than to analyse these inequalities, income
may be the preferable indicator, as it seems to capture the
most variation in late life health. If, on the other hand, the
primary objective of a study is to examine health inequalities,
the choice of indicator should be theoretically guided.
EDUCATION AND DEMENTIA: PROTECTION ONLY
AMONG THE YOUNG-OLD?
D.Seblova1,2, A.Lager1,2,3, 1. Aging Research Center,
Karolinska Institutet and Stockholm University, Stockholm,
Sweden, 2. Karolinska Institutet:Department of Public
Health Sciences, Stockholm, Sweden, 3. Centre for
Epidemiology and Community Medicine, Stockholm
County Council, Stockholm, Sweden
Whether the association between education and demen-
tia is causal remains unknown. Our study examines this
association in Swedish register data as well as the effect
of a natural experiment prolonging compulsory school-
ing from six to seven years. Individuals born from 1920
to 1937 (n=1 373 936) were followed up in the National
94
Inpatient Register from 1980 to 2011 for hospitalizations
with dementia diagnosis (n=103 235). Educational measures
(schooling type, highest degree achieved and years of educa-
tion) were derived from a 1970 census. In a Cox model,
one year of education was associated with 4% lower risk of
hospitalization with dementia diagnosis among 6078years
old (HR=0.96, 95% CI: 0.960.97), adjusting for cohort,
sex and geographical area. The association was robust to
changes in the operationalization of education. Further, a
dose-response association was present across the whole
spectrum of educational attainment. Among 7992 years
old, one year of education was associated only with 1%
lower risk of dementia (HR=0.99, 95%-CI: 0.980.99), and
that was driven mainly by a low risk among those with uni-
versity education. The results from the natural experiment,
which prolonged schooling at the lower end of the educa-
tional attainment spectrum, also indicate a protective effect,
but again only among the 6078years old. In summary, we
find preliminary support for a causal protective effect of
education on dementia. However, it is possible that prolong-
ing schooling at the lower end of the educational spectrum,
from 6 to 7years, may not buffer against neurodegenerative
processes among the oldest old.
SESSION 395 (SYMPOSIUM)
STANFORD CENTER ON LONGEVITY PRESENTS:
STARTING POINTS FOR REDESIGNING LONGER
LIVES
Chair: T.Sims, Stanford Center on Longevity
Co-Chair: L.L.Carstensen, Stanford University
Improved longevity is among the most remarkable
achievements in all of human history and one of our greatest
challenges. The mission of the Stanford Center on Longevity
(SCL) is to redesign long life employing science and technol-
ogy to alleviate the potential challenges of longer lives and
improve the well-being of people of all ages. To commemo-
rate SCLs 10th year, we will feature seminal projects underway
that focus on optimizing longevity using multi-disciplinary
and multi-method approaches. In this symposium, we will
present four projects addressing timely issues stemming from
longer lives. Tamara Sims will provide an overview of the
Sightlines Project which aims to capture how well Americans
of all ages are doing financially, socially, and physically over
historical time in an effort to identify critical, actionable
areas to better prepare society for long lives. Marti DeLeima
will discuss work on financial fraud and ways of identify-
ing those most at risk for victimization. Iya Vargas will pre-
sent research aimed at promoting volunteerism among older
adults as a way to promote well-being and inter-generational
contact. Finally, Mary Rosenberger will discuss how utilizing
a 24-hour activity cycle can better leverage new wearable
technologies to enhance health. Taken together, these studies
are designed to foster dialogue and multi-disciplinary col-
laboration among typically disconnected worlds. In doing
so, SCL aims to develop workable solutions to urgent issues
confronting the world as the population ages.
Innovation in Aging, 2017, Vol. 1, No. S1
THE SIGHTLINES PROJECT: TRACKING
KEY INDICATORS OF LONGEVITY ACROSS
GENERATIONS
T.Sims1, L.L.Carstensen1,2, T.Rando1,3, A.Yotopoulos1,
M.Deevy1, K.Smith1, 1. Stanford Center on Longevity,
Stanford, California, 2. Stanford University Psychology
Department, Stanford, California, 3. Stanford University
School of Medicine, Stanford, California
More Americans are living to 100 than ever before. Yet,
we are ill-prepared to navigate long life. A flagship pro-
ject of SCL, Sightlines investigates how well Americans
are doing on three key indicators: financial security, social
engagement and healthy living. We examined eight nation-
ally representative, multi-year datasets surveying more
than 1.2 million Americans. On average, financial secu-
rity (e.g., home ownership, lack of debt) has decreased
since 2000 for those under the age of 75. Social engage-
ment (e.g., interactions with family/friends/communities)
remained stable since 1995 for most age groups, except
Baby Boomers who show significant decline. For Healthy
Living, we observed some gains (e.g., physical activity) and
some losses (e.g., increased sedentary behavior) since 2002.
Many of these trends vary by socioeconomic status and
ethnicity. These findings can shape policy, guide product
development, and inform individual-level interventions to
ensure independent, 100-year lives.
ESTIMATING THE IMPACT OF FRAUD IN THE
UNITED STATES
M.DeLiema, M.Deevy, Stanford Center on Longevity,
Stanford, California
Financial fraud poses a significant threat to the finan-
cial security of aging societies. Despite billions of dollars
lost to fraud each year, the United States has yet to rou-
tinely administer a national survey to estimate the extent
of the problem. In collaboration with fraud researchers and
policymakers, we are developing a definitional framework
and survey to measure rates of fraud in an online sample
of 2,000 adults. Thirty-eight percent reported victimization
by one or more types of fraud in the past year. Consumer
products and services were the most common scams fol-
lowed by investment fraud. Risk factors included younger
age, chronic life stressors, and risky investment preferences.
In 2017, the survey will be launched as a module with the
National Crime Victimization Survey and administered to
over 50,000 households. Data will help identify trends in
fraud prevalence and inform where to allocate prevention
resources to protect those most at risk.
INCREASING RETIREES SOCIAL ENGAGEMENT
THROUGH MEANINGFUL VOLUNTEERISM
M.E.Vargas1, A.Yotopoulos1, J.W.Rowe2, 1. Stanford
Center on Longevity, Stanford, California, 2. Columbia
University, New York, New York
The SCL Santa Clara County Volunteer Project is a multi-
phase effort aimed at improving the health of County retir-
ees through volunteerism, as well as improving the health
and well-being of the recipients of the volunteerism and
ultimately reducing the cost of medical care to the county.
Working closely with the leadership of Santa Clara County,
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Innovation in Aging, 2017, Vol. 1, No. S1
we first administered a survey to 4000 county workers and
retirees. Using the information learned from the survey, we
are now recruiting 250 retirees and near-retirees into vol-
unteer roles in the community, initially as developmental
screeners for young children ages 0 to 5, and are following
them over a two year period. The final phase envisions a
large-scale longitudinal study measuring physical and cogni-
tive health outcomes, monitoring health care utilization, and
examining expected reductions in health care costs among
volunteers in a wide variety of County volunteer positions.
24 HOURS OF PHYSICAL ACTIVITY, SEDENTARY
BEHAVIOR, AND SLEEP WITH WEARABLE DEVICES
M.Rosenberger, K.Smith, Stanford Center on Longevity,
Stanford, California
Wearable devices can provide a detailed description of
daily activities, giving researchers the capability to create a
new model of healthy living by using an interdisciplinary
approach to disease prevention. Acombination of expertise
from exercise science, sedentary behavior research and sleep
studies is needed to understand the relationship of all human
activity to disease and longevity. Optimizing a 24-hour activ-
ity cycle is likely to be a key part of utilizing this new tech-
nology for health research and interventions. Additionally,
it creates a new avenue for studying how behavior affects
aging and how to best optimize activity for longevity. This
presentation will describe the 24-hour activity cycle, why it
is important for health, where the data are being collected,
and how researchers are currently using the data to answer
public health questions. Important future research directions
will be highlighted.
SESSION 400 (SYMPOSIUM)
TRANSLATING EVIDENCE-BASED DEMENTIA
CARE FOR OLDER ADULTS AND FAMILIES INTO
PRACTICE: COPE CT STUDY
Chair: R.H.Fortinsky, University of Connecticut, Old
Lyme, Connecticut
Discussant: L.N.Gitlin, School of Nursing, Johns Hopkins
University, Baltimore, Maryland
This symposium contributes new knowledge to current
efforts to successfully translate evidence-based interventions
into existing home and community-based service settings
for older adults with dementia and their family caregiv-
ers. We report on several aspects of the ongoing COPE CT
study, which incorporates and evaluates implementation
of the evidence-based Care of Persons with Dementia in
their Environments (COPE) intervention into Connecticuts
Medicaid waiver and state-funded homecare program for
older adults. In COPE, occupational therapists teach fam-
ily caregivers problem solving skills for managing dementia-
related symptoms and their own stress, and nurses assess
persons with dementia for underlying medical conditions
that may affect function and behavior. In the COPE CT
randomized trial, COPE services are added or not added
to existing homecare service plans for older adults with
dementia and their family caregivers (dyads). In this sympo-
sium, Fortinsky will first explain the COPE CT translational
study design and report findings to date regarding enrolled
dyad characteristics and clinical findings from COPE
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95
interventionists. Piersol will then explain the principles and
components of COPE, and how its fidelity is monitored in
the COPE CT study. Molony will then provide perspectives
from care management organizations responsible for coor-
dinating publicly-funded homecare services. Robison will
then report focus group findings regarding home care pro-
gram care managers experiences incorporating COPE into
daily practice. Pizzi will then report findings from economic
impact analysis data. Discussant Gitlin will comment on
study implications for efforts elsewhere translating evidence-
based interventions for this growing target population into
homecare practice and policies.
OVERVIEW OF COPE CT STUDY DESIGN
AND SELECTED SAMPLE AND TREATMENT
CHARACTERISTICS
R.H.Fortinsky, UConn Center on Aging, University of
Connecticut, Old Lyme, Connecticut
The COPE CT study tests effectiveness of incorporating
the Care of Persons with Dementia in their Environments
intervention (COPE) into care plans of older adults with
dementia (OAD) and their family caregivers (dyads) enrolled
in Connecticuts Medicaid waiver and state-funded home-
care program. In this presentation, we explain the studys
translational design, report interim results, and discuss pro-
ject potential for replication. Eligible dyads are randomly
assigned either to COPE plus usual care services, or usual
care services only. Outcomes include functional independ-
ence for OAD, and perceived well-being for caregivers.
Recruitment goal=290 dyads. Among 127 dyads enrolled to
date: 81% of OAD and 72% of caregivers are female; mean/
s.d. ages=84.7/7.6 for OAD and 61.3/11.9 for caregivers;
20% Black; daughters are most common caregivers. Most
dyads receiving COPE complete all sessions. Nurse assess-
ment of OAD has revealed medical conditions warranting
physician treatment. Replicability potential is high because
all states offer similar homecare programs.
CARE OF PERSONS WITH DEMENTIA IN
THEIR ENVIRONMENTS (COPE): PRINCIPLES,
CHARACTERISTICS, AND FIDELITY
C.V.Piersol1, L.N.Gitlin2, 1. Thomas Jefferson University,
Philadelphia, Pennsylvania, 2. Johns Hopkins University,
Baltimore, Maryland
COPE seeks to support the capabilities of older adults
with dementia (OADs) living at home by reducing environ-
mental stressors and enhancing caregiver knowledge and
skill. COPE-CT, a translational study, tests the effective-
ness of incorporating the intervention into Connecticuts
Medicaid waiver program. This presentation describes inter-
vention principles and characteristics and fidelity approach.
COPE is theory-driven and sensitive to cultural attributes,
focuses on caregiver-identified problems, provides empiri-
cally derived strategies and resources, and is designed to be
transportable to real-world practice. COPE is delivered by
advanced practice nurses (APN) [two sessions] and occupa-
tional therapists (OT) [10 sessions] who communicate assess-
ment findings and care emergencies to agency care managers,
an important translational element. The fidelity plan initially
involves intensive monitoring and measurement of delivery,
receipt and enactment components using traditional scientific
96
methods and practical approaches. Future plans are to have
fidelity measures built into care delivery with care managers
providing oversight.
COPE CT FROM ORGANIZATIONAL AND PUBLIC
POLICY PERSPECTIVES
S.Molony, Quinnipiac University, Hamden, Connecticut
Home and community-based services (HCBS) offer a
lower-cost option than institutional long-term care, while
supporting older adults in their preferred setting. Nearly 70
percent of people with dementia live at home (Alzheimers
Association, 2009) and almost one-quarter has Medicaid
coverage (Kaiser Family Foundation, 2015). HCBS services
vary from state to state and while many provide options for
long-term services and supports (LTSS) such as personal care,
case management, physical or occupational therapy, few of
these services are designed to formally address the needs of
family caregivers essential to successful community living
for persons with dementia. The COPE intervention offers a
unique constellation of supports to these families that can
be integrated into existing LTSS care management models.
This paper compares and contrasts usual care with the
enhanced supports offered as part of the COPE intervention
and identifies key points for successful implementation by
care managers and HCBS policymakers.
CARE MANAGER PERSPECTIVES ON COPE
INTERVENTION IMPLEMENTATION IN THE CT
HOME CARE PROGRAM FOR ELDERS
J.T.Robison1, R.H.Fortinsky1, L.N.Gitlin2, 1. UConn
Center on Aging, University of Connecticut, Old Lyme,
Connecticut, 2. Johns Hopkins University, Baltimore,
Maryland
An important aspect of the COPE CT study translational
design is understanding implementation processes to enable
widespread adoption of COPE within the CT Home Care
Program for Elders (CHCPE), and within Medicaid waiver
and state-funded homecare programs elsewhere. We draw
upon Normalization Process Theory (NPT) which posits
specific criteria for judging implementation potential of an
intervention, how practice settings may be affected by the
intervention, and how the intervention can be modified
to support its implementation. Focus groups designed in
accordance with NPT are conducted annually in years 25
of the study period with CHCPE care managers and COPE
interventionists. This presentation reports findings from the
6 care manager focus groups held during study years 2 and
3, with special emphasis on their experiences recruiting par-
ticipants from their client caseloads, perceived COPE inter-
vention benefits and challenges, and how well COPE services
are integrated into their daily service coordination activities
COST ANALYSIS PLAN AND CAREGIVERS
WILLINGNESS TO PAY FOR COPE-CT: INTERIM
FINDINGS
L.Pizzi2, E.Jutkowitz4, K.Prioli2, L.N.Gitlin3,
R.H.Fortinsky1, 1. UConn Center on Aging, University
of Connecticut, Old Lyme, Connecticut, 2. Thomas
Jefferson University, Philadelphia, Pennsylvania, 3. Johns
Hopkins University, Baltimore, Maryland, 4. University of
Minnesota, Mineapolis, Minnesota
Innovation in Aging, 2017, Vol. 1, No. S1
To inform a net financial benefit analysis of COPE-CT
from the Medicaid perspective, a variable map was devel-
oped which included relevant costs and willingness-to-pay
(WTP) for the program. WTP for non-pharmacological
behavioral programs is critical to translation because it
indicates the monetary value caregivers place on these ser-
vices. 85 participating caregivers were read a brief descrip-
tion of COPE-CT at baseline and asked to estimate their per
session WTP using a contingent valuation method. Results
were grouped by WTP thresholds.
WTP/session ranged from $0 to $200. 21 CG (24.7%)
were unwilling to pay for this program, 17(20%) willing
to pay $1025/session, 21(24.7%) willing to pay $5075/
session, 19(22.4%) willing to pay $100125/session, and
7(8.2%) willing to pay $150200/session. The variable map
will also be presented as a tool to explain how we will create
the specific direct and indirect cost measures that will be used
in the economic analysis for the COPE-CT study.
SESSION 405 (SYMPOSIUM)
FRAILTY IN OLDER ADULTS: INNOVATIVE
PERSPECTIVES ON EARLY DETECTION AND
INTERVENTION
Chair: S.de Bruin, National Institute for Public Health and
the Environment, Netherlands
Discussant: T.Kardol, Vrije Universiteit Brussel, Brussel,
Belgium
A MULTIDIMENSIONAL APPROACH OF FRAILTY IN
THE GENERAL POPULATIONTHE DOETINCHEM
COHORT STUDY
L.Rietman1,2, S.van Oostrom1, D.van der A1, S.Picavet1,
M.Lette1, M.Verschuren1,2, S.de Bruin1, A.Spijkerman1, 1.
National Institute for Public Health and the Environment,
Bilthoven, Netherlands, 2. Julius Center, Utrecht,
Netherlands
Accumulation of problems in physical, psychological,
cognitive, or social functioning is characteristic for frail indi-
viduals. This study explored which sociodemographic and
lifestyle factors, life events and health characteristics were
associated with these four frailty domains. The study sample
included 4019 men and women (aged 4081years) examined
in 20082012 of the Doetinchem Cohort Study. About 17%
of the population was frail at one or more domains, with
limited overlap between the frailty domains. Being physi-
cally active was consistently associated with a lower risk of
being frail on each of the four domains. Short or long sleep
duration was associated with a higher risk of being physi-
cally, psychologically, and socially frail. In conclusion, con-
sidering multiple frailty domains is important because the
majority of frail people were frail on one domain of frailty
only. Lifestyle factors including physical activity, smoking
and sleep duration were cross-sectionnally associated with
multiple domains of frailty.
AGING IN PLACE WITH FORMAL AND INFORMAL
CARE: OLDER PEOPLES NEEDS AND PREFERENCES
M.Lette1, A.Stoop2, L.Lemmens2, Y.Buist2, C.Baan2,3,
S.de Bruin2, 1. VU University Medical Centre, Amsterdam,
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Innovation in Aging, 2017, Vol. 1, No. S1
Netherlands, 2. National Institute for Public Health and the
Environment, Bilthoven, Netherlands, 3. Tilburg University,
Tilburg, Netherlands
Older people in the Netherlands are increasingly being
stimulated to remain independent and live at home for as
long as possible, with help from formal and informal caregiv-
ers. In-depth interviews were conducted with 36 older people
and provided insight into what older people need with regard
to health, wellbeing and aging in place. Mobility appears to
be essential for remaining independent. Additional impor-
tant preconditions for living independently at home were
good cognitive health, appropriate housing conditions and
practical help (e.g. housekeeping, maintenance, administra-
tion). With regard to wellbeing, feeling respected and hav-
ing a sense purpose and autonomy were important, as well
as having social relationships. Respondents indicated to be
reluctant to ask for structural help from their informal net-
work, and they also felt that problems related to wellbeing
were primarily their own responsibility. These results may
help caregivers when organizing preventive (in)formal care
and support for older people.
IMPROVING EARLY DETECTION INITIATIVES:
PERSPECTIVES OF PROFESSIONALS IN THE
NETHERLANDS
L.Lemmens1, Y.Buist1, M.Lette1,2, A.Stoop1,2, C.Baan1,3, indicated several sociodemographic and socioeconomic risk
S.de Bruin1, 1. National Institute for Public Health and
the Environment, Bilthoven, Netherlands, 2. VU University
Medical Centre, Amsterdam, Netherlands, 3. University of
Tilburg, Tilburg, Netherlands
Many initiatives are developed aiming to proactively
identify health and social problems in (frail) older people.
Early detection and proactive delivery of care and support
could help older people to age in place and remain inde-
pendent. Previous research shows that these initiatives do
not always meet the needs and preferences of older people
with regard to e.g. setting, timing and scope. In-depth inter-
views with nineteen professionals in preventive elderly care
were conducted to identify areas of improvement in existing
initiatives. Identified improvement areas included: 1. More
tailored approach, 2. Better information for older people
(and thereby raising awareness about anticipating on future
needs), 3. More use of informal networks, 4. Better align-
ment of initiatives within the neighborhood, 5.More atten-
tion for groups that are difficult to reach. It is recommended
to take these starting-points for improvement into account
to better align early detection initiatives with older peoples
needs and preferences.
EARLY DETECTION OF FRAILTY IN COMMUNITY-
DWELLING OLDER ADULTS BY PREVENTIVE HOME
VISITS
B.Fret, D.Vert, L.De Donder, Educational Sciences, Vrije an innovative mixed-methods study undertaken in England
Universiteit Brussel, Brussels, Brussels, Belgium
Timely detection of frailty and preventive home interven-
tions can allow older people to age well at home. Research
indicates that preventive home visits can have a preventive
effect on frailty for a well-defined population. The current
paper will test the effectiveness and experiences with a con-
secutive model of preventive home visits: step 1 visit by
volunteers, step 2: visit by professionals. Quantitative and
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97
qualitative data are collected during preventive home visits
performed among 450 community-dwelling older adults liv-
ing in three cities in Flanders, varying in urbanisation rate
(Tienen, Gent and Knokke-Heist). Results point towards the
possibilities and constraints of performing preventive home
visits by volunteers and develop guidelines and profiles.
Second, findings demonstrate the effectiveness of the pre-
ventive home visits in terms of detected cases who are frail
but lacked care and support. Finally, preventive home visits
can guide to the most appropriate interventions, taking into
account the clients preferences.
DETECTION AND PREVENTION OF FRAILTY:
INCREASING EFFECTIVENESS USING EVIDENCE-
BASED RISK PROFILES
E.Dierckx, A.Smetcoren, L.De Donder, S.Dury, Vrije
Universiteit Brussel, Brussels, Brussels, Belgium
This paper investigates risk profiles of frailty among older
people, as these are essential for detecting individuals at risk
for adverse outcomes and to undertake specific preventive
actions. Frailty is not only a physical problem, but also refers
to emotional, social, and environmental hazards. In a first
phase, data from the Belgian Ageing Studies, a cross-sec-
tional study among home-dwelling older people (N= 28,049)
were analyzed using multivariate regression models. Findings
profiles for frailty (domains). In a second phase (January
2017), these risk profiles are validated in three municipalities
in Belgium. Samples are drawn from the population registers
based on the detected risk characteristics. Results will dem-
onstrate the effectiveness and efficiency of using these risk
profiles among 900 older people. In the discussion, this paper
elaborates on practical implications to use these profiles in
detection and prevention of frailty.
SESSION 410 (SYMPOSIUM)
EMPOWERMENT, EMOTIONAL LABOR, AND
EVERYDAY ENCOUNTERS IN HOME CARE FOR
PERSONS WITH DEMENTIA
Chair: K.Scales, Duke University, Durham, North Carolina
Home care encompasses a range of services designed to
meet individuals long-term care and support needs in their
home setting, thereby promoting independence and delaying
admission to institutional care. Addressing concerns about
home-care quality is a priority across many care systems,
including in England, as reflected in the recent release of the
Quality Standard for Homecare for Older People (NICE,
2016). Little is known, however, about how good home
care that which is person-centered, well-coordinated, and
consistently staffed is understood and implemented in daily
practice, particularly for those with dementia. Drawing from
in collaboration with a large international home-care pro-
vider, the purpose of this symposium is to advance under-
standing of the structure and content of daily in-home care
for clients with mild to moderate dementia. The primary data
sources are extensive fieldnotes from one year of participant
observation and weekly diary entries maintained by 11 paid
caregivers over eight weeks. The first paper will discuss
the tensions between autonomy (or empowerment) and
98
support in the daily delivery of care. The second paper will
describe the emotional labor undertaken by home-care staff,
with attention to how their deployment of tact to maintain
clients dignity highlights the inherent conflicts of the paid
caregiving relationship. The final paper will draw from the
caregiver diaries to discuss the everyday challenges of pro-
viding consistently good care within broader structural
conditions. Implications for workforce development, quality
improvement, and commissioning of home-care services will
be discussed.
EMPOWERMENT IN HOME CARE FOR PERSONS
WITH DEMENTIA: IMPLICATIONS FOR PERSON-
CENTERED CARE
K.Scales1, K.Pollock2, C.Travers3, L.Perry-Young2,
S.Wilkinson2, N.Manning4, J.Schneider2, 1. Center for the
Study of Aging and Human Development, Duke University,
Durham, North Carolina, 2. University of Nottingham,
Nottingham, United Kingdom, 3. Loughborough University,
Loughborough, United Kingdom, 4. Kings College London,
London, United Kingdom
A key element of person-centered care, which is a prior-
ity across long-term care systems, is the empowerment of
direct-care workers understood as the legitimated auton-
omy to adapt care around individuals needs and preferences,
instead of completing tasks by rote and routine. The nature
of empowerment in the particular context of home-care is
not well-understood, however. This paper draws from eth-
nographic data collected as part of a mixed-methods study
of good home care to describe how caregiver autonomy
is enacted and experienced in daily care. We examine the
close link between autonomy and isolation for these work-
ers, which can curtail the knowledge exchange that supports
person-centered care in other settings. We also examine the
relational and structural limits of autonomy, highlighting
organizational surveillance techniques as a particular exam-
ple. The paper concludes with a discussion of the implica-
tions of these findings for efforts to empower direct-care staff
to provide person-centered in-home care.
CLOSE ENCOUNTERS OF THE CARING KIND:
EXAMINING EVERYDAY EXPERIENCES OF HOME
CARE USING STAFF DIARIES
C.Travers2, K.Pollock3, K.Scales1, L.Perry-Young3,
S.Wilkinson3, N.Manning4, J.Schneider3, 1. Center
for the Study of Aging and Human Development, Duke
University, Durham, North Carolina, 2. Loughborough
University, Loughborough, United Kingdom, 3. University
of Nottingham, Nottingham, United Kingdom, 4. Kings
College London, London, United Kingdom
Written diaries are increasingly used to gather data in
academic, educational and vocational settings. Diaries get us
up close to peoples lived experiences, yielding rich data
free from retrospective bias. As part of a mixed-methods
study, 11 home caregivers for clients with dementia kept
reflective diaries for eight weeks. This paper reports findings
from the diaries relating to: caregivers key skills, including
their efforts to preserve clients dignity and agency and to
mediate among clients, relatives, and the home-care organi-
zation; the daily demands of the job, including physical and
Innovation in Aging, 2017, Vol. 1, No. S1
emotional stressors; the challenges of the job, from interper-
sonal to logistical tasks; and the daily experiences of job-
related satisfaction, including the practices of self as a skilled
and caring worker and the sense of being appreciated. These
findings are discussed in relation to the caregivers represen-
tations of home-care clients in the diaries, which range from
idealization to candor.
TACT AND DUPLICITY IN INTERPERSONAL
RELATIONS BETWEEN PAID HOME CAREGIVERS
AND THEIR CLIENTS
K.Pollock2, K.Scales1, C.Travers3, L.Perry-Young2,
S.Wilkinson2, N.Manning4, J.Schneider2, 1. Center for the
Study of Aging and Human Development, Duke University,
Durham, North Carolina, 2. University of Nottingham,
Nottingham, United Kingdom, 3. Loughborough University,
Loughborough, United Kingdom, 4. Kings College London,
London, United Kingdom
This paper explores tensions arising from caregivers prac-
tices of skilled interpersonal work, specifically the exercise of
tact to protect the dignity of clients. The threat to self-esteem
from low-paid, low-status employment is buffered by satis-
faction from close relationships with clients. Emotional labor
required of caregivers in the course of routine work may be
rewarded by emotional capital and enhanced self-worth.
Caregivers exercise great skill in supporting personhood and
agency, particularly to deflect and cover up mishaps of men-
tal and physical incompetence. However, the requirement
or feeling rule of tact to maintain the personal dignity
of clients breaches norms of fair and transparent dealing
between people in close interpersonal relationships. Tact may
be a manifestation of professional skill but can also under-
mine the authenticity in relationships between client and car-
egiver that its exercise aims to instantiate, and underlines the
ambiguous nature of a personal relationship underpinned by
pay.
SESSION 415 (SYMPOSIUM)
INTEGRATED CARE FOR PEOPLE WITH COMPLEX
CARE NEEDS: PAST, PRESENT, AND FUTURE
Chair: J.M.Wiener, RTI International, Washington, District
of Columbia
Co-Chair: W.L.Anderson, RTI International, Research
Triangle Park, North Carolina
Discussant: J.Chen Hansen, American Geriatrics Society,
New York, New York
Integrated care systems have a primary goal of providing
coordinated care using formal linkages of different types of
providers to provide high quality care to populations with
complex care needs. The symposium will open with a back-
ground analysis of the need for integrated care systems for
people with complex care needs, including an overview of
the benefits and challenges. The symposium will then present
three research projects funded by the U.S. Department of
Health and Human Services Office of the Assistant Secretary
for Planning and Evaluation that examine the past results,
present challenges and future opportunities for integrated
care. The first paper analyzes the effect that Minnesotas
well-established integrated systems of care have had on
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Innovation in Aging, 2017, Vol. 1, No. S1
health care and long-term services and supports (LTSS) use
among dually eligible individuals over age 65. The second
paper examines several current integrated systems of care
to determine how care coordination is operationalized and
the challenges that remain when exchanging information
across acute care and LTSS providers. The third paper will
examine the opportunities and challenges for expanding the
Program of All-Inclusive Care for the Elderly (PACE), a fully-
integrated care system, to serve younger people with disa-
bilities and the implications of these findings for the older
populations currently served by PACE. The discussant will
respond to the studies findings and discuss the evolution of
integrated care and the potential for these delivery systems
to provide high quality care for populations with complex
and unique needs.
WHERES THE REST OF ME? THE CASE FOR
INTEGRATED CARE
J.M.Wiener, RTI International, Washington, District of
Columbia
Older people with disabilities currently receive care in a
fragmented and uncoordinated financing and service delivery
system, both within and between the health and long-term
care systems. Financing for acute care is largely the respon-
sibility of Medicare and the federal government, while long-
term services and supports (LTSS) is dominated by Medicaid
and state governments. As a result, no organization is respon-
sible for managing all aspects of care for a person. Indeed,
under the current system, the financial incentives are to shift
costs between Medicare and Medicaid, especially for users of
LTSS, where Medicaids financial role is large for LTSS and
small for medical care and Medicares financial role is small
for LTSS and large for medical care. The fragmented financ-
ing and delivery system has negative consequences for older
people, including high levels of hospitalization and poten-
tially avoidable hospitalizations.
INTEGRATING CARE FOR DUAL MEDICARE-
MEDICAID ELIGIBLE SENIORS: ANEW LOOK AT THE
MINNESOTA MODEL
W.L.Anderson1, S.Long2, Z.Feng1, 1. RTI International,
Research Triangle Park, North Carolina, 2. Urban Institute,
Washington, District of Columbia
With few incentives for program coordination, the 10
million Americans who are dually eligible for Medicare and
Medicaid often receive fragmented and inefficient care. Using
20102012 Medicare and Medicaid fee-for-service claims,
managed care encounters, and enrollment data, we assessed
the impact of enrollment in the Minnesota Senior Health
Option (MSHO) a state-wide fully-integrated Medicare-
Medicaid model and the first of its kindon health care
and long-term services and supports use among elderly dual
eligibles, relative to similar enrollees in Minnesota Senior
Care Plus (MSC+), a Medicaid-only managed care plan with
Medicare fee for service. MSHO enrollees had 60 percent
higher likelihood of community-based services use and 49
percent lower likelihood of hospital-based care than similar
MSC+ enrollees. Adopting fully-integrated care models simi-
lar to MSHO in Minnesota may have merit for other States
as they consider strategies to improve care delivery for dual
eligibles under Medicare and Medicaid.
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99
INFORMATION EXCHANGE IN INTEGRATED CARE
MODELS
M.Knowles1, S.Mitchell2, E.G.Walsh3, M.Ignaczak4,
L.Bercaw3, 1. Aging, Disability, and Long-Term Care,
RTI International, Durham, North Carolina, 2. Digital
Health Policy and Standards, RTI International, Chicago,
Illinois, 3. Aging, Disability, and Long-Term Care, RTI
International, Waltham, Massachusetts, 4. Quality
Measurement and Health Policy, RTI International,
Washington, District of Columbia
Integrated care models offer the organizational structure
to support the coordination needed to provide high qual-
ity care to populations with long-term service and support
(LTSS) needs. This study describes how care coordination
is operationalized by examining the information exchange
processes in several integrated care models. We conducted
an environmental scan, convened a technical advisory group,
interviewed subject matter experts, and conducted case stud-
ies of three integrated care systems. We determined that care
coordination and information exchange remain high touch
processes, and organizational trust and personal relation-
ships between providers remain foundational to successful
care coordination; existing electronic health records are inad-
equate for integrated care models because they do not cap-
ture all information needed to support those with LTSS needs;
electronic exchange of information with LTSS providers gen-
erally does not occur; and interpretation differences of regu-
lations that protect patient health information create barriers
to exchanging information and providing coordinated care.
CHALLENGES AND OPPORTUNITIES TO EXPAND
THE PACE INTEGRATED CARE MODEL TO NEW
POPULATIONS
S.Karon, M.Knowles, E.Vreeland, R.Love, G.Chiri, RTI
International, Research Triangle Park, North Carolina
The PACE program has a long history of successfully
serving people age 55 and older who need nursing home level
of care in the community. The program provides integrated
medical and social services, coordinated through highly-
structured interdisciplinary teams and primarily provided
through adult day health centers. The PACE Innovation Act
of 2015 allows expansion of this model to other populations.
We present findings from a recent study of how the PACE
model might serve younger people with physical, intellec-
tual, developmental, or mental health disabilities. Challenges
identified include the structure and function of the interdis-
ciplinary teams, acceptability of day center-based services,
organizational capacity to support populations with unique
needs, and adequacy of payment risk adjustment methodolo-
gies. We will discuss implications of these findings for the
older populations currently served by PACE, and identify
ways in which the PACE model might evolve to meet chang-
ing views of service provision and coordination.
SESSION 420 (SYMPOSIUM)
INTERNATIONAL PERSPECTIVES ON DIVERSE
ROLES FOR OLDER PEOPLE IN HIGHER EDUCATION
Chair: T.Scharf, Newcastle University, United Kingdom
In focusing on students between the ages of 1824, tra-
ditional models of higher education (HE) typically overlook
100
issues arising from demographic change. However, trends
towards lifelong learning in some countries have increased
age diversity within university classrooms. Further, increas-
ing acceptance of the importance of public involvement and
engagement (PPI/E) has created new opportunities for older
people to connect with teaching and research taking place in
HE. This symposium will draw on key international exam-
ples to explore the increasingly diverse roles of older people
in HE. Matthew Kaplan will describe the Intergenerational
Leadership Institute, a certificate training program devel-
oped by Penn State University for older adults already
engaged in volunteering but with an interest in getting more
involved, at a leadership level, in developing or expanding
intergenerational programs in their areas of interest. Alison
Phinney will discuss working in partnership with older peo-
ple to undertake applied nursing research projects. Thomas
Scharf will explore learnings that arise from developing a
new educational programme for older adults in Ireland,
Touchstone, aimed at promoting civic engagement in
later life. Ellen Tullo will present insights arising from the
involvement of older adults in the design, development and
delivery of an interdisciplinary module for undergraduate
students in the UK. By comparing and contrasting these
examples, and the roles that older people may adopt, con-
tributors will critically review benefits and challenges associ-
ated with involving older people in the life and work of HE
institutions.
UNIVERSITY AS INTERGENERATIONAL LEARNING
AND LEADERSHIP INCUBATOR
M.Kaplan, The Pennsylvania State University, State
College, Pennsylvania
Public awareness and interest in intergenerational pro-
grams is strong, fueled in part by a growing literature that
attests to wide-ranging benefits for program participants
and their communities. Participants tend to derive richer
life perspectives, enhance social support networks, and find
new pathways to civic engagement and community service.
However, even successful programs tend to have difficulty
finding skilled staff members to assist with program plan-
ning, activity facilitation, and program evaluation. Penn
State Universitys Intergenerational Leadership Institute (ILI)
is a lifelong learning and civic engagement program for older
adults as well as an incubator for new intergenerational pro-
gram development. ILI participants gain skills in reaching
out to age-diverse populations, facilitating communication
and cooperation across generations, and building consen-
sus and teamwork among partnering organizations. The ILI
adopts a micro-level approach to community innovation and
service, focusing on the utilization of local assets and skills to
shape self-help strategies at the local level
INCLUDING OLDER PEOPLE IN RESEARCH TOWARD
CHANGE
A.Phinney, J.Baumbusch, L.Hung, University Of British
Columbia, Vancouver, British Columbia, Canada
Through our respective programs of research, we seek to
improve long term residential care services, support mean-
ingful activity for older people in community settings, and
enhance the physical environment for older patients in acute
care hospitals. What unites our work is a commitment to
Innovation in Aging, 2017, Vol. 1, No. S1
using research as a vehicle for effecting positive change in
the health and social care systems. This pragmatist lean-
ing has led us as nurses to consider older people not as the
focus of our research, but as our partners in research. We
discuss three ways that older people have been involved in
our work: as informants; as advisors; and as co-researchers.
We provide examples from various projects to illustrate
the challenges and benefits of older people being included
through these kinds of partnering roles, and where we see
potential to further develop this approach to applied nurs-
ing research.
DEVELOPING ACIVIC EDUCATION PROGRAMME
FOR OLDER PEOPLE: LESSONS FROM IRELAND
T.Scharf1, B.McDonald2, A.Atkins3, 1. Newcastle
University, Newcastle, United Kingdom, 2. National
University of Ireland Galway, Galway, Ireland, 3. University
College Dublin, Dublin, Ireland
Touchstone is a civic engagement programme that aims
to develop the skills and capacities of a diverse population
of older people to engage in community and, potentially,
age-friendly initiatives. This paper reviews the experience of
developing Touchstone in Ireland as a short course with the
potential to generate participant-directed projects. We high-
light the value of collaboration between higher education
and community partners, presenting insights from a mixed-
methods evaluation of two Touchstone courses involving 50
people aged 50 and over. Drawing on pre- and post-course
questionnaires, two focus groups, and a range of observa-
tional data, the paper highlights opportunities and challenges
emerging from development of the Touchstone programme.
The paper concludes with an assessment of the potential role
for higher education in Ireland and other countries in embed-
ding age-friendly initiatives, founded on meaningful active
engagement of ageing adults, within local communities.
SESSION 425 (SYMPOSIUM)
TECHNOLOGY SUPPORTING PEOPLE WITH
DEMENTIA
Chair: W.Moyle, Griffith University, Brisbane, Queensland,
Australia
Co-Chair: L.P.de Witte, Zuyd University of Applied
Sciences, Heerlen, Netherlands
New as well as existing technologies can help the person
with dementia and family carers to reduce social isolation
and behavioral and psychological symptoms of dementia
(BPSD), and therefore help to make the disease more man-
ageable. This symposium, presented by leaders in the field
of technology and social robots aims to assist participants
to recognise the benefits of technology use in dementia care.
An introduction to new online platforms to support family
and community dwelling older people will demonstrate the
relationship between independence and technology, while
an overview of three social and telepresence robot projects
will demonstrate the importance of these technologies in
reducing social isolation and BPSD. The three symsposium
presentations will be complemented by the introduction of
a new measurement of engagement - an important concept
when measuring the effect of technology and persons with
dementia.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
IMPROVING DEMENTIA CARE THROUGH SOCIAL
AND TELEPRESENCE ROBOTS
W.Moyle1, C.Jones1, B.Sung2, T.Dwan1, J.Murfield1, of simple and clear apps, the platform offers a market place
1. Menzies Health Institute QLD, Griffith University,
Brisbane, Queensland, Australia, 2. Curtin University, Perth,
Western Australia, Australia
The complexity of dementia, and the differing care ser-
vices, makes it difficult to establish best practices for man-
aging behavioural and psychological symptoms of dementia
(BPSD). Our team have been trialling robots in the commu-
nity and a social robotic laboratory. This presentation will
demonstrate what we have learnt to date about the impact
of using the robots in dementia care. Findings related to
improvements in engagement, socialisation and mood as
well as the feasibility of using social and telepresence robots
from three studies will be outlined: 1)Acluster-randomised
controlled trial (n=415, people with dementia living in long-
term care), with three treatment groups a robotic animal
(PARO), a non-robotic animal (Plush-Toy), and usual care
(control); 2)Acase study of five dyads (people with dementia
and family) using telepresence robots in a 6-week interven-
tion; and 3) family, people with dementia and health pro-
fessionals acceptance of telepresence robots in a laboratory
trial.
ONLINE PLATFORM TO SUPPORT THE NETWORK
OF CAREGIVERS OF PEOPLE WITH DEMENTIA
E.van Rossum, R.Verwey, A.Boessen, L.P.de Witte, were assessed for Principal Components analysis along with
S.Willard, Zuyd University of Applied Sciences, Heerlen,
Netherlands
Care technology is used insufficiently to support persons
with dementia, their family and professional caregivers. We
integrated a range of eHealth services and applications into
an online platform, with the aim to strengthen care and
support networks of persons with dementia. The platform
was developed in an iterative user centered way, based on
an available platform. It consists of cubes with informa-
tion about dementia (care), video communication options, a
calendar and care plan. Afirst version was tested during 10
weeks in the networks of four community-dwelling persons
with dementia. Family caregivers reported that they were
better informed and felt more in control. Care professionals
reported improved communication and better understanding
among themselves and with family caregivers. In the autumn
of 2016 the platform will be tested in 40 patient networks
over a 4months period. We will report the results of this field
test and discuss the next steps.
A COMMUNITY ICT PLATFORM TO SUPPORT
COMMUNITY-DWELLING ELDERLY PEOPLE:
FEASIBILITY AND IMPACT
S.Willard1, E.van Rossum1,2, M.Spreeuwenberg1,2,
L.P.de Witte1,3, 1. Zuyd University of Applied Sciences,
Heerlen, Netherlands, 2. Maastricht University, Maastricht,
Netherlands, 3. University of Sheffield, Sheffield, United
Kingdom
Older people prefer to stay independent and active in
their own environment. Information and communication
technology can support them in accomplishing these goals.
This is challenging though, as many are not familiar with
technology. We introduced a community ICT platform in
IAGG 2017 World Congress
101
Heerlen, a city with a highly ageing population, in close col-
laboration with older persons and active citizens. By means
for mutual services, community information, access to pro-
fessional services, and possibilities to set up new community
activities. Aprocess evaluation is conducted to study the use
of and experiences with the platform. In addition, the plat-
forms impact on independent functioning, social contacts
and involvement in community activities is studied in 150
users over a 12months period. We will report data over the
first 4months and discuss the role of such platforms in future
care and support models.
ASSESSING THE USE OF TECHNOLOGY TO ENGAGE
PEOPLE WITH DEMENTIA
C.Jones1, B.Sung2, W.Moyle1, 1. Menzies Health Institute
QLD, Griffith University, Brisbane, Queensland, Australia,
2. Curtin University, Perth, Western Australia, Australia
The study of engagement (i.e. social interaction/connec-
tion) in people with dementia can determine the effectiveness
of using technology to promote meaningful activity and to
improve quality of life. This paper presents the psychometric
properties of a recently developed 10-item Engagement of
a Person with Dementia Scale (EPWDS). Four raters each
watched and completed the EPWDS for 132 videos of peo-
ple with dementia using PARO, a social companion robot
for ten minutes. Psychometric properties of the EPWDS
measures of construct validity (i.e. convergent validity),
internal consistency, test-retest reliability and inter-rater reli-
ability. The EPWDS is reliable and shows validity in assess-
ing engagement when using technology in five dimensions:
affective, visual, verbal, behavioural, and social engagement.
Importantly, it can be used to demonstrate the benefits of
using technology to improve quality of life in people with
dementia.
SESSION 430 (SYMPOSIUM)
FINANCING SERVICES FOR OLDER ADULTS WITH
DAILY LIVING NEEDS: U.S. VS. INTERNATIONAL
REFORM EFFORTS
Chair: G.E.Alkema, The SCAN Foundation, Long Beach,
California
Over half of all adults turning 65 in the United States
will experience a high need (needing assistance with two or
more activities of daily living or experiencing severe cogni-
tive impairment) for long-term services and supports (LTSS)
over their lifetime. Fifteen percent will experience high need
for five or more years. However, the United States lacks an
insurance system to protect older adults from the risks asso-
ciated with this need. It relies, instead, on an unsustainable
mix of out-of-pocket payments, unpaid family caregiving
and financing from Medicaid, a welfare-based healthcare
program for low-income individuals.
Over the past two years, several influential bipartisan
groups have developed recommendations for shifting the
financing of LTSS to an insurance-based system. In this sym-
posium, long-term care financing leaders will 1)share insights
from new economic modeling platform that supported pol-
icy recommendation development, 2) discuss the structure
102
and status of policy recommendations to date, and 3)com-
pare these proposals with long-term care systems from other
countries also preparing for a rapidly aging population.
LTSS RISKS AND COSTS IN THE U.S.: NEW
RESEARCH INFORMS FINANCING SOLUTIONS
A.Tumlinson, Anne Tumlinson Innovations, LLC,
Washington, District of Columbia
New economic modeling from the Washington, DC-based
research organization, the Urban Institute, has changed the
policy conversation about long-term supports and services
(LTSS) financing reform in the U.S. The Urban Institute has
developed a micro-simulation model of the lifetime risk of
needing LTSS and the costs associated with this risk. In this
presentation, Anne Tumlinson, project coordinator for the
modeling work, will share the major findings and discuss
their implications. These include average lifetime risk for
needing a high level of LTSS and the average costs of this risk,
by financing sources out-of-pocket spending and Medicaid.
This presentation will explain how these risks vary by gender
and income, and how the averages mask an uneven distribu-
tion of risk. This presentation will then present results from
simulations of new insurance programs; the winners and los-
ers under a variety of approaches.
BUILDING ANEW LTSS FINANCING SYSTEM IN THE
U.S.: BIPARTISAN LEADERS JOIN TOGETHER TO
CRAFT SOLUTIONS
K.J.Hayes, Bipartisan Policy Center, Washington, District
of Columbia
The Washington, DC-based Bipartisan Policy Center
(BPC) has been working, over the past two years, to rec-
ommend reforms for financing Long-Term Services and
Supports (LTSS) in the U.S. Their work, chaired by Former
Senate Majority Leaders Tom Daschle and Bill Frist, Former
Congressional Budget Office Director Alice Rivlin, and
Former Governor and Department of Health and Human
Services Secretary Tommy Thompson, considered a wide
range of private and public sector options. This presentation
will share BPCs final recommendations on the roles of pri-
vate long-term care insurance markets and public insurance
programs, as well as insights on BPCs decision-making pro-
cess, and how the economic modeling influenced those deci-
sions. This presentation will also discuss the challenges that
U.S.policymakers face in reforming the current system and
political feasibility of reform given these challenges.
NEW LTSS FINANCING REFORM OPTIONS IN THE
U.S. AND HOW THESE RELATE TO INTERNATIONAL
EXPERIENCES
H.Gleckman, The Urban Institute, Washington, District of
Columbia
While the 2010 Affordable Care Act (ACA) extended
healthcare coverage to most Americans, it did not improve
the financing of long-term services and supports (LTSS).
As a result, a group of influential non-government stake-
holders and thought leaders formed the Long-Term Care
Financing Collaborative to develop detailed recommenda-
tions for enhancing both finance and delivery of LTSS. In
this presentation, Howard Gleckman, a senior fellow at the
Urban Institute and one of the Collaboratives conveners,
Innovation in Aging, 2017, Vol. 1, No. S1
will discuss its recommendations, including a universal cata-
strophic insurance program. This presentation will compare
the Collaboratives recommendations with LTSS financing
systems in selected other countries, and explain how lessons
from these countries are informing reform efforts in the U.S.
SESSION 435 (SYMPOSIUM)
SOCIAL ISOLATION AND LONELINESS: APLACE-
BASED PERSPECTIVE
Chair: R.Winterton, La Trobe University, Wodonga,
Victoria, Australia
As the population ages, more older people across the
world are living alone, such that social isolation and loneli-
ness have emerged as a key policy and practice challenge,
with important implications for the health and wellbeing
of older people. Thus, governments at all levels as well as
major non-profit organizations have implemented a range
of health promotion interventions designed to address this
intransigent problem. In recent years, for example, Age UK
has developed the Campaign to End Loneliness, while the
Australian Red Cross is currently running a campaign called
Doing it Tough designed to reduce older peoples feelings of
loneliness and isolation.
However, whilst researchers, policy-makers and practi-
tioners all recognise this area as a major concern, there is an
important gap in understanding of how social isolation and
loneliness are impacted by the environments in which older
people live. Thus, presenters at this Symposium will address
this issue from a number of place-based perspectives, both
across and within national boundaries, as well as across the
rural / urban divide. Rurality is a particular focus as many
older people across the world live in geographically isolated
communities.
By exploring how social isolation and loneliness may dif-
fer according to the places people live, this Symposium will
challenge us to explore the design and implementation of
more appropriate and effective social interventions.
DOES LONELINESS AMONG OLDER PEOPLE VARY
WITH THE PLACE THEY LIVE?
C.Victor, J.Pikhartova, Brunel University London,
London, United Kingdom
There are variations between different countries in
reported levels of loneliness but less attention has been given
to variations within countries. We use data from the English
Longitudinal Study of Ageing (ELSA) to investigate if loneli-
ness for older people varies between different areas (urban,
rural, inner city and deprivation status). Areas are classified
using standard measures of deprivation and type (urban,
rural) and we use 2 loneliness measures: R-UCLA scale and
a self-rating question.
4,765 individuals were present in both waves 2 and 6
(mean age 71.6years (wave 6)). Loneliness prevalence was
18% in wave 2 and 20% in wave 6.Loneliness was higher
for those living in deprived areas (ORs from 1.4 to 1.8)
compared to those who were not although the relationship
was attenuated when confounding factors were taken into
account (OR 1.11; 95%CI 1.021.20). There was no relation
between loneliness and type of area (urban/rural).
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
UNDERSTANDING LONELINESS IN AUSTRALIAN
RURAL AGEING POPULATIONS: AMIXED METHODS
APPROACH
S.Hodgkin, R.Winterton, J.Warburton, John Richards
Initiative, La Trobe University, Wodonga, Victoria, Australia
Utilising data from six Australian rural regions, this
mixed-methods study sought to understand both the predic-
tors of loneliness, and how loneliness is constructed among
diverse rural ageing populations. At stage one, cross sectional
data was collected via a telephone survey (n=266), with
measures relating to wellness, health, social capital, social
ties and reciprocal support, and loneliness. This was followed
by qualitative, semi structured interviews (n=60), which
sought to expand on the quantitative findings. A standard
multiple regression found that wellness, mental and physi-
cal health, support received and community characteristics
predicted 38.5% of the variability seen in loneliness. Other
variables, (age, gender, social and community participation)
did not contribute to the amount of variability in loneliness
scores. This presentation critically discusses these findings in
the context of the qualitative data relating to loneliness, and
highlights how rural older adults construct loneliness in rela-
tion to micro and macro environmental characteristics.
FEELINGS OF LONELINESS IN AN URBANIZED
COUNTRY: DOES PLACE AND CIVIC ENGAGEMENT
MATTER?
S.Dury, N.De Witte, D.Vert, L.De Donder, A.Smetcoren, separation, divorce, labour force participation and migration
S.Van Regenmortel, Vrije Universiteit Brussel, Brussels,
Belgium
This paper explores the relationships between environ-
mental features, civic engagement and feelings of loneliness.
It raises the question of how neighborhoods and munici-
palities promote or hinder feelings of loneliness. Data for
the research are derived from the Belgian Ageing Studies, a
structured survey among community-dwelling older people
(n= 28 094, in 83 municipalities. We conducted multivari-
ate regression models which included environmental factors
(degree of urbanization, neighborhood connectedness and
satisfaction, quantity and quality of contact with neighbors)
and civic engagement (personal leisure, civic participation,
informal help, community leisure, and volunteer work) on
feelings of loneliness (social and emotional loneliness). The
results indicate that feeling connected to the neighborhood,
having qualitative contact with neighbors, and doing volun-
teer work or particicipate in an association lowers feelings
of social loneliness. The conclusion raises practical implica-
tions and formulates a number of policy recommendations
to tackle feelings of loneliness in an aging society.
THE IMPACT OF RURALITY, DISADVANTAGE, AND
POPULATION TURNOVER ON SOCIAL ISOLATION
AND LONELINESS
V.Burholt, D.Morgan, Swansea University, Swansea,
United Kingdom
This study draws on the CFAS Wales data to test a path-
way from poor health to loneliness in later life. We hypoth-
esize that poor health will increase the risk of social isolation,
and that social isolation will mediate between health and
loneliness. Further, we hypothesize that rural environments,
disadvantage places and population turnover will amplify
IAGG 2017 World Congress
103
exclusion from social resources. We conceptualize a media-
tion model and a moderated-mediation model. Nationally
representative data on older people living in Wales are used
to validate the hypothesized pathways. The results indicate
that our hypotheses are partially supported. We demonstrate
that there are distinct pathways from poor health to loneli-
ness in different types of areas. The statistical models increase
our understanding of the contribution that environment has
in social isolation and the experience of loneliness. We sug-
gest that it is insufficient to consider loneliness as an outcome
of interactions between individual-level characteristics.
SESSION 440 (SYMPOSIUM)
CHALLENGES FOR CONTEMPORARY
GRANDPARENTING: GENDER, WORK,
IMMIGRATION AND DISABILITY
Chair: S.Moffatt, Newcastle University, Newcastle upon
Tyne, United Kingdom
Co-Chair: H.Merrick, Newcastle University, Newcastle
upon Tyne, United Kingdom
Discussant: M.Silverstein, Syracuse University, Syracues,
New York
Increased life expectancy offers the potential for grand-
children to establish much longer term relationships with
their grandparents, yet contemporary patterns of marriage,
make the experience of being a grandparent more complex
and diverse. It is widely accepted that grandparents play an
important role practically, emotionally and financially, but
that this varies across cultures, social and family norms
and welfare states. Gender, retirement practices, policies to
extend working life, socio-economic factors and migration
patterns are key to a better understanding of grandparenting
in the 21st century, yet much is poorly comprehended and
inadequately theorised. This symposium will address some
of these gaps and draw on European, North American and
globally focused research. Paper 1 examines the impact of
social policies to extend working lives on grandparenting in
the UK from the perspective of both women and men. Paper
2 focuses on the extensive childcare provided by working
grandmothers in the US and how this impacts on their own
lifecourse. Paper 3 explores cultural expectations amongst
immigrant grandmothers in the US, and the conflicts which
can ensue when norms contrast with their country of origin.
The final paper considers the experiences of grandparenting
in the context of childhood disability and the challenges this
can present across three generations of the family as the
grandparent ages. More broadly, this symposium enables
debate about how intergenerational relations, social policies,
migration, gender, agency and structure will lead to a better
understanding of contemporary grandparenting.
GRANDPARENTS, CARE, GENDER, AND FLEXIBLE
WORK IN THE UK
D.Lain1, W.Loretto2, 1. University of Brighton, Brighton,
United Kingdom, 2. University of Edinburgh, Edinburgh,
United Kingdom
UK grandparents are an important source of childcare pro-
vision for working parents (Glaser etal, 2010). At the same
104
time, however, there are increasing pressures for older peo-
ple to remain in work, creating a potential tension between
working and caring. We therefore need a much better under-
standing of the experiences, preferences and perspectives of
grandparents providing care and how their decisions interact
with their domestic, work and retirement circumstances. The
paper presents results from a project qualitatively interview-
ing 60 UK grandparents that regularly care for their grand-
children while their adult children are at work. The sample
includes grandmothers and grandfathers, and is stratified to
include working and non-working grandparents on high to
low incomes. Key findings relate to the influences of work-
related flexibility and part-time work on caring; the impor-
tance of resources in terms of exercising control; and the role
of grandfathers in caring.
CULTURAL AND GENDERED EXPECTATIONS
OF LATIN AMERICAN AND CARIBBEAN
GRANDMOTHERS IN THE U.S.
Y.Abdul-Malak, Syracuse University, Syracuse, New York
As with any other groups in the U.S, immigrant grand-
mothers provide care for grandchildren when their adult
children are in need of assistance and public programs do not
provide adequate support. This paper focuses on the theoret-
ical framework of carework outside of the Western context.
It draws on in-depth interviews with 15 immigrant non-cus-
todial grandmothers from Latin America and the Caribbean
and examines how contrasting cultural and gendered expec-
tations between the sending and receiving countries make
grandmothering challenging. Disciplining grandchildren
was one of the more salient issues that was raised through
almost all the interviews. Immigrant grandmothers attempt
to reconcile the forms of discipline from their home countries
and what they perceive as the tolerance that is pervasive in
Americans childrearing practices. The issue of disciplining
their grandchildren engenders some type of emotional stress
that might have some deleterious effects on grandmothers
health.
GRANDPARENTING DISABLED CHILDREN:
EXPERIENCES FROM THE UK
S.Moffatt, M.Tse Laurence, L.Pennington, Institute of
Health and Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
Grandparenting in the context of childhood disability, is
an under-researched area, particularly in the UK. This quali-
tative study draws on in-depth interviews with nine grand-
parents (seven grandmothers) of children aged 319 years
with a range of developmental disabilities. Grandparenting
norms were similar to grandparents of non-disabled chil-
dren, namely to not interfere and be there. However, this SUMMER SCHOOL ON AGEING
was complemented by intensive grandparenting, and grand-
parents simultaneously expressed positive and negative feel-
ings and exercised considerable agency to achieve a balance
in their relationships with their disabled and non-disabled
grandchildren. Grandparents reflected on the impact of their
own ageing and death in the context of the continued needs
of their disabled grandchild, and worried for their adult
children, denied a normal life course. The ageing of the
disabled grandchild and grandparents impacts on the type
and intensity of grandparenting provided, with particular
Innovation in Aging, 2017, Vol. 1, No. S1
implications for the care responsibilities of middle genera-
tion adult children.
SESSION 445 (SYMPOSIUM)
BUILDING INTERDISCIPLINARY RESEARCH
CAPACITY: LESSONS FROM THE INTERNATIONAL
SUMMER SCHOOLS ON AGING
Chair: G.Lamura, INRCA - National Institute of Health
and Science on Ageing, Ancona, Marche, Italy
Co-Chair: A.Martin-Matthews, University of British
Columbia, Vancouver, British Columbia, Canada
Discussant: A.C.Walker, University of Sheffield
The objective of this symposium is to consider the
rationale, delivery and outcomes of an International
Summer School on Ageing (ISSA) for doctoral students
and post-doctoral fellows, held in 2012 (Italy), 2014
(Sweden) and 2016 (Canada). The creation of the ISSA
is a direct response to the Road Map for European
Ageing Research (Walker etal., 2011), produced by the
European Commissions FuturAGE project. ISSA is unique
in its interdisciplinary approach, international audience
(of both participants and mentors), and focus on ageing-
related contents as well as methodological and research
development issues. We analyse the outcomes of three
ISSA. Data are based on participants assessments at the
end of each and then six months post-ISSA (six data-sets
totally). The perspectives of several ISSA alumni (among
its 60 graduates) reflect different national and disciplinary
(including clinical) contexts in appraising ISSAs short-
and longer-term impacts. Findings underscore the value
of role-modelling through interaction with established
researchers and the development of international research
networks, leading to active interdisciplinary collabora-
tions. This symposium also contextualizes approaches to
the future of interdisciplinary education on ageing, com-
paring ISSA with other national and international initia-
tives. The training of early career researchers remains often
largely mono-disciplinary, thus challenging researchers
professional capacities to understand the holistic nature
of the ageing process. ISSA underscores instead the value
of additional interdisciplinary training within an inter-
national framework. The FuturAGE project leader, Alan
Walker (UK), is discussant, and will highlight how initia-
tives like ISSA can play a strategic role in capacity building
in ageing research.
BUILDING FUTURE COHORTS OF RESEARCHERS:
RATIONALE AND AIMS OF AN INTERNATIONAL
G.Lamura1, A.Martin-Matthews2, C.Chiatti1, T.Svensson3,
1. INRCA - National Institute of Health and Science on
Ageing, Ancona, Marche, Italy, 2. University of British
Columbia, Vancouver, British Columbia, Canada, 3. Lund
University, Lund, Sweden
Globally, increasing efforts are being undertaken to set
up programmes aimed at enhancing size, interdisciplinarity,
international focus and quality of new cohorts of research-
ers in ageing-related issues. Awareness of such developments,
as well as of the wide-ranging priorities identified by the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
FuturAGE Road Map for European Ageing Research,
prompted a group of researchers from countries with
quite different gerontological traditions (Canada, Italy and
Sweden) to initiate an International Summer School on
Ageing (ISSA). This presentation provides an introduction
to the rationale and objectives of the ISSA, starting with
an overview of existing models for building a community
of age-focused researchers. Lessons from different training
initiatives are also discussed, including the Summer Program
in Aging organised by Canadas Institute of Aging. Finally,
ISSAs design, implementation and evaluation structure will
be illustrated, highlighting the solutions adopted to enhance
the capacities of participants for collaborating across disci-
plines, sectors and geographical areas.
OVERVIEW OF THE MAIN CONTENTS AND
OUTCOMES OF THE ISSA: EVALUATION AND
FOLLOW-UP STRATEGIES
F.Barbabella1,2, C.Chiatti1, R.Papa1, 1. INRCA - National
Institute of Health and Science on Ageing, Ancona, Marche,
Italy, 2. Linnaeus University, Kalmar, Sweden
This contribution aims at illustrating contents and out-
comes of the first three editions of the ISSA, including its
mid-term impact on the careers of early-stage researchers
who attended it. A longitudinal assessment was conducted
with all participants (N=60), both at post-event and 6-month
follow-up for each ISSA. Assessment included a questionnaire
with structured and semi-structured questions on the satis-
faction and usefulness of each module, as well as on advan-
tages from participating in the ISSA. Findings underline the
high rating of professional and research skills development
in training for publication and grant-crafting. Furthermore,
interaction with established researchers and being part of
a research network were perceived as main benefits after
attendance. Some students reported that, after the event, they
remained in contact for study or research purposes. Results
suggest that ISSA represented an exceptional opportunity
for capacity building and to establish connections between
researchers with different disciplinary backgrounds.
FROM ISSA STUDENT TO ALUMNI: LEARNING
OUTCOMES AND EXPERIENCES OF PARTICIPANTS
C.Nilsen2, E.Tullo1, S.Van Regenmortel3, 1. Newcastle
University, Newcastle upon Tyne, United Kingdom, 2.
Aging Research Center - Karolinska Institutet & Stockholm
University, Stockholm, Sweden, 3. Vrije Universiteit,
Brussels, Belgium
This presentation will compare and contrast the personal
perspectives of three students who each attended different
iterations of the International Summer School of Ageing
(ISSA): 2012, 2014 and 2016. We will outline the key learn-
ing outcomes we obtained during the summer school and
what this meant for our career trajectories after the event.
In particular, we will discuss why and how participation in
the summer school increased our confidence as early career
researchers, gave hands-on tips and tricks, and allowed us
to establish an international professional network beyond
our home institutions. We will describe examples of concrete
academic outputs prompted by participation in ISSA such
as international conference symposia and ongoing collabora-
tion between ISSA students and faculty members.
IAGG 2017 World Congress
105
THE FUTURE OF INTERDISCIPLINARY AND CROSS-
NATIONAL GRADUATE EDUCATION ON AGING
AND HEALTH
S.Iwarsson, Department of Health Sciences, Faculty
of Medicine and Centre for Ageing and Supportive
Environments (CASE), Lund University, Lund, Sweden
Building upon the experiences of establishing a graduate
school integrated in a center for research on aging (CASE) and
the national graduate school for aging and health (SWEAH)
in Sweden, Lund University is a founding partner of ISSA.
Nurtured by collective as well as personal experiences of
graduate supervision and examination internationally,
trends useful for future interdisciplinary and cross-national
education endeavors will be presented and problematized.
Evaluation results show that students are highly motivated
for interdisciplinary research, but also that they find it chal-
lenging to integrate such perspectives in their thesis projects.
Students as well as supervisors must engage in networking
beyond their comfort zones, while balancing mono-discipli-
nary formal requirements and interdisciplinary ambitions.
PhD student engagement in cross-national research intro-
duces even further challenges, but is highly rewarding for
those involved. Truly committed and open-minded senior
researchers serving as role models constitute a prime require-
ment for the future of such developments.
SESSION 450 (SYMPOSIUM)
THE WORLDWIDE FACE OF ELDER ABUSE:
COMMONALITIES AND DIFFERENCES AMONG
SELECTED WHO REGIONS
Chair: P.B.Teaster, Virginia Polytechnic Institute & State
University, Blacksburg, Virginia
Discussant: G.Antezberger, Cleveland State University,
Cleveland, Ohio
Building upon the first international study, The Worldview
Environmental Scan on Elder Abuse, this symposium presents
findings from the second international study, The Worldwide
Face of Elder Abuse. Specifically, the purpose of this study was
to understand commonalities and differences among World
Health Regions concerning how and why people abuse older
adults. The aims of the study were to:(1) increase the number
of survey respondents, both in terms of represented persons
and countries, (2) expand the group of experts and exper-
tise in the field of elder abuse through the formation or use
of related national multidisciplinary teams, and (3) explore
undisclosed areas of inquiry with respect to elder abuse as a
global problem. Participants in this symposium will present
the following information: background of the study, meth-
odology of the study, characterizations of cases from Asia,
Europe, North America, and South America. The symposium
concludes with observations from the case studies from the
four regions as well as study implications and next steps.
OVERVIEW AND MAJOR FINDINGS FROM THE
WORLDWIDE FACE OF ELDER ABUSE STUDY
P.B.Teaster, R.H.Weaver, Human Development, Virginia
Polytechnic Institute & State University, Blacksburg,
Virginia
The first large-scale international study, the WorldView
Environmental Scan on Elder Abuse, explored the nature
106
and response to elder abuse (53 individual countries, 6 WHO
regions). Results indicated that the problem of elder abuse
existed and that no single definition applied. In developing
countries, poverty and lack of social support were leading
causes of elder abuse in developing countries; in developed
countries, living alone and lack of social support were lead-
ing causes. Building upon the Scan, the Worldwide Face of
Elder Abuse is the second ever large-scale international study
of elder abuse. This presentation summarizes the major find-
ings from the study, in which exploitation by a family mem-
ber is prevalent across the majority of cases, and concludes
with implications of the findings and future directions for
conducting future large-scale international studies.
THE FACE OF ELDER ABUSE IN ASIA
E.Yan, G.Fang, The University of Hong Kong, Hong Kong,
Hong Kong
Asian population is aging at an unprecedentedly fast pace.
By 2050, 24% of the population would age 60 or above
(HelpAge International, 2013). This presentation outlines
the current state of knowledge of elder abuse in Asia, with
a particular emphasis on studies conducted in Chinese soci-
eties. The presenter highlights the changing cultural values
and sociodemographic characteristics and their relevance to
understanding elder abuse in Chinese populations. Efforts to
prevent and intervene elder abuse in Chinese societies will
also be discussed.
THE FACE OF ELDER ABUSE IN EUROPE
B.Penhale, School of Health Sciences, University of East
Anglia, Norwich, United Kingdom
This paper will provide an overview of elder abuse, with
a focus on UK and European perspectives. The issues and
developments that have occurred will be briefly explored.
Over the last decade there has been increasing recognition
of abuse and neglect of older adults as a social problem.
Anumber of European countries have been working in this
area but are at different stages of development. Recognition
of abuse remains problematic. Defining and identifying
abuse remain difficult, perhaps even more when the abuse
occurs within institutional settings. Techniques of interven-
tion with victims of abuse and those who abuse are in com-
paratively early stages of development, although there has
been progress with systems for health and care profession-
als. Responses to the problem of elder abuse from several
European countries will be explored, although there will be
a concentration on techniques of intervention from a UK
perspective.
THE FACE OF ELDER ABUSE IN SOUTH AMERICA
L.Daichman, ILC-Argentina, Buenos Aires, Argentina
In South America, there is a growing understanding that
providers of public and private services abuse the human
rights of frail older people by failing to provide personal
care, adequate treatment, and basic nutrition and hydration.
Over the last 15 years, policymakers, health professionals,
users, and carers in Argentina have collaborated to publi-
cise the benefits of providing compassionate, humane, and
empathic care to elders. A better understanding of human
rights and a new International Convention for the Rights
of Older Persons will improve all types of care and prevent
Innovation in Aging, 2017, Vol. 1, No. S1
institutional neglect and abuse. National campaigns such as
La Cultura del Buen Trato and training over 25,000 caregiv-
ers have concentrated on positive reinforcement and sup-
port to staff delivering care to older people. Highlighting
the importance of human rights in the care of older people
emphasises that dignified care is the responsibility of all staff
as well as those who commission care.
ELDER ABUSE IN CANADA: AGROWING DILEMMA
IN AN AGING SOCIETY
E.Podnieks, University of Toronto, Toronto, Ontario,
Canada
According to Statistics Canada, eight million adults will
be over the age of 65 by 2031, nearly 25 percent of the
population. Increasingly, older adults report being victims of
abuse, even though Canada has actively addressed the prob-
lem since the early 1980s (Podnieks, 1989). This presentation
describes the most recent study to quantify the extent of elder
abuse and neglect in Canada (McDonald, 2016). More than
three quarters of a million Canadian elders suffered some
form of abuse last year, more than double the 1998 find-
ing. One reason could be a rise in financial abuse, the second
most frequent form behind psychological abuse. The most
important risk factor was depression, followed by having
been abused in another stage of the life course. This presen-
tation describes the studys guiding theoretical framework,
methodology, and findings and draws conclusions and offers
implications for future research and services for maltreated
older adults in Canada.
SESSION 455 (SYMPOSIUM)
COMMUNITY FOR SUCCESSFUL AGEING (COMSA)
@WHAMPOA: CREATING AN ECOSYSTEM FOR
AGEING IN PLACE
Chair: S.Harding, International Longevity Centre,
Singapore, Singapore
Discussant: H.J.Vrijhoef, Saw Swee Hock School of Public
Health, National University of Singapore, Singapore,
Singapore
Ageing in Place remains the Holy Grail for aged care
planning despite advances made in healthcare, home tech-
nology, housing design and healthcare financing. It requires
coordinated, multipronged efforts from policy, research and
practice to re-engineer the ecosystem where people live,
work, play and age. One such re-engineering project has been
initiated by Tsao Foundation, a Singapore-based but region-
ally oriented non-governmental organisation, in 2013.
This symposium showcases Tsao Foundations ground-
up, community-wide demonstration project called the
Community for Successful Ageing or ComSA. The impetus
for ComSA comes from the Foundations mission to fulfil
older persons needs and aspirations for their continuing
healthcare and personal growth. Situated in a relatively lower-
income and higher elder concentration locality in Whampoa,
ComSA created a unique ecosystem that responds to policy
and market challenges in a non-welfare state. ComSA pulls
together multiple components for successful ageing, which
include: multidisciplinary health and social services, civic
empowerment and participation and policymaking.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
ComSA planners, implementers, providers and research-
ers will be speaking at the symposium. Talks will be followed
by discussions with participants for the following topic areas:
1. An overview of ComSA its theoretical framework and
essential components
2. The development of a system of care in ComSA from
case finding, primary care, care management to service pro-
vider networking
3. The development and activation of the grassroots com-
munity from self-care to self-development
4. An overview of research activities measuring pro-
cesses and outcomes
AN OVERVIEW OF COMSAITS THEORETICAL
FRAMEWORK AND ESSENTIAL COMPONENTS
M.Tsao1, W.Ng1, K.Peh1, S.Harding1, Z.J.Hildon2,3,
Z.Z.Lim1,2, H.J.Vrijhoef2,4,5, 1. Tsao Foundation,
Singapore, Singapore, 2. Saw Swee Hock School of Public
Health, National University of Singapore, Singapore,
Singapore, 3. London School of Hygiene and Tropical
Medicine, London, United Kingdom, 4. National University
Health System, Singapore, Singapore, 5. Department of
Patient & Care, Maastricht University Medical Center,
Maastricht, Netherlands
The ComSA (Community for Successful Ageing) @
Whampoa initiated by Tsao Foundation (Singapore) brings
together multidisciplinary expertise for optimising oppor-
tunities in longevity and improving the quality of life of
older persons in the interconnected areas of health, personal
empowerment, social participation and wellbeing. This ses-
sion gives an overview of various ComSA components and
the theories underpinning ComSA.
THE DEVELOPMENT OF ASYSTEM OF CARE FOR
THE AT-RISK ELDERS IN COMSA
W.Ng, K.Peh, H.Chua, F.Hon, E.Koh, P.Cheong, Tsao hence required persistent effort to build relationship. The
Foundation, Singapore, Singapore
ComSA @Whampoa has two major domains: the System
of Care (SoC) and Community Development. The SoC
domain aims to create a comprehensive and integrated
delivery system for care of the at-risk elderly. This session
describes the creation of the SoC through three key com-
ponents: 1) the development of novel biopsychosocial risk
screener that identifies vulnerable community-dwelling older
adults; 2) the provision of stratified aged care service by a
multidisciplinary care management team in partnership with
age-friendly primary health care providers; and 3)the crea-
tion of a service provider network. SoC implementers will
also share their journey in developing the program, feedback
gathered from the clients and SoCs impacts on the overall
ComSA ecosystem. A more in-depth discussion of the care
management component is available in the fourth presenta-
tion of the symposium.
COMMUNITY DEVELOPMENT IN COMSA: FROM
SELF-CARE TO SELF-DEVELOPMENT
M.B.Geronimo, E.S.Ahmad, J.Lee, S.Harding, Tsao
Foundation, Singapore, Singapore
ComSA @Whampoa has two major domains: the System
of Care and Community Development (CD). The CD domain
addresses psycho-social needs of ageing. It aims to increase
IAGG 2017 World Congress
107
older persons sense of health and wellbeing by: address-
ing problems of alienation and apathy; improving sense of
optimism and community pride; cultivating leadership and
trust among community members. This session describes
the creation of CD through three key components: 1) the
development of an educational intervention to assist elders
to develop positive attitudes and behaviours toward self-care
and wellness; 2)the creation of platform for elders to address
their biopsychosocial challenges and collectively find solu-
tions; 3) the facilitation of longer-term, elder-initiated civic
action groups in partnership with stakeholders from across
all sectors and age groups. CD implementers will also share
their journey in developing the program, feedback gathered
from the clients and CDs impacts on the overall ComSA
ecosystem.
CARE MANAGEMENT IN COMSA: SHIFTING
FROM AHOSPITAL-CENTRED TO APROACTIVE,
COMMUNITY-BASED APPROACH
H.Chua, K.Peh, F.Hon, E.Koh, P.Cheong, W.Ng, Tsao
Foundation, Singapore, Singapore
Background: Traditionally, case management (CM) in
Singapore adopts a hospital-centric model: CM clients are
identified only by the hospitals; and referred by the hospitals
to community-based providers. ComSA-CM aims to reverse
this process by proactively identify clients even before prob-
lems are developed or worsen. Method: Selected case studies
from ComSA-CM will be presented to explore: methodol-
ogy used for proactive detection of CM clients; how care
is integrated with other service providers; major operational
challenges; and potential outcomes achieved. Results: This
new care model required big changes in care focus, CM
approaches and relationship to the clients. Adjustments were
required for roles, skillset and the pacing with the clients.
Most well (but at-risk) clients would resist CM initially;
acceptance of CM was facilitated by a concurrent commu-
nity activation project. Conclusion: Community-based CM
is proactive in preventing deterioration in clients already at-
risk for hospitalisation.
SESSION 460 (POSTER)
ACUTE CARE I
MAKING BETTER DECISIONS ABOUT POST-ACUTE
CARE: KEY STAKEHOLDER PERSPECTIVES
R.E.Burke1, E.Lawrence1, A.Ladebue1, R.Ayele1,
J.Reither1, J.Jones2, E.Cumbler3, R.Allyn4, 1. Research
and Hospital Medicine Sections, Denver VA Medical Center,
Denver, Colorado, 2. University of Colorado College of
Nursing, Aurora, Colorado, 3. University of Colorado
School of Medicine, Aurora, Colorado, 4. Denver Health
and Hospital Authority, Denver, Colorado
The number of older adults discharged to post-acute care
(PAC) facilities after hospitalization is increasing rapidly, but
their clinical course is uncertain. We sought to understand
how the decision to go to a PAC facility after hospitalization
is made from the perspectives of hospital-based clinicians
(physicians, nurses, therapists, social workers), patients, and
108
caregivers. We also wanted to understand the perspective of
PAC-based clinicians, patients, and caregivers on the content
and quality of this decision-making. We conducted 70 semi-
structured interviews at three hospital-based units and two
skilled nursing facilities with content focusing on the knowl-
edge, attitudes, and beliefs of participants regarding PAC. We
used a team-based approach to analysis with both inductive
and deductive components informed by social constructiv-
ism, transitions of care principles, and systems engineering.
Among hospital providers, decision-making is decentralized
and implicit, without consensus on which patients should
go to PAC or when they are ready to be discharged. There
was strong tension between patient autonomy and provider
paternalism, and little feedback to improve decision-mak-
ing. Patients and caregivers identified several systems bar-
riers, including insurance coverage and hospital length of
stay, which affected their decision-making. PAC providers
identified common transitional care deficits and highlighted
the increasing acuity and complexity of patients admit-
ted to PAC, while patients and caregivers expressed stress
and uncertainty about payment and planning for a possible
return home. Decision-making about PAC is highly variable
but can have a profound impact on outcomes; understanding
these perspectives and identifying best practices for shared
decision-making may improve outcomes.
ANTITHROMBOTIC AGENTS INTAKE PRIOR TO
INJURY DOES NOT AFFECT OUTCOME AFTER ATBI
IN ELDERLY PATIENTS
J.Julien1,2, G.Alsideiri5, J.Marcoux3, M.Feyz4, E.de
Guise1,2,6, 1. Psychology, Montreal University, Laval,
Quebec, Canada, 2. Centre de recherche interdisciplinaire
en radaptation du Montral mtropolitain, Montreal, factors were from different dominions: socio demographic,
Quebec, Canada, 3. Neurology and Neurosurgery
Department, McGill University Health Centre, Montreal,
Quebec, Canada, 4. Traumatic Brain Injury Program,
McGill University Health Centre, Montreal, Quebec,
Canada, 5. Montreal Neurological institute & Hospital,
McGill University, Montreal, Quebec, Canada, 6. Research
Institute-McGill University Health Center, Montreal,
Quebec, Canada
Previous studies have shown that anticoagulation is asso-
ciated with a higher risk of bleeding after traumatic brain
injury (TBI) and a higher mortality rate. However, other
studies have shown conflicting results on the outcome after
a TBI in anticoagulated patients. The purpose of this study
is to investigate the effect of risk factors including interna-
tional normalized ratio (INR) as well as the Partial throm-
boplastin time (PTT) scores on outcome following TBI in
the elderly population. Data were retrospectively collected
on patients (n=982) aged 65 and above who were admitted
post TBI to the McGill University Health Centre-Montreal
General Hospital from 2000 to 2011. Age, Injury Severity
Score (ISS), Glasgow Coma Scale score (GCS), type of
trauma (isolated TBI vs polytrauma including TBI), initial
CT scan results according to the Marshall classification and
the INR and PTT scores and prescriptions of antiplatelet or
anticoagulant agents (AP/AC) were collected. We found that
age is significantly associated with an increase in the rate of
death (CSHR:1.08, 95%CI(1.06, 1.11) and in the rate of
discharge to a long-term facility (CSHR:1.06, 95%CI (1.03,
Innovation in Aging, 2017, Vol. 1, No. S1
1.09)). PTT values above 60 adversely affected outcome in
patients not on AP/AC only, and INR values had no effect
on outcome or CT findings. Age and injury severity rather
than antithrombotic agent intake are associated with adverse
acute outcome in hospitalized elderly TBI patients.
MORTALITY AND ASSOCIATED RISK FACTORS
FOR OLDER ADULTS VISITING THE EMERGENCY
DEPARTMENT
C.Garcia-Pena3, P.Tella1, L.Robles2, U.Perez1, 1. Geriatric
Epidemiology Research, National Institute of Geriatrics,
Mexico City, Distrito Federal, Mexico, 2. National Institute
of Psychiatry Ramn de la Fuente Muiz, Mexico City,
Mexico City, Mexico, 3. Research Department, National
Institute of Geriatrics, Mexico City, Mexico City, Mexico
Context: The recent increase in population aging has
implications in every level of health, including acute care in
an emergency department context. In order to allocate care
for those in the highest risk of mortality, factors associated
with lower survival in older adults that assist to emergency
departments are needed.
Design: Cohort study
Setting: Observation and emergency department of two
General hospitals of the Metropolitan area of Mexico City.
Patients or other participants: adults over 60years of age,
of both sexes, beneficiaries of the Mexican Institute of Social
Security and residents of the Metropolitan area of Mexico
City who were admitted for observation to an emergency
department of one of the two participating general hospitals
Main and secondary outcome measures: All-cause mor-
tality from the time of hospital admission until a follow-
up home visit after discharge was measured. Included risk
health-care related, health-related (mental and physical) and
in-hospital care-related. Survival functions were estimated
using Kaplan-Meier curves, and associated life tables were
calculated. Hazard ratios were derived from Cox regression
models in a multivariate analysis.
Results: From 1,406 older adults 59.17% were women
(n=701). Independent mortality risk factors found were age,
schooling, delayed emergency assistance, length of stay in
the ED, ED with geriatric care trained residents, handgrip
strength, cognitive status, worsening delirium, decline in
functional status and frailty.
Conclusion: The health system must adapt to the mul-
tidisciplinary needs of the older adults, emergency depart-
ments may represent triggers for mortality.
IMPACT OF AGERIATRIC CO-MANAGEMENT
PROGRAM FOR ELECTIVE JOINT REPLACEMENT
J.C.Defillo2,1, J.Goncalves Monteiro1,3, L.E.Rubin1,4,
J.Froehlich1,4, K.Butterfield1,3, L.McNicoll1,2,3, 1. Alpert
Medical School of Brown University, Providence, Rhode
Island, 2. University Medicine Foundation, Department
of Internal Medicine, Division of Geriatrics and Palliative
Medicine, Providence, Rhode Island, 3. Department of
Medicine, Rhode Island Hospital, Providence, Rhode
Island, 4. Dapertment of Orthopaedic Surgery, Division of
Adult Reconstruction, Providence, Rhode Island
Introduction: Geriatric co-management models (GCM)
within orthopedic surgery have emerged in the last decade,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
especially with hip fractures. Our aim was to compare a GCM
program for elective knee (TKA) and hip (THA) replacement
with historical (HG) and concurrent control (CG) groups
in regards primarily to length of stay (LOS) and secondar-
ily to 30-day readmission rates (RaR), mortality, and home
discharges. Methods: Retrospective cohort design, including
patients aged 70 and above undergoing elective joint replace-
ment in a community hospital, November 2011 to December
2013. Protocols for geriatric syndromes and post-operative
complications were developed. Of 1167 patients, 33.8%
were HC. After GCM implementation, 344/733 (44.5%)
were GCM patients. Outcomes were analyzed using multi-
variate analysis. Results: Baseline characteristics were similar
except for slightly lower ASA score (p=0.06) and fewer rates
of TKA (31.8% [GCM] vs 33.1% [CG] and 35.0% [HG],
p<0.001). GCM group had significantly lower mean LOS
(3.6 vs. 4.2 [CG] and 4.0 [HG], p<0.001). Rehabilitation dis-
charges (29.1% vs. 36.8% [CG] and 34.0% [HG], p=0.97),
and RaR (21.8% vs. 40.0% [CG] and 38.2% [HG], p=0.43)
trended lower in GCM, but did not achieve statistical signifi-
cance. In-hospital deaths were low (3 [CG] and 0 [GCM]).
Conclusions: AGCM program for elective joint replacement
is effective in reducing length of stay. Thirty-day readmission
rates were 45% lower. Discharges to rehabilitation were less
common by up to 20%. The positive impact of GCM on
elective arthroplasty, if disseminated widely, could improve
care for this vulnerable group of older orthopedic patients.
ESTIMATION OF APPENDICULAR MUSCLE
MASS IN HOSPITALIZED OLDER ADULTS USING
BIOELECTRICAL IMPEDANCE
R.R.Deer, L.Akhverdiyeva, E.Volpi, Sealy Center on
Aging, University of Texas Medical Branch, Galveston,
Texas
Sarcopenia is now a billable ICD-10 geriatric condition
characterized by low appendicular skeletal muscle mass
(ASMM) and low function. There is an increasing need of
portable, provider-friendly, cost-effective methods for the
estimation of ASMM.
The purpose of this study was to develop and validate an
ASMM prediction model using Bio Impedance Analysis and
DXA as reference. To increase applicability of our method,
we used a single frequency foot-to-foot BIA scale (Tanita
BF-350) that determines weight and percent fat mass (FM).
Awhole body scan (DXA, GE Lunar) was used to precisely
determine ASMM.
Subjects (n=171, 65 yrs.) were enrolled during an acute
hospitalization at UTMB. Testing included: demographics
(age, gender, race), body composition (DXA, BIA, anthro-
pometric measures), physical function (gait speed, grip
strength), independence questionnaires (ADL, IADL) and
chart review (blood metabolic panels, admission history).
FM derived from DXA (FMDXA) was positively corre-
lated with that measured by BIA (FMBIA) (r=0.792, p<0.01).
A Bland-Altman plot showed that BIA underestimated FM
by 3.445.49% (p<0.01). Scatterplots for linearity were
run on all testing variables. FMBIA, grip strength, and BMI
had linear relationships with ASMMDXA. Astepwise multiple
regression was used to derive the ASMM prediction model
using the following statistically significant variables: gender,
FMBIA, grip strength and BMI.
IAGG 2017 World Congress
109
Once validated with a larger sample, this equation could
be used in a hospital setting to estimate ASMM using a sim-
ple, portable and cost-effective device. Those identified to
have low ASMM could then undergo further functional test-
ing for diagnosis and treatment for sarcopenia.
COMPARISONS BETWEEN PREVALENT AND
INCIDENT DELIRIUM IN OLDER ADULTS:
APROSPECTIVE COHORT STUDY
T.J.Avelino-Silva, F.Campora, J.A.Esper Curiati, W.Jacob-
Filho, Division of Geriatrics, Department of Internal
Medicine, University of Sao Paulo Medical School, Sao
Paulo, SP, Brazil
We sought to compare clinical characteristics and mortal-
ity associated with prevalent and incident delirium in hos-
pitalized older adults. We conducted a prospective cohort
study in a university hospital geriatric ward, from 2009
2014, in Sao Paulo, Brazil. We included hospitalizations of
acutely ill patients aged +60 years who experienced delir-
ium. Delirium was detected using CAM criteria and defined
either as prevalent (diagnosed at admission) or incident
(diagnosed throughout hospitalization). Patients were sub-
mitted to standardized comprehensive geriatric assessments
at admission. Additional clinical data were documented
upon death or discharge. We compared the association of
each group with in-hospital mortality using Cox propor-
tional hazards models. We included 535 hospitalizations
with a mean age of 82 years. Overall, 62% were women,
43% had moderate/severe dementia, 32% died in the hos-
pital. Delirium was detected at admission in 70% of the
cases. Prevalent delirium happened in older patients (mean
age 83vs.80years;p=0.001), was more frequently associated
with dementia (49vs.29%;p<0.001), and more commonly
precipitated by infections (80vs.64%;p<0.001). Medications
precipitated a greater proportion of incident delirium cases
(14vs.6%;p=0.025). We did not observe differences in delir-
ium severity according to Delirium Index scores (p=0.45).
Mortality was similar (32% for prevalent, 31% for incident
delirium) and the adjusted hazard ratio for in-hospital death
for prevalent delirium did not differ from incident delirium
(HR=0.84; 95%CI=0.561.26). Two in three cases of delir-
ium in acutely ill older adults were diagnosed at admission.
Though similar regarding severity and prognosis, prevalent
and incident delirium had distinctive predisposing and pre-
cipitating factors, which might justify different management
approaches.
THIRTY-DAY RE-HOSPITALIZATION PREVENTION:
MULTIDISCIPLINARY REVIEW OF MEDICATION
OMISSIONS AND ERRORS
L.Cummings Vaughn1, H.Pautler2, S.Birge1, 1. Washington
University in St. Louis, Saint Louis, Missouri, 2. Barnes
Jewish Hospital, Saint Louis, Missouri
Medication errors can contribute to re-hospitalization.
Centers for Medicare and Medicaid Services has targeted
discharge medications to reduce errors and 30-day re-hos-
pitalization. To characterize discharge medications, a phar-
macist and geriatrician reviewed medical records of patients
over the age of 65. The aim was to identify recurring medi-
cation errors that could be targeted by discharge coordina-
tors. Errors were identified in 97% of patients, of which 34%
110
were omissions and 66% inappropriate. Of the latter, 53%
were considered potential contributors to re-hospitalization
in 60 days. The most common inappropriate errors were
loop diuretics (14%), antihypertensives (9%), and sliding
scale short-acting insulin (6%). The most common omissions
were failure to treat vitamin D (32%) and B12 deficiencies
(32%) and iron deficiency anemia (18%).
In summary, medication errors at discharge are com-
mon and can increase the risk of re-hospitalization. These
observations suggest that more effective strategies should be
implemented to reduce discharge medication errors.
HOSPITAL-WIDE COMPREHENSIVE GERIATRIC
ASSESSMENT (CGA) FOR OLDER PEOPLE:
EMERGING MODELS OF CARE
P.McCue1, A.McLeod2, K.Phelps3, K.Nockels3,
S.Conroy3, H.Roberts4, S.Kennedy5, S.G.Parker1, 1.
Institute for Ageing, Newcastle University, Newcastle upon
Tyne, United Kingdom, 2. Newcastle upon Tyne Hospitals,
Newcastle upon Tyne, United Kingdom, 3. Leicester
University, Leicester, UK, United Kingdom, 4. Southampton
University, Southampton, United Kingdom, 5. Sheffield
University, Sheffield, United Kingdom
Recent years have seen increased use of acute hospitals
by older people. The effectiveness of CGA for inpatients is
well established, but delivery of hospital wide CGA is not
extensively described. The UK National Institute for Health
Research recently called for more research on the delivery of
hospital wide CGA.
We performed an umbrella review of reviews of inpa-
tient CGA [PROSPERO 2015:CRD42015019159] which
identified evidence syntheses published between 2009 and
2015. We also reviewed research papers and abstracts pub-
lished since the most recent included review (20132015).
We searched the Cochrane Database of Systematic Reviews,
Database of Abstracts of Reviews and Effects, MEDLINE
and EMBASE, for recent trials (RCTs), evaluations and con-
ference abstracts describing CGA for hospital inpatients over
65years. We used content analysis to create an overview of
recently reported trends in hospital wide CGA
We screened 715 publications and selected 12 reviews, 17
papers and 34 abstracts for review. The umbrella review iden-
tified that frailty is not widely examined as a target for, or a
determinant of CGA outcome. Recent papers and abstracts
describe team based interventions, adjustment of skill mix and
the use of protocols. Settings included the ED, acute assess-
ment, surgical and oncology units. We found no recent RCTs
which evaluated the effectiveness of CGA in these acute inpa-
tient settings. Specific care processes for delirium, risk screen-
ing, medications and daily ward / board rounds were described.
New CGA trials which stratify participants for frailty and
evaluate effectiveness in new hospital wide settings and ser-
vices are justified.
EFFECTS OF AMBIENT TEMPERATURE ON
MORTALITY OF HOSPITALIZED OLDER ADULTS:
APROSPECTIVE COHORT STUDY
T.J.Avelino-Silva, F.Campora, J.A.Esper Curiati, W.Jacob-
Filho, Division of Geriatrics, Department of Internal
Medicine, University of Sao Paulo Medical School, Sao
Paulo, SP, Brazil
Innovation in Aging, 2017, Vol. 1, No. S1
Older adults are particularly susceptible to harm result-
ing from exposure to extreme temperatures, but this has not
been fully explored in the context of geriatric care. We sought
to determine if temperature extremes are associated with in-
hospital mortality in acutely ill older adults. We included
hospitalizations of acutely ill patients aged +60years, admit-
ted to the geriatric ward of a university hospital, from 2009
2015, in Sao Paulo, Brazil. Our primary outcome was time
to in-hospital death and we used mean daily temperatures
to assess the effect of temperature on mortality. Mean daily
temperatures at the high 95th/90th percentiles were defined as
extreme heat, and at the low 10th/5th percentiles as extreme
cold. Covariates included month of the year, weather and
air quality variables, and data from standardized compre-
hensive geriatric assessments. Multivariate analysis was per-
formed using Cox proportional hazards models. We included
1,403 cases, with a mean age of 80years. Overall, 61% were
women, median Charlson Comorbidity Index was 3, and
in-hospital mortality reached 19%. Temperature percentile
cut-offs were: 15oC; 16oC; 25oC; 26oC. Mortality was high-
est in the 95th percentile group, reaching 27%. The adjusted
hazard ratio for all-cause mortality in the 26oC group as
compared to the 16.1-25oC group was 1.89 (95%CI=1.14
3.12; p=0.013). The associations between other mean daily
temperature groups and mortality were not statistically
significant. In conclusion, a mean daily temperature higher
than 26oC was independently associated with increased in-
hospital mortality. Public health and hospital administrators
should take this effect into account when developing hospital
facilities.
PRELIMINARY RESULT ON GERIATRIC-SURGERY
ATTENTION IN COLORECTAL SURGERY:
ARETROSPECTIVE COHORT STUDY
J.Llabata-Broseta1,2, F.J.Tarazona-Santabalbina1,2,
.Belenguer-Varea1,2, D. lvarez-Martnez2, C.Trescoli
Serrano1, D.Cuesta-Peredo1,2, J.Avellana-Zaragoza2, 1.
Geriatric Medicine, Hospital Universitario de la Ribera
(Alzira, Valncia, Spain), Alzira, Valncia, Spain, 2.
Universidad Catlica de Valencia. San Vicente Mrtir,
Valncia, Spain
Introduction: Population aging is generating an increase
of hospital surgical activity in geriatric patients. Given the
functional, cognitive, social and clinical profile of these
patients, comprehensive geriatric assessment (CGA) is a use-
ful tool to identify clinical and functional problems.
Objectives: To evaluate the possible improvement of hos-
pital care from an interdisciplinary approach using CGA in
elective surgery for colorectal neoplasia.
Methodology: Aretrospective cohort study was designed
in patients over 69 admitted for colorectal cancer sur-
gery between 2007 and 2012. Exposed (Geriatric-Surgery
Intervention Group=GSG) were defined as the patients
treated with interdisciplinary attention and no exposed
(Usual Care Group=UCG) were defined as the patients
treated by surgeons during hospital admission.
Results: The sample was composed of 310 patients (203
in GSG and 107 in UCG). GSG presented a higher mean
age 77.5 (SD 4.8) versus 75.3 (SD 4.8) years, p<0.001, and
higher score in Charlson index (5.2 (SD 3.5) vs 4.2 (SD 3.4),
p=0.013. During hospital admission there were no difference
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in number of complications, hospital stay and in-hospital
mortality. GSG presented a significant reduction in the odds
ratio OR of in-hospital delirium 0.22 (95% CI 0.08 to 0.60;
p =0.003). Cox regression showed no significant difference
in mortality between groups during 12 months follow-up
period after hospital discharge (Hazard ratio 0.98, 95% CI
0.31 to 3.14 p=0.977).
Conclusions: Although higher age and comorbidity, GSG
patients reduced OR of delirium. Future clinical trials could
demonstrate the effectiveness of interdisciplinary teams in
geriatric patients with elective colorectal cancer surgery.
TRENDS IN GERIATRIC EMERGENCY MEDICINE
FOR OLDER ADULT PATIENTS
J.G.Schumacher1, J.Hirshon2, T.Hogan3, P.Magidson2,
M.Chrisman4, 1. University of Maryland, Baltimore
County, Baltimore, Maryland, 2. University of Maryland,
Baltimore, Baltimore, Maryland, 3. University of Chicago,
Chicago, Illinois, 4. Winterpark Hospital, Winterpark,
Florida
Older adults have sought treatment in emergency depart-
ments (EDs) since their inception, however, increasing num-
bers of older adult ED patients present unique challenges
to EDs. This research examines the emergence of dedicated
U.S. geriatric emergency departments (GEDs) and related
models of ED care between 20072015. Survey data was
collected from N=53U.S. hospitals out of a total of N=82
hospitals identified as promoting their geriatric emergency
medical services. Analysis reveals substantial heterogeneity in
the organization and provision of care. Annual openings of
new GEDs reached N=15 in 2013 with fewer than half that
number opening in any other year. Over 85% of setting used
the term senior in their title in contrast to geriatric. Most
GEDs did not allocate dedicated GED space (56%), how-
ever, the majority (>80%) made modifications to bedding,
flooring, lighting, and clinical procedures in a portion of the
ED. Respondents noted challenges in GED staffing, training
& education, availability of validated screening tools, and
sustained support of the hospital administration. Overall,
the care of acutely ill older patients remains in flux. Current
ED settings make specific modifications based on local needs
and resources in the absence of strong incentives to adopt
recently released national geriatric emergency department
guidelines and principles (2014).
LONG-TERM PROGNOSIS OF UPPER
GASTROINTESTINAL BLEEDING IN THE ELDERLY
POPULATION
A.Negers2, N.Carbonell2, M.Verny1, C.Thomas1,
J.Boddaert1, D.Thabut1, H.Vallet1, 1. Geriatric depart-
ment, Pitie Salpetriere hospital, Paris, France, 2. Saint
Antoine hospital, Paris, France
Although upper gastrointestinal bleeding (UGIB) repre-
sents a frequent medical situation with a high in-hospital
mortality rate in the elderly population, data concerning long
term prognosis are lacking and are essential to improve their
medical care.
In this prospective observational study, all patients who
have undergone an upper gastrointestinal endoscopy for
bleeding were included between june 2015 and may 2016.
Comorbidities were evaluated with the Cumulative Illness
IAGG 2017 World Congress
111
Rating Scale (CIRS), functional autonomy with Activities
of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL) scales, and frailty with Rockwood scale.
Primary objective was the 6-months mortality. Secondary
objective was the comparison between 6-months and pre-
hospital functional autonomy.
Fifty seven patients (age 83 [7987] years, 58% women)
were included. The median CIRS score was 10 [815],
with scores of 5.5 [46] ADL, 3 [14] IADL and 5 [56]
Rockwood. Main clinical presentation and etiology were
respectively represented by melena (n=41, 72%) and gas-
troduodenal ulcers (n=38; 67%). Fifty six percent of patients
(n=32) presented at least one complication during hospitali-
zation and intra-hospital mortality rate was 18% (n=10). At
6months, 48% of patients were dead. Among the survivors,
92% returned home. There was no difference for functional
autonomy between pre-hospitalization and 6-months evalu-
ation (ADL score 5.5 [4.56] (p=0.31), IADL score 2 [14]
(p=0.73), Rockwood score 5 [46] (p=0.59)).
In the elderly, UGIB are associated with a high 6-months
mortality rate. However, functional autonomy is preserved
in survivors.
EXERCISE, PROTEIN, AND ELECTRIC STIMULATION
REDUCES ICU ASSOCIATED SARCOPENIA IN OLDER
PATIENTS
A.C.Verceles1,2, M.C.Serra1, C.Wells1, D.Davis1,
J.Sorkin1,2, M.L.Terrin1, G.Alon1, A.P.Goldberg1, 1.
University of Maryland School of Medicine, Baltimore,
Maryland, 2. University of Maryland Claude D.Pepper
Older Americans Independence Center, Baltimore,
Maryland
Background: Older, critically ill patients receiving mechan-
ical ventilation (MV) are more susceptible to ICU-related
sarcopenia due to undernutrition, preexisting comorbidities,
and physical deconditioning. We developed an intervention
(ExPrES) which incorporates mobility and strengthening
exercise (Ex), high-protein supplementation (Pr) and neu-
romuscular electric stimulation (ES) for 14days to prevent
sarcopenia in older, ICU patients.
Methods: Pilot study comparing the effects of ExPrES
on nutrition goals, muscle mass, and functional mobility
compared to usual ICU care. Exercise was mobility-based,
protein was supplemented to 1.61.75g/kg/d actual body
weight, and electric stimulation consisted of two 30-minute
treatments/day.
Results: We studied 22 ICU patients receiving MV (9
ExPrES, 13 control; mean age 614 yrs, BMI 301kg/m2).
The ExPrES group received more dietician-recommended
calories (89 vs. 56%) and protein (88 vs. 39%) compared
to controls. Although both groups were initially in negative
nitrogen balance, by day 4 the ExPrES group achieved posi-
tive balance while the control group remained negative. The
ExPrES group experienced less leg muscle loss (day 07, -8
vs. -13%; day 014, -12 vs. -23%) compared to the control
group. The ExPrES group improved their gait speed while the
controls speed decreased (+0.37 vs. - 0.05 m/s).
Conclusion: These results suggest that a daily intervention
combining mobility and strength-based rehabilitation, pro-
tein supplementation, and electric stimulation can achieve
positive nitrogen balance and reduce muscle loss in older,
112
critically ill patients over 14 days. Furthermore, this inter-
vention can potentially reduce the neuromyopathic, mobility
and malnutrition-associated complications associated with a
prolonged ICU stay.
SESSION 465 (POSTER)
ADVANCE CARE PLANNING AND END-OF-LIFE
DECISIONS
RELIGIOSITY AND ADVANCE CARE PLANNING BY
WHITE AND AFRICAN AMERICAN OLDER ADULTS
C.Koss, University of Kansas, Lawrence, Kansas
Well-documented racial disparities in advance care plan-
ning (ACP) raise concerns regarding end-of-life care received
by African Americans (AA). Although no clear reasons for
disparities have been identified, religiosity is one commonly
proposed explanation. Health and Retirement Study data
(N=6,861) were analyzed to examine how religious affili-
ation, behaviors, and beliefs were associated with written
and verbal ACP and to determine if religiosity explained
ACP disparities between older Whites and AAs. The odds of
advance directive completion were twice as high for Whites
after controlling for demographic and health-related covari-
ates (OR=2.51). Similar results were shown for advance
care discussion (OR=2.42). More frequent religious service
attendance was associated with higher odds of advance
directive completion (OR=1.12), and more frequent prayer
was positively related to verbal ACP (OR=1.08). Importance
of religion was negatively associated with advance directive
completion (OR=.87). Compared to those with no religious
affiliation, Catholics (OR=.68) and Protestants (OR=.73)
were less likely to engage in advance care discussion. In
intragroup analyses, religious service attendance was posi-
tively associated with advance directive completion for both
Whites and AAs. Whites who were Catholic and AAs who
were Protestant were less likely to discuss treatment pref-
erences compared to those with no religious affiliation. For
White participants only, importance of religion exhibited a
negative relationship with written ACP, whereas more fre-
quent prayer was associated with higher odds of both writ-
ten and verbal ACP. Although religiosity did not explain race
disparities, distinct aspects of religiosity influenced ACP both
negatively and positively, and these effects varied by race.
EARLY UPTAKE OF NEW U.S. CENTER FOR
MEDICARE AND MEDICAID SERVICES ADVANCE
CARE PLANNING PAYMENT
M.Tai-Seale1, Y.Yang1, E.Dillon1, S.Tapper2, S.Lai3,
P.Yu4, H.Allore5, C.S.Ritchie6, 1. Palo Alto Medical
Foundation Research Institute, Mountain View, California,
2. Palo Alto Medical Foundation, Santa Cruz, California,
3. Palo Alto Medical Foundation, Palo Alto, California, 4.
Hartford HealthCare, Hartford, Connecticut, 5. Yale School
of Medicine, New Haven, Connecticut, 6. UCSF School of
Medicine, San Francisco, California
January 2016 began the Center for Medicare and
Medicaid Services reimbursement for advance care plan-
ning (ACP) conversations. Multiple stakeholders are inter-
ested in knowing the impact of this highly anticipated new
Innovation in Aging, 2017, Vol. 1, No. S1
reimbursement option. We examined the number of ambula-
tory care providers billing for ACP conversation as of June
30, 2016, along with historical ACP documentation (includ-
ing Advance Health Care Directives (AHCD) and Physician
Orders for Life Sustaining Treatment (POLST)) in a large
multi-specialty healthcare system with an integrated mul-
tidisciplinary community-based palliative care program. In
six months, 69 of 1,200 providers billed for ACP conversa-
tions, suggesting a modest yet meaningful uptake of the new
ACP payment. Retrospectively, among 3,444 patients 65
with serious illnesses and no pre-existing ACP documenta-
tion, only 14% (N=483) had ACP documented in an digitally
extractable location in the electronic health records at the
end of a two-year period (20132014). Among the 6% of
the 3,444 seriously ill patients who received palliative care
services, 65% had ACP documented. In contrast, only 11%
of those without palliative care had ACP. Propensity score
weighted regression analyses showed a strong and statisti-
cally significant relationship between receiving palliative
care and AHCD (OR=14.2, 95%CI=5.1~39.6) and POLST
(OR=175.8, 95%CI=24.9~1243.2). We conclude that pay-
ing for ACP is a meaningful first step, which has resulted in
a modest and growing number of providers reimbursed for
ACP conversations. Systemic efforts are essential to improve
providers competencies in and patients readiness for ACP
discussions. Palliative care services should be integrated into
routine care for seriously ill patients.
FACILITATORS AND BARRIERS FOR ADVANCE
CARE PLANNING AMONG ETHNIC MINORITIES:
SYSTEMATIC REVIEW
M.Hong, E.Yi, K.J.Johnson, M.E.Adamek, Indiana
University, Indianapolis, Indiana
Growing evidence suggests under-engagement in advance
care planning (ACP) among ethnic minorities in the U.S.
However, findings about factors affecting ACP among ethnic
minorities are fragmented. The purpose of this study was to
synthesize findings from prior research about ACP among
ethnic minorities and identify facilitators and barriers toward
it. Out of 633 studies identified through an extensive litera-
ture search, only 25 studies met our inclusion criteria such
as primary evidence, study location (U.S.), publication year
(since 2006), study purpose (ACP) and sample (ethnic minor-
ity adults or older adults). Four categories of facilitators and
barriers were identified: Socio-demographic factors, health
care experiences, cultural values, and spirituality. Socio-
demographic factors such as education and financial resources
showed inconsistent findings regarding their association with
ACP engagement. However, health literacy (knowledge and
awareness about ACP) and past experiences with ACP are a
common facilitator for ACP across ethnic minority groups,
whereas mistrust toward health care system was identified
as a barrier only for Black Americans. Collectivistic/family-
centered cultural values greatly influenced ACP engagement
among Latinos and Asian Americans; however, spirituality/
religion played an important role among Blacks. The results
of this systematic review illuminate facilitators and barri-
ers that can be utilized to promote ACP for ethnic minori-
ties. Educational interventions can be an effective venue to
facilitate ACP for ethnic minorities by improving awareness
about ACP. In such interventions, health care professionals
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
may need to consider including family members or clergy to
address culturally unique barriers toward ACP.
INTENTION TO DISCUSS ADVANCE CARE
PLANNING AMONG KOREAN AMERICANS
M.Hong1, B.L.Casado2, S.Lee3, 1. Indiana University,
Indianapolis, Indiana, 2. Colorado State University, Fort
Collins, Colorado, 3. San Jose State University, San Jose,
California
Despite a growing interest in end-of-life care, there is a
dearth of research about advance care planning (ACP) among
ethnic minorities. The purpose of this study was to examine
intention of ACP among Korean Americans. Two specific
objectives were: 1)to identify factors affecting intention of
ACP and 2) test the Theory of Reasoned Action (TRA) in
explaining intention of ACP. The TRA explains that subjec-
tive norms, attitudes toward behavior, and perceived behav-
ioral control predict intentions and behaviors. Specifically,
using a culturally expanded TRA model, direct effects of
acculturation on attitudes, norms and perceived control;
and direct effects of attitudes, norms, and perceived control
on intention of ACP were hypothesized. Data was drawn
from a cross-sectional survey with 226 Korean Americans.
Multivariate regression analysis revealed that greater knowl-
edge about Alzheimers and more positive attitudes and
stronger subjective norms were associated with greater inten-
tion of ACP. The initial path model of a culturally expanded
TRA model yielded a poor model fit. However, a revised path
model produced an excellent model fit. In the revised model,
direct effects of perceived control on attitudes and norms,
and direct effects of attitudes and norms on intention were
found. Perceived control had only an indirect effect on inten-
tion through attitudes and norms. Reluctance to seek medi-
cal assistance often found in Korean Americans may explain
the direct effect of perceived control on attitudes and norms
regarding ACP. The finding of the revised model suggests the
importance of culturally sensitive approach to promote ACP
among this population.
WHAT ENCOURAGES JAPANESE ADULT CHILDREN
TO INITIATE END-OF-LIFE DISCUSSION WITH
AGING PARENTS?
C.Shimada, R.Hirayama, K.Nakazato, T.Wakui, Human
Care Research Team, Tokyo Metropolitan Institute of
Gerontology, Tokyo, Japan
Sharing ones wishes about end-of-life care with family
members is critical for older adults to receive their preferred
course of care until the final days of their lives. This is espe-
cially true in Japan, where families are required to serve as
surrogate decision makers for older adults. It has been found,
however, that Japanese older adults are hesitant to bring up
end-of-life issues in family conversation, suggesting the need
for their family members to initiate end-of-life discussion.
In this study, using online survey data from 1,010 Japanese
adult children with at least one living parent aged 65 or older,
we explored factors that encourage these children to talk to
their parents about end-of-life issues. In doing so, we focused
on (a) childrens perceptions of parents personality (e.g.,
whether, in childrens view, parents were confident in their
idea), (b) childrens attitudes toward parent care and end-of-
life discussion (e.g., whether children anticipated that they
IAGG 2017 World Congress
113
would assume the role of parent caregiver, whether children
recognized the importance of such discussion), (c) parents
medical history, and (d) both childrens and parents soci-
odemographic characteristics. Results of logistic regression
analysis indicated that childrens attitudes rather than other
factors explained whether they broached end-of-life issues to
their parents. Our findings suggest that, in Japan, approach-
ing to adult childrens idea about parent care role and end-
of-life discussion can prompt them to initiate such discussion
with aging parents regardless of sociodemographic back-
ground as well as how they view their parents personality.
THE ROLE OF PERSONALITY IN ADVANCE CARE
PLANNING
K.Kittle, B.Gaines, K.Boerner, University of Massachusetts
Boston, Boston, Massachusetts
The topic of end-of-life care planning has received a surge
of attention in recent years. Previous research has identified
several social factors as predictors of advance care planning
(ACP). However, the association between personality factors
and ACP is not well-established. The aim of this study was
to explore the association between the Big Five personal-
ity dimensions and ACP. Data from the 2012 wave of the
HRS were analyzed. In the HRS, ACP activity was assessed
with a series of questions about participation in informal
discussions and completion of a living will and/or durable
power of attorney. The sample included community dwell-
ing adults age 65 and older who provided complete data
on indicators of ACP (n=3,514). Descriptive, bivariate and
multinomial logistic regression analyses were conducted.
Approximately 45% of respondents reported both informal
and formal participation, 28% were non-planners, 15% par-
ticipated in informal planning only and 12% completed for-
mal plans only. Compared to non-planners, the full model
showed that individuals scoring high on Neuroticism were
less likely to engage in informal planning (RRR = 0.78, p
<.05), while those who scored high on Openness were more
likely to engage in informal planning (RRR=1.41, p <.01).
Individuals scoring high on extroversion (RRR = 1.23, p
<.05) and Conscientious (RRR = 1.36, p <.05) were more
likely to engage in both formal and informal ACP. These
findings suggest that personality dimensions may need to be
considered in the discussion of factors that may facilitate or
hinder engagement in ACP.
END-OF-LIFE DECISION-MAKING AMONG AFRICAN
AMERICANS WITH SERIOUS ILLNESS
E.R.Smith-Howell1,2, S.H.Meghani1,2, S.Hickman3, 1.
University of Pennsylvania, Philadelphia, Pennsylvania,
2. NewCourtland Center for Transitions and Health,
Philadelphia, Pennsylvania, 3. Indiana University School of
Nursing, Indianapolis, Indiana
African Americans (AA) tendency to choose life-prolong-
ing treatments (LPT) over comfort-focused (CFC) care at end-
of-life (EOL) is well documented, however there is limited
research that describes AA experiences of EOL care decision-
making. The study objective was to describe AA bereaved
family members experiences of EOL decision-making and
their perceptions of the decision to continue or discontinue
LPT at EOL. Aconceptual framework informed by the lit-
erature and the Ottawa Decision Support Framework guided
114
this study. Purposive sampling was used to recruit fifteen
AA bereaved family members of AAs who died 26months
prior to enrollment from the palliative care program in a
safety-net hospital and a large metropolitan church in the
Midwest. Decedent mean age 68.7 was years. Participants
were selected based on their Decisional Conflict Scale scores.
Data were collected by telephone, using a semi-structured
interview guide, and analyzed using qualitative descriptive
methods and content analysis. Qualitative themes related to
AA family members experiences in EOL decision-making
included understanding, relationships with healthcare pro-
viders, and quality of communication. Additional qualita-
tive themes were related to perceptions of the decision to
continue LPT (e.g., a lack of understanding) or discontinue
LPT (e.g., patient preferences). Religious values and cultural
values did not emerge as major themes in relation to family
members EOL decision-making. This study contributes evi-
dence that quality of communication with healthcare provid-
ers plays a critical role for AAs in EOL decision-making, and
challenges the majority of the literature that suggests reli-
gious and cultural values play prominent roles in AA EOL
decision-making.
END-OF-LIFE DECISIONS FOR PEOPLE WITH
INTELLECTUAL DISABILITIES: PREHOSPITAL
PROVIDERS PERSPECTIVE
J.McGinley, D.P.Waldrop, School of Social Work,
University at Buffalo, Fairport, New York
Individuals with intellectual disabilities (ID) represent
1% of the population. Older adults are the fastest growing
segment of this population with projections for a doubling
by 2030 and a tripling within the foreseeable future The
Institute of Medicine (2014) found that only 1% of this pop-
ulation engage in advance care planning (ACP). Prehospital
providers (Paramedics and Emergency Medical Technicians)
are often first responders when family or professional car-
egivers find a person with ID in medical crisis and their deci-
sions about treatment or transport influence how and where
the person will die.
The purpose of this two-phase, mixed methods study
was to explore how frequently medical orders (MOs)
inform decision making during end-of-life calls and pre-
hospital providers opinions about MOs in emergency
care for people with ID. Phase one survey data (N=245)
was collected to determine the frequency of different
end-of-life calls; 62.7% of prehospital providers treated
an individual with ID and a completed MO. Phase two
in-depth interviews (N=50) explored how prehospital
providers made end-of-life decisions. Utilizing a critical
discourse analysis approach, three themes were identified
as informing prehospital providers opinions about MOs
for this population: provider familiarity; organizational
processes; sociocultural context of ID. Ethical challenges
raised by providers, including decision making capacity,
are elucidated.
Results suggest that end-of-life decision making among
older adults with ID is multifaceted. Although MOs are being
presented with increased frequency during emergency calls,
multiple (individual, facility and systems) factors inform pre-
hospital providers opinions of these documents and subse-
quently may impact decision making at end-of-life.
Innovation in Aging, 2017, Vol. 1, No. S1
ASSESSING READINESS IN ADYADIC CARE
PLANNING INTERVENTION FOR EARLY DEMENTIA
S.Orsulic-Jeras, E.Shelton, C.J.Whitlatch, Benjamin Rose
Institute on Agin, Cleveland, Ohio
Evidence supports designing proactive, dyadic interven-
tions for use in the early stages leads to more effective deci-
sion making, and provides an opportunity to document and
validate the person with dementias (PWDs) care prefer-
ences. SHARE (Support, Health, Activities, Resources, and
Education) a seven-session, counseling-based intervention
aims to encourage and support care dyads to have important
discussions about health care preferences that are often put
off or avoided until the later stages of dementia. Although
having these discussions early on are critical, many care dyads
are not yet ready to have them. This paper will describe how
SHARE Counselors are trained to assess care dyads readi-
ness using an adapted, 4-stage version of the Transtheoretical
Model (TTM). SHARE Counselors rated readiness of each
care partner at baseline, after 6 sessions (8 weeks from base-
line), and again after a final booster session (20 weeks from
baseline). Findings from readiness assessments administered
to 128 early-stage dementia care dyads will be used to illus-
trate: 1)how care partners who were less ready at baseline
responded to discussions about future care, 2)strategies used
by SHARE Counselors to engage care partners even when
each started off at a different level of readiness, 3)how initial
readiness levels at baseline impacted whether or not dyad
completed the full intervention protocol, and 4)whether or
not readiness improved over time as a result of the interven-
tion. Discussion will highlight why understanding PWD and
caregiver (CG) readiness is critical when engaging in sensi-
tive discussions on future care needs.
SESSION 470 (POSTER)
AGEISM AND AGE DISCRIMINATION
LOVE IN LATE LIFE: PERSISTENT AND PREVALENT
E.Kahana1, B.Kahana2, T.Bhatta1, M.Slone1, 1. Sociology,
Case Western Reserve University, Cleveland, Ohio, 2.
Cleveland State University, Cleveland, Ohio
Our study explores concepts reflecting broad defini-
tions of love in old age. Research documents the value of
prosocial behaviors and of altruistic attitudes for enhancing
well-being among older adults. While romantic love is also
said to persist in old age, scientific studies primarily focus
on social supports and care-giving.Yet, hardly any scientific
studies address the broader and less technical concept of
love in relation to experiences of older adults. In this study
we focus on self-reports by older adults about experiencing
and giving love in their lives. In our panel study of older
adults living independently in the community (N=340) we
inquired to what extent respondents feel love towards others
and to what extent they experience being loved by others.
Based on interviews with community dwelling older adults
(mean age=75), we found that the overwhelming majority
(92.7%) report that they feel much or very much love for
other people. Similarly the vast majority reported that they
feel loved by others (88.3%). Women and married people
were significantly more likely to report both loving others
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and being loved. Based on the high prevalence of love in the
lives of older adults and the enduring nature of love over
time, our findings support the view that love is a cultural uni-
versal. With more and more people living to reach old-age,
recognizing the almost universal potential of older adults for
loving and being loved become important challenges to disa-
vowing ageism and for maintaining a civil society.
AGEIST STEREOTYPES AND THE
INTERGENERATIONAL REENGAGEMENT OF OLDER
ADULTS
G.D.Rowles1, M.A.Guest1, T.Kruger2, A.M.Schuster1, 269)
K.A.Anderson3, K.A.Nikzad-Terhune4, V.Lawson 1, 1.
University of Kentucky, Lexington, Kentucky, 2. Indiana
State University, Terre Haute, Indiana, 3. University of
Montana, Missoula, Montana, 4. Northern Kentucky
University, Highland Heights, Kentucky
In many traditional societies across the world, aging is
viewed positively and older adults are fully integrated into
their community, holding positions of influence and respect.
In contrast, gerontophobia and gerontological illiteracy in
most developed societies reinforces ageism--prejudice and
discrimination against older adults--that estranges genera-
tions. In this three year study we examine the perceptions and
representations of aging and old age of 1,034 undergraduate
students completing introductory courses at six universi-
ties across the United States. The study examined views and
representations of aging and old age. Students were asked
to provide an age at which they considered an individual
to be old, to list words they associated with old person
and grandma/grandpa, and to draw a sketch representing
aging. Findings indicate that (1) students consider a person
to be old in the United States at 65years of age, (2) have a
far more positive view of older adults they know personally
(i.e. their grandparents) than older adults as a category; and
(3) images of aging, as represented in hand drawn sketches,
are predominantly negative; they focus on a relatively short
period at the end of life and are pervaded by concern for
time, physical decline, medical care, institutionalization, and
death. The findings reinforce the need for renewed efforts in
developed societies to combat age stereotyping and ageism
through gerontological education in order to facilitate the
intergenerational reengagement of older adults as lifelong
contributors to community life and culture.
RACIAL DIFFERENCES IN ATTITUDES TOWARD
AGING, AGING KNOWLEDGE, AND CONTACT
R.C.Intrieri, M.L.Kurth, Psychology, Western Illinois
University, Macomb, Illinois
Ageism is defined as the systematic stereotyping of and
discrimination against older people, because they are old, just
as racism and sexism have accomplished this with skin color
and gender (Butler, 1975). Ageism in the twenty-first cen-
tury may be more compelling than ever because of the sheer
number of Baby Boomers turning 65 daily. Current popula-
tion estimates suggest that the percentage of older adults will
grow to about 18% of the population by 2030 (Cohn &
Taylor, 2010). It is believed that misconceptions about aging
are developed and maintained due to misinformation about
aging and lack of meaningful contact with older adults.
Butlers acknowledgment of ageism as a systemic problem
IAGG 2017 World Congress
115
has generated research attempting to develop an adequate
way to measure ageism, knowledge about aging, and attitudes
toward older people. This research examined differences in
attitudes toward aging, knowledge of aging and contact fre-
quency between non-Hispanic whites and African-American
young adults. Participants were 96 African-American (Mean
age 19.27, SD=1.318) and 175 Non-Hispanic Whites (Mean
age 19.87, SD=1.685) that were part of a larger study.
ANOVA revealed significant group differences on the Aging
Semantic Differential-Instrumental factor (F(1, 269)=8.169,
p=.005) and on the Fraboni Scale-Anitlocution factor (F(1,
=13.117, p<.0001). No significant differences emerged
between groups on either the Facts on Aging Quiz-Revised
or everyday contact with older adults. Results suggest that
while Non-Hispanic Whites held more negative attitudes
toward older adults and higher levels of ageism they also
showed higher levels of knowledge and a lower frequency of
elder contact.
PERSONAL BELIEFS AND REACTIONS TO AGE AND
MEMORY THREAT IN EVERYDAY MATERIALS
C.M.Strickland-Hughes1, R.L.West2, 1. Psychology,
University of Florida, Gainesville, Florida, 2. University of
Florida, Gainesville, Florida
Older adults hold complex, yet predominantly negative,
beliefs about aging. When experimenters emphasize negative
stereotypes about aging, it can be a threat, affecting older
adults physical performance, self-perceptions of aging, and
memory. Reactions to stereotyping may vary with the situ-
ation or the individual. This study examines the impact of
stereotype exposure for the first time with common everyday
materials and evaluates the impact of stereotype exposure on
personal beliefs and memory. Apriori personal beliefs (e.g.,
sense of control over memory) may promote resilience to ste-
reotypes, and beliefs may change after stereotype exposure.
Participants were 34 men and women (ages 5075; M=62).
Everyday stimuli were newspaper cartoons, jumble puz-
zles, and word searches. Astereotype group saw stimuli with
embedded age (e.g., weak, inept) and memory (e.g., dementia,
forgetting) stereotypes. Acontrol group saw similar stimuli
without stereotype words. We controlled stereotype expo-
sure, level of negativity, number of words, and stimulus size.
Two-thirds of the stereotype group later reported awareness
of the stimulus characteristics (aware group). Multiple
measures of beliefs and memory were examined before and
after stimulus exposure. The control and stereotype groups
were comparable on beliefs and memory before working
with the familiar materials. After exposure, 1)the stereotype
group had higher story recall scores, and 2)the aware group
showed the lowest perceived memory threat and the highest
general memory evaluation. These results show that those
who noticed the stereotypes counteracted their influence.
Focusing on how to train stereotype awareness and response
would be useful in future research.
MINDFUL AGING: THE IMPACT OF TRAIT
MINDFULNESS ON AGING STEREOTYPES
S.Mallya, V.Huang, A.J.Fiocco, Psychology, Ryerson
University, Toronto, Ontario, Canada
With a growing aging population, it is important to
understand factors that encourage or discourage healthy
116
aging processes as we get older. Previous research has shown
that negative beliefs about aging (i.e., negative aging ste-
reotypes) can negatively affect health behaviours, memory
performance and physical function. Thus, discovering ways
to decrease negative aging stereotypes may aid in promot-
ing healthy aging. It is postulated that mindfulness may
attenuate negative aging stereotypes, as mindfulness culti-
vates openness, curiosity, and non-judgment. In the present
study, we assessed whether mindfulness was associated with
fewer negative beliefs and opinions about aging. Participants
(N = 201) aged 55+ completed the Five Facet Mindfulness
Questionnaire (FFMQ) and the Expectations Regarding
Aging Survey (ERA-38) as part of an online study examining
the psychological correlates of health behaviour in middle-
aged and older adults. Controlling for age, sex, education,
and retirement status, multiple regression analyses show that
enhanced trait mindfulness is significantly associated with
more positive beliefs about aging and expectations regard-
ing cognitive function, mental health, sleep, and appearance
(all ps <.05). These data suggest that interventions aimed at
changing attitudes and beliefs, such as mindfulness-based
interventions, may reduce negative aging stereotypes and
improve quality of life among older adults.
RESPECTED OR ABURDEN? GLOBAL ATTITUDES
TOWARD OLDER PEOPLE USING THE WORLD
VALUES SURVEY WAVE 6
P.Nash1, M.Schneiders2, A.Officer2, A.Jotheeswaran2, 1.
Swansea University, Cardiff, United Kingdom, 2. World
Health Organisation, Geneva, Switzerland
The world population over age 60 is expected to double
from 20002050, with 80% of this cohort expected to live
in low- and middle-income countries by the middle of the
century. The extent to which individuals and societies are
able to benefit from population ageing will largely depend
on their perceptions of ageing and older people. Public dis-
course around population ageing is discouraging, depict-
ing older people as burdensome for health, economies and
public spending. These narratives exemplify everyday age-
ism, as statements are built on assumptions that ignore
older peoples value and potential. Stereotypes and atti-
tudes, acquired across the lifecourse, do not simply abate
when an individual reaches older age. Negative implicit
ageist attitudes are held and internalised by older people
themselves, resulting in physical, cognitive and wellbe-
ing declines. Wave 6 of the World Values Survey sampled
over 85,000 participants from 60 countries and included
assessments on attitudes toward ageing. Our preliminary
analyses reveal marked differences in older peoples roles
between countries and cultures, suggesting that socioeco-
nomic development, income inequality, valuing youth-ori-
ented culture and breakdown of family support structures
affect levels of societal ageism. Further, there are significant
differences between developed and developing countries,
which reflect the economic aspirations of both societies and
individuals and mirror the implicit and explicit reporting
of ageism-related items. The internalisation of this ageism
and its physical outcomes has implications for utilisation
of scarce primary healthcare resources across nations, but
can be mitigated through well-defined approaches to tack-
ling both implicit and explicit ageism.
Innovation in Aging, 2017, Vol. 1, No. S1
GENDERED AGEISM AND MICRO AGGRESSIONS IN
THE WORKPLACE
P.Taylor1,2, C.McLoughlin1,2, 1. Federation University
Australia, Melbourne, Victoria, Australia, 2. National
Seniors Australia, Melbourne, Victoria, Australia
The intersection of gender and age discrimination has
formed an important facet of research concerning barriers
to prolonging working lives. With increasing public policy
interest in integrating later retirement into successful age-
ing frameworks, research has sought to understand whether
workplace age discrimination is experienced differently by
men and women at later career stages. While simplistic addi-
tive or multiplicative effects of being an older woman on
experiences of workplace discrimination have been posited,
research has been inconclusive. While some studies report
gendered ageism affecting older women others find that older
men appear to struggle with what has been argued to likely
be their first experiences of workplace discrimination as they
pass beyond what have traditionally been the prime working
years. Attempting to overcome the common methodological
error of measuring discrimination with leading, unsophisti-
cated self-report items, this presentation draws on nation-
ally representative data from a survey of 3000 Australians
obtained using the everyday discrimination approach to
measuring workplace discrimination. Binary logistic regres-
sion was used to assess the probabilities of experiencing 12
workplace discrimination behaviors across age, gender and
functional capacity while controlling for employment type
and socioeconomic position. The results replicate some
studies findings of counter-intuitive patterns of workplace
discrimination across gender and age group, with discrimina-
tion more frequently reported by younger men. It is argued
that a more nuanced approach to considering the intersec-
tion of age and gender is required and that in considering
policy approaches to supporting longer working lives the
role of age discrimination should not be overstated.
THE INFLUENCE OF AGEISM ON LIFE
SATISFACTION OF OLDER ADULTS
H.Kim1, H.Kang2, 1. Gerontology Center, Lawrence,
University of Kansas, Lawrence, Kansas, 2. School of Social
Welfare, University of Kansas, Lawrence, Kansas
Older adults experience discrimination in a number of
different ways due to their age, and this has potential to
negatively affect their psychological well-being. The purpose
of this study was to investigate the relationship between age
discrimination and life satisfaction among older adults, and
how this may be eased by other, constructive experiences of
aging, such as a positive outlook on aging and participation
in volunteer work.
This study used Health and Retirement Study data (2012
wave), selecting 1,975 persons (58% female) who claimed to
experience age discrimination in daily life. Scales measuring
the extent of perceived discrimination (in six circumstances)
and life satisfaction were used to test the main relationship.
Mediating variables were measured by a scale of positive
self-perceptions about aging and by the frequency of volun-
teer activities. Participants age and gender were controlled.
Perceived discrimination was most frequent in people
feeling treated with less courtesy and respect and feeling
treated as if they are not smart. Higher levels of perceived
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
discrimination were associated with lower life satisfaction,
even after controlling for age and gender. However, the
direct relationship between perceived bias and decreased
life satisfaction (b=-.16, p<.05) was significantly mediated
by a positive outlook on aging (b=.48, p<.05) and by volun-
teer work experience (b=.06, p<.05). In conclusion, ageism
has a negative effect to older adults current life satisfac-
tion. At the same time, if older adults participate in mean-
ingful activities, or have a positive self-perception, these
are potential resources for reducing negative experiences of
aging.
AGE DIFFERENCES IN THE EFFECTS OF SELF-
STIGMAS ON WELL-BEING
J.Bookwala, Lafayette College, Easton, Pennsylvania
The present study used two-wave data from a probabil-
ity-based sample of adults in the US to examine the effects of
self-stigmas on physical and emotional well-being. Data were
drawn from 1,216 core participants of the National Survey
for Midlife Development in the United States (T1 mean
age=48.8, 50.5% women). Using mixed linear effects mod-
els, 3 stigma groups (no stigma, single stigma, multiple stig-
mas) were compared across 3 age groups (2039, 4059, and
60+ at T1) and over time on the five indicators of well-being.
Results revealed a significant stigma group x age group inter-
action effect for positive and negative affect (F[4,1204]5.63,
p<.001 and F[4,1204]=5.69, p<.001, respectively), but not
physical health. Post-hoc comparisons showed that for both
positive and negative affect, older adults had significantly
better emotional well-being in the single and multiple stigma
groups than their younger and middle-aged peers; in the no-
stigma group, younger adults scored lower than older adults
on positive affect and higher on negative affect but these
effects were small in magnitude. These results are consistent
with Carstensens theory of socioemotional selectivity, which
states that with age, individuals are more strongly motivated
to regulate their emotional well-being and, thus, to expend
effort toward enhancing positive emotions and minimizing
negative emotions. Thus, older adults may de-emphasize
stigma-based experiences and show greater emotional resil-
ience in the face of such experiences relative to younger and
middle-aged individuals. It is important to note, however,
that older adults resilience did not transfer to the domain
of physical health.
OLD AND UNEMPLOYABLE? HOW AGE-BASED
STEREOTYPES AFFECT WILLINGNESS TO HIRE JOB
CANDIDATES
H.J.Swift, D.Abrams, L.Cuthbert, School of Psychology, gerontology work, and a relationship with gender which
University of Kent, Canterbury, United Kingdom
Across the world people are required or want to work
until an increasingly old age. But how might prospective
employers view job applicants who have skills and qualities
that they associate with older adults? This paper draws on
social role theory, age stereotypes and research on hiring
biases, and reports 3 experimental- online - studies using
age-diverse North American participants. These studies
reveal that a) positive older age stereotype characteristics
are viewed less favorably as criteria for job hire, b) even
when the job role is low status a younger stereotype pro-
file tends to be preferred, and c) an older stereotype profile
IAGG 2017 World Congress
117
is only considered hirable when the role is explicitly cast
as subordinate to that of a candidate with a younger age
profile. Implications for age-positive selection procedures
and ways to reduce the impact of implicit age biases are
discussed.
WHAT FACTORS ARE RELATED TO MEDICAL
STUDENTS AND DOCTORS ATTITUDES TOWARD
OLDER PATIENTS?
R.Samra1, T.Cox3, A.Gordon4, S.Conroy3, M.Lucassen1,
A.Griffiths4, 1. The Open University, Milton Keynes,
United Kingdom, 3. Birkbeck University of London,
London, United Kingdom, 3. University of Leicester,
Leicester, United Kingdom, 4. University of Nottingham,
Nottingham, United Kingdom
Background: A large research base exists on the rela-
tionship between medical students and doctors attitudes
towards older patients with a variety of demographic,
educational/training, job/career factors. Studies report
conflicting findings and little consensus on associated
variables.
Methods: Asystematic review on the worldwide English
language literature.Ten databases were searched (including
Medline, PsychInfo and Science Direct) from database incep-
tion to December 2015 using a systematic search strategy.
Quality was assessed.
Results: The search identified 2336 articles; thirty-eight
studies met the eligibility criteria. Very few variables dem-
onstrated consistent relationships with attitudes. Students
year of medical school, doctors years of practice or seniority,
participants age and ethnicity did not demonstrate a rela-
tionship with attitudes. Participants level of intrinsic moti-
vation and increased interest in working with older people
were positively related with attitudes. The relationship with
gender was mixed; of the 28 studies examining gender and
attitudes, 18 found no significant relationship. However, the
remaining ten studies concluded that females reported more
positive attitudes towards older patients than males; no stud-
ies reported more positive attitudes in males. None of the
38 studies measured social desirability (e.g. impression man-
agement), despite other studies demonstrating that socially
desirable responding correlates with attitudes towards
older people in other participants (Cherry, Allen, Denver &
Holland, 2015)and female medical students score higher on
social desirability than males (Merrill, Lorimor, Thornby &
Vallbona, 1998).
Conclusions: Attitudes towards older patients show a
relationship with participants motivation type, interest in
warrants further investigation.
AGEISM AND SATISFACTION IN LATER LIFE:
RESULTS FROM THE HEALTH AND RETIREMENT
STUDY
L.Huang1, M.Zhu2, 1. School of Social Work, Grand Valley
State University, Grand Rapids, Michigan, 2. East China
University of Science and Technology, Shanghai, China
Purpose: To investigate the prevalence of ageism and the
relationships between ageism and satisfaction in later life in
the United States.
Design: Cross-sectional analysis
118
Setting: The 2010 wave of the Health and Retirement
Study, a national representative panel study of older
Americans.
Participants: Analysis is based on 10,937 older Americans
aged 65 and above.
Measures: Ageism is conceptualized with two meas-
ures: The Everyday Discrimination Scale, and one item
question about whether or not discrimination experience
was specially based on age. The satisfaction measure con-
sists of Aging Satisfaction and Satisfaction with Life in
Domains.
Results: Preliminary data analyses indicate ageism is a
pervasive aging experience in the United States. Chi-Square
tests show statistical differences in the levels of aging sat-
isfaction and life satisfaction between participants with or
without everyday discrimination experience and age-based
discrimination. T-tests suggest that participants who expe-
rienced everyday discrimination had significant differences
in aging satisfaction and life satisfaction, and that age-based
discrimination experience is correlated with significant dif-
ferences in aging satisfaction. However, t-tests do not indicate
that ageism experiences predict levels of aging satisfaction
and life satisfaction.
Conclusion: In light of new understanding of discrimina-
tion and its negative impact on older adults physical health,
mental health, and subjective well being, this empirical study
adds emerging evidence on ageism and satisfaction in later
life in the United States. Despite its limitations, this proposed
study has significant implications for cultural changes in
public discourse and human services involving older adults
in the United States and globally.
GRAY PANTHERS GROWL AT THE MEDIA, AND
MAKE THEIR OWN
A.Ciafone, Media & Cinema Studies, The University of
Illinois at Urbana-Champaign, Urbana, Illinois
Drawing on archival research and close readings of media
texts, this paper will exam the confluence of two remarkable
moments in the history of the representation of older women
in the media in a decade otherwise known for its social and
cultural conservatism. In the 1980s, armed with the concept
of ageism, coined in just 1969, and experience in the femi-
nist and civil rights movements, the members of the Gray
Panthers set out to intervene in the representation of older
women in the media. Mobilizing through their Media Watch
Committee, they monitored TV for examples of ageism, con-
ducted media literacy campaigns, and produced conferences
and even their own media content to combat stereotypes
and construct an alternative vision of aging. Not unrelated,
women of the same generation appeared on TV with more
agency namely in The Golden Girls, 227 and Murder She
Wrote leading the LA Times to ponder whether there was
a representational shift on TV, even a waning devotion to
youth. But as an Annenberg study of the time suggested,
this drop in the bucket does not make a ripple when you
consider that the representation of people over 65 was only
around one-fifth their actual proportion in the US popula-
tion, and were treated disrespectfully most of the time.
These TV exceptions proved the rule, then, and make the
gray women of the 1980s and their media interventions all
the more important to study.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 475 (POSTER)
AGING IN MINORITY AND DIVERSE POPULATIONS
RACE/ETHNIC DISPARITIES IN EXPOSURE TO
CHRONIC STRESSORS VARIES BY AGE AMONG
OLDER ADULTS
L.Brown1, U.Mitchell1,2, J.Ailshire1, 1. USC Davis School
of Gerontology, Los Angeles, California, 2. University of
Illinois Chicago, Chicago, Illinois
Chronic stress exposure is linked to worse mental and
physical health and blacks tend to report more stress expo-
sure than whites. The experience of chronic stressors may
vary across the older adult life course, making it important
to investigate age differences in the race disparity in chronic
stress exposure among older adults. We examine age vari-
ation in race/ethnic differences in the number of reported
chronic stressors in five key domains: health, financial,
residential, employment, and relationship. Data come from
6,878 white, black, and Hispanic adults age 54+ from the
psychosocial subsample of the 2006 Health and Retirement
Study. Descriptive results show whites and Hispanics report
a decline in exposure to financial, residential, employment,
and relationship stress after age 70. Yet, blacks report an
increase in residential stress and relatively smaller decline in
financial, employment, and relationship stress after age 70.
Reports of health related stress increases for all race/ethnic
groups after age 70. Multivariate results show that blacks
(=0.23, p<0.001) and Hispanics (=0.13, p<0.01) report
more stressors than whites. But while fewer stressors are
reported by adults 70+, compared to the young-old (=-0.18,
p<0.001), analysis of age interactions shows that blacks ages
70+ reported more stressors than their white counterparts
(=0.14, p<0.05). Importantly, total stress burden is similar
among blacks and whites ages 5469. Black-white differ-
ences were similar after adjustment for sociodemographic
characteristics. Hispanic-white differences were attenuated
after adjusting for SES. Thus, race/ethnic disparities in stress
may reflect differential experiences of age-related declines in
chronic stress exposure.
CHINESE COMPREHENSIVE HEALTH ASSESSMENT
SCALE AND HEALTH STATUS OF THE COMMUNITY-
DWELLING ELDERLY
J.Li1, X.Li1, R.Gao1, K.Du2, 1. Nursing, Xian Jiaotong
University, Xian, Shaanxi, China, 2. Xian Aerospace
General Hospital, Xian, Shaanxi, China
Purpose: To develop Chinese comprehensive health assess-
ment scale (CCHAS) for community-dwelling elderly with
chronic diseases and to examine its reliability and validity.
Method: The original CCHAS was developed using lit-
erature review and in-depth interviews, as well as Delphi
method. 440 community dwelling elderly were selected to
complete the scale and SF-36.
Results: The CCHAS contained 30 items, including: phys-
ical health, activities of daily living, mental health, social
adaptation and general health. The total Cronbachs alpha
coefficient of the scale was 0.81, and the split half reliability
was 0.93. The total CVI of the scale was 0.87. Pearson cor-
relation coefficient between the CCHAS scale and SF-36 was
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
0.83. 56.59% of the elderly has good health status, while
9.77% has poor.
Conclusion: The CCHAS has acceptable reliability and
validity and is significantly correlated with SF-36. The results
demonstrate that the scale can be applied to health evalua-
tions in community-dwelling elderly in China.
DYNAMICS OF DISABILITY AND DEPENDENCY:
EXAMINING THE HISPANIC PARADOX
THROUGHOUT ADULT LIFE
S.B.Laditka, J.N.Laditka, University of North Carolina at
Charlotte, Charlotte, North Carolina
Research often shows that Hispanics in the United States
have lower adult mortality than non-Hispanic whites (here-
after whites). Much less is known about adult life course
functioning among Hispanics. We studied functioning in
activities of daily living (ADLs), distinguishing between disa-
bility (having difficulty but not having help) and dependency
(having help), among Hispanic, African American, and white
women and men, using data from the Health and Retirement
Study (10 waves 19942012, ages 51+, n=35,797, 152,822
functional status and death transitions). Multinomial logistic
Markov models estimated monthly probabilities of transi-
tioning among ADL status levels and to death, adjusted for
age, sex, education, and race/ethnicity. Using the probabilities
we created large populations with microsimulation, meas-
uring monthly disability status for each individual, age 51
through death. Women with high school education illustrate
the primary results: Life expectancy was greater for Hispanics
than African Americans or whites, respectively at age 70, for
example, 88.1, 85.2, and 86.4. The population percentage
having difficulty was higher for African Americans than for
Hispanics or whites at ages 6090 (p<0.01), respectively at
age 70: 38.4%, 33.9%, and 34.9% (no significant differ-
ences between Hispanics and whites). The population per-
centage having help was higher for Hispanics and African
Americans than for whites at ages 6090 (p<0.01), respec-
tively at age 70: 6.3%, 7.5%, and 4.6% (no significant dif-
ferences between Hispanics and African Americans). Results
were similar for men. At midlife and older ages Hispanics
may have relatively high rates of disabilities that require help
from another person despite having lower mortality.
UNCOVERING NEUROPROCESSING AND SELF-
MANAGEMENT BEHAVIORS IN PREHYPERTENSIVE
AFRICAN AMERICANS
K.Wright1, L.M.Jones1, D.Fresco2, J.T.Wright1, insurance (enabling) and to have a fair/poor rating of oral
J.P.Freidman1, A.I.Jack1, M.Wallace1, S.M.Moore1, 1. health (needs). The odds of not using preventive dental ser-
Case Western Reserve University, Copley, Ohio, 2. Kent
State University, Kent, Ohio
Aims: African Americans with prehypertension have a
35% greater risk of progressing to hypertension as compared
to Caucasian Americans. In this pilot study, we investigated
how two neural networks associated with task-oriented and
emotional/motivational cognition relate to self-management
behaviors in prehypertensive African Americans. Methods.
Community dwelling African Americans who met eligibil-
ity criteria of prehypertension, a systolic BP 120139 and
diastolic BP 8089 mmHg, were enrolled. Participants
completed brain imaging and surveys on everyday dis-
crimination, self-compassion, decentering, social support,
IAGG 2017 World Congress
119
self-efficacy, self-regulation, and the Nutrient Data Systems
Report. Data were examined using descriptive statistics and
correlation analysis. Results: Twenty participants, women
(n=11) and men (n=9) aged 2676 (M=51.9, SD=12.2) were
enrolled. Findings from our pilot study indicated that eve-
ryday discrimination was associated with activation in the
ventromedial prefrontal cortex and task positive/default
mode networks (r=-.72, p=.05; r=-.70, p=.05 respectively).
Activation in the ventromedial prefrontal cortex was asso-
ciated with social support (r=.58, p=.06). Self-compassion
and decentering were not associated with neurocognitive
processing. Although self-efficacy was not associated with
neurocognitive processing, self-efficacy was associated with
self-regulation (r=.53, p=.03) and decentering (r=.64, p=.05).
Conclusions: Findings indicate that neurocognitive process-
ing are associated with everyday discrimination and social
support. As we continue to examine the role of neurocog-
nitive processing, we will use these findings to guide future
work with self-management interventions and the possible
underlying neurobiological mechanisms.
ORAL HEALTH AND DENTAL CARE IN OLDER
ASIAN AMERICANS
Y.Jang1, H.Yoon1, N.S.Park2, D.A.Chiriboga2, 1. The
University of Texas at Austin, Austin, Texas, 2. University of
South Florida, Tampa, Florida
Responding to the paucity of information on oral health
and dental care in older Asian Americans, the present study
examined the status and factors associated with dental health
insurance, self-rated oral health, and use of preventive dental
service. Data were driven from 533 older adult participants
(aged 60 and older) in the 2015 Asian American Quality
of Life Survey conducted in Central Texas. The criterion
variables of interest were selected based on the Andersens
behavioral model of health services: enabling (dental health
insurance), needs (self-rated oral health), and utilization (use
of preventive dental service) variables. Using a sequential
design, the predictive model of each outcome was built, and
sociodemographic and immigration-related variables were
used as common covariates. More than 60% of the sample
had no dental insurance, 45% reported that their oral health
was either fair or poor, and 44% had not had dental check-up
in the past 12months. Aseries of logistic regression analyses
identified the factors posing a significant risk to oral health
and dental care. For example, those who had limited English
proficiency were three times more likely to lack dental health
vice (utilization) were six times higher among those with no
dental insurance coverage (enabling). The overall findings
demonstrate substantial inequality in oral health and dental
care outcomes in older Asian Americans and suggest strate-
gies to promote their access to dental services.
AGE DIFFERENCES IN THE REASONS OLDER
IMMIGRANTS RETURN TO MEXICO
A.Vega, K.B.Hirschman, University of Pennsylvania,
Philadelphia, Pennsylvania
Mexicans are the largest immigrant group in the U.S.and
are aging rapidly. Data support that many return to Mexico
due to economic factors such as employment. Few studies
120
have investigated if older immigrants return to Mexico for dif-
ferent reasons than younger immigrants. Using the Mexican
Health and Aging Study (N=963), we examine whether
Mexican immigrants in the U.S. who returned to Mexico
at age 50 and older report different reasons for returning
than those who returned at younger ages. Few immigrants
(regardless of age) returned to Mexico for economic reasons.
In multinomial logistic regression modeling, older immi-
grants were more likely to return to Mexico due to illness
(OR=3.06, 95% CI=1.29, 7.27) and just as likely to return
because they missed family (OR=0.76, 95% CI=0.43, 1.33).
Older Mexican immigrants in the U.S.with limited access to
health care and/or caregiver support may return to Mexico.
COMMUNITY OF VOICES CHOIR STUDY TO
PROMOTE HEALTH IN DIVERSE OLDER ADULTS
J.K.Johnson, S.Gregorich, A.M.Napoles, J.D.Flatt, experienced a greater number of significant SLEs when com-
W.B.Max, D.L.Pounds, A.Paniagua, A.L.Stewart, pared to non-minority aging adults. The meaning of social
University of California, San Francisco, San Francisco,
California
BACKGROUND AND PURPOSE:
With the rise in the number of older adults, there is an
urgent need to develop cost-effective interventions that can
be easily adapted for adults from diverse racial/ethnic and
socioeconomic backgrounds. The goal of this presentation is
to describe the baseline and 6-month randomized results from
the Community of Voices (Comunidad de Voces) study that
is examining the effect of a 12-month community choir inter-
vention on the health and well-being of diverse older adults.
METHODS:
This study used a cluster-randomized controlled design.
Twelve San Francisco Administration-on-Aging (AoA) senior
centers were randomized in matched pairs to either begin
the choir immediately (intervention) or wait 6 months to
begin (control). Participants attended weekly, 90-minute
choir sessions focused on psychosocial, cognitive, and physi-
cal engagement and led by professional music directors. We
collected primary and secondary outcomes at baseline and
6months that focus on psychosocial, physical function, and
cognition using the NIH Toolbox and legacy measures.
RESULTS:
A total of 819 individuals expressed interest in the study,
and 390 participants (61%) enrolled in the study; 92% com-
pleted the 6-month assessment. The sample included 35%
non-Latino White, 20% Black, 18% Latino, and 27% Asian/
Pacific Islander; mean age was 71years (range 6093, SD=7);
76% were women. Twenty six percent rated their health as
fair or poor. Results on the primary outcomes from the base-
line and 6-month assessments will be discussed.
DISCUSSION:
Working collaboratively with AoA senior centers facili-
tated recruitment and retention. If efficacious and cost-effec-
tive, the intervention could serve as an easily translatable
model for promoting optimal aging and reducing health
disparities.
SOCIAL SUPPORT, STRESSFUL LIFE EVENTS AND
LIFE SATISFACTION: MINORITY AND NON-
MINORITY BABY BOOMERS
C.L.Barragan, School of Social Work, Eastern Michigan
University, Madison Heights, Michigan
Innovation in Aging, 2017, Vol. 1, No. S1
The first wave of the Baby Boomer cohort approached
retirement age in 2010, officially entering older adulthood.
But this generation is vastly different than other cohorts.
They are more active, educated, and are living and working
longer. Older adults ultimately feel their social networks are
as important as their health (Farquhar, 1995). Social support
acts as a buffer between stress and well-being (Chronister,
Chou, & Liao, 2013) following stressful life events (SLEs)
(Hsu, 2011). Those without meaningful social support are
lonelier (Utz, Swenson, Caserta, Lund, & deVries, 2014)and
have lower life satisfaction (Nilsson, Rana, & Kabir, 2006),
highlighting the importance of social support. Minorities
frequently use kin networks for support which can be a
specific concern as these peer and family supports are also
aging (Park et al., 2013). Because of systemic heath and
access disparities, minorities typically turn 65 having already
support on the relationship between SLEs and life satisfac-
tion between minority and non-minority elders of the Baby
Boomer generation is examined in this work. This research
utilized the Health and Retirement Study (HRS) (2006
through 2012)to perform a one-way ANCOVA. The inter-
action was significant between SLEs and changes in social
support (F(5,3915)=7.87, p<.001) n2=.012) with significant
differences between Minority (M=.046, SD=1.64) and Non-
minority (M=.989, SD=2.16) respondents and levels of SLEs.
Cultural differences in regards to social support networks is
also discussed.
DOES THE HISPANIC EPIDEMIOLOGICAL PARADOX
EXTEND TO CHILDHOOD ADVERSITY AND LATER
LIFE DISABILITY?
J.N.Laditka, S.B.Laditka, University of North Carolina at
Charlotte, Charlotte, North Carolina
Evidence suggests adverse circumstances during child-
hood increase later life disability. Little research has exam-
ined whether this association affects Hispanic Americans,
whose life course health dynamics often differ from other
groups. We estimated this association for African American,
Hispanic, and non-Hispanic white women and men for eight
childhood circumstances: fair or poor health, poverty, father
or mother with education less than grade 8, household moves
or receipt of money from family due to financial difficulties,
father with extended unemployment, or no father in the
household, using data from the Health and Retirement Study
(8 waves, 19982012, ages 51+, n=29,629, 136,704 func-
tional status and death transitions). We used a 5-level index
of childhood risk factors, none to 4 or more. Multinomial
logistic Markov models estimated monthly probabilities
of transitioning among having difficulty with activities of
daily living (ADLs), having help with ADLs, and death,
adjusted for age, gender, education, and race/ethnicity. We
used the probabilities to conduct microsimulations, creating
large populations with monthly functional status measures
through death for each individual, and analyzed outcomes
in those populations. Women age 70 with high school educa-
tion illustrate results (all p<0.001): Comparing those with 4
or more adversities to those reporting none, for Hispanics
the percentage of remaining life with ADL difficulty was
8.7% greater, and with ADL help 9.8% greater. Comparable
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
results were 7.5% and 9.1% for African Americans, 9.7%
and 6.8% for whites. Childhood adversity was not associ-
ated with mortality. Childhood adversity increased later life
disability similarly for African Americans, Hispanics, and
whites.
OLDER IMMIGRANTS CARDIOVASCULAR HEALTH:
MEASURING RISK AND THE IMPACT OF SOCIAL
DETERMINANTS
T.Sadarangani1, M.Jared2, 1. New York University, New
York, New York, 2. New York University Rory Meyers
College of Nursing, New York, New York
The population of immigrants who resettle in older and
middle age, also known as late-life immigrants (LLI), is
expected to grow threefold by 2050. The stressors of aging
and resettlement predispose LLI to negative health outcomes,
including the development of cardiovascular disease (CVD).
Despite the passage of the Patient Protection and Affordable
Care Act (PPACA), affordable health insurance remains out
of reach for most newly arrived LLI. Simultaneously, increas-
ing numbers of uninsured LLI are presenting to emergency
departments with life-threatening complications of CVD,
including myocardial infarction.
Little is known about the financial and clinical benefits
of expanding access to health insurance for LLI. This study,
a secondary analysis of data from the National Health and
Nutrition Examination Survey (NHANES), (1) examined the
association between health insurance coverage and CVD risk
(using two separate dependent measures: Framingham Risk
Score and the presence of Metabolic Syndrome) among older
immigrants and (2) explored the role of health insurance in
CVD relative to other socially determined access barriers
within immigrants social ecology using hierarchical block
regression. Early results found foreign born middle-aged
and older adults to be a heterogeneous group who are less
likely to be insured than the native born. Moreover, unin-
sured older immigrants have worse CVD risk profiles than
their insured counterparts. Health insurance is a critical bar-
rier to health access within immigrants complex social ecol-
ogy. Acost-benefit analysis is needed to determine the most
effective method of expanding insurance coverage to recently
arrived LLI.
RELIGION AND DEPRESSION SEVERITY IN OLDER
SEXUAL-MINORITY ADULTS
C.Escher, F.Ma, S.Spies-Upton, S.Paulraj, C.Cummings, general heath and, more specifically, mental health among
L.M.Brown, T.Tormala, R.G.Gomez, PhD Program
in Clinical Psychology, Palo Alto University, Palo Alto,
California
Older sexual minorities belonging to a religious group
may experience poorer psychological wellbeing, as they have
historically been discriminated against by religious commu-
nities. However, some research suggests that LGBTQ individ-
uals can benefit from religious support. This study examined
the relations of outness to religious community and religious
activity with depression in 102 lesbian, gay, and bisexual
adults over the age of 55. As part of a larger study, partici-
pants completed the Religion and Spirituality Questionnaire
and the Center for Epidemiological Studies Depression Scale.
Of those who reported being religious or spiritual (n=87),
outness to religious community was significantly correlated
IAGG 2017 World Congress
121
with relying on religious teachings for problems, satisfaction
with outness to religious community, relying on religious
beliefs as a guide, and praying (ps<.05). When examining
sexual minority subgroups, correlations indicated that out-
ness to religious community was related to greater involve-
ment in their religion in bisexuals and lesbians, but not in
gay men. As for wellbeing and religion, depression severity
was negatively correlated to outness to religious community
and praying in Lesbians. In Gay men, depression was nega-
tively correlated with belief in god and praying. In contrast,
in bisexuals, satisfaction with outness, belief in god, and
praying were positively correlated with depression indicating
that religion may have a detrimental effect on depression.
These findings suggest that some aspects of religion may be
beneficial to the wellbeing of older sexual minorities, but the
benefits may vary across sexual minority groups.
MENTAL HEALTH SERVICE UTILIZATION AMONG
AGING LATINO AND ASIAN AMERICANS: THE ROLE
OF SOCIAL CAPITAL
J.Muruthi, D.C.Lewis, K.G.Emerson, University of
Georgia, Athens, Georgia
This study examines how rates of mental health service
utilization are impacted by both social capital (friend sup-
port, family support, and neighborhood cohesion) and immi-
gration factors (English proficiency and length of residence
in the United States (U.S.). Immigrants to the U.S.often face
unique challenges (such as discrimination, language barrier,
housing and transportation problems, sparse community and
individual resources, and limited access to health services),
which place them at risk for deficits in health. Studies have
shown that social capital and immigration factors indepen-
dently have significant impacts on immigrants health out-
comes. We analyzed the mental health service use data on
individuals aged 55 and older from the National Latino and
Asian American Study. We found three primary themes asso-
ciated with mental health service use: Asignificant variation
in service utilization within and between the sample depend-
ing on their English proficiency and length of residence; All
indicators of social capital impact the rates of service utili-
zation but the patterns of associations vary; and that fam-
ily support had both independent and direct effects on the
rates of service use even after accounting for socioeconomic
status (SES). This study highlights the significance of social
capital, immigration factors and SES as determinants of
aging immigrants. Findings from this study not only add to
the aging health and minority literature but they also point
to the need for effective and culturally-appropriate mental
health interventions.
IMPACT OF PHYSICAL-MENTAL COMORBIDITY ON
SUBJECTIVE WELL-BEING AMONG DIVERSE ELDERS
S.Y.Wang, G.Kim, University of Alabama, Tuscaloosa,
Alabama
Objectives: Older adults are more likely to be burdened
by multiple health conditions, and physical-mental comor-
bidity adversely affects ones well-being. However, little is
known about comorbidity as a determinant for subjective
well-being (SWB). Thus, this study examined racial/ethnic
variations in the relationship between types and severity
122
of physical-mental comorbidity and SWB among diverse
elders.
Methods: Drawn from the National Health and Aging
Trends Study in 2011, 8064 elders (White, Black, Hispanic,
or Asian) aged 65 or older were included for analyses.
Participants were grouped using sixteen common physical
health conditions and two mental disorders to examine influ-
ences of comorbidity. Chi-square analyses were used to com-
pare racially/ethnically diverse participants on demographic
variables and types of comorbidity. Analyses of covariance
(ANCOVAs) were used to assess the relationship between
types and severity of comorbidity and SWB across four
major racial/ethnic groups.
Results: Significant differences were found on back-
ground characteristics and types of comorbidity among
racially/ethnically diverse elders. For main analysis results
(ANCOVAs), Blacks and Hispanics reported higher SWB
than Whites after controlling for covariates (F(3, 6818)=7.26,
p < .001). Participants with physical-mental comorbidity
reported lower SWB compared to healthy participants (F(3,
6818)
= 38.16, p < .001). As the severity of physical-mental
comorbidity increased, SWB decreased (F(2, 1337) = 3.13, p <
.05).
Conclusion: This study provided detailed descriptions
and comprehensive knowledge of the relationship between
physical-mental comorbidity and SWB among diverse elders.
Identifying racial/ethnic-specific correlates of comorbidities
and SWB may help healthcare providers develop interven-
tion programs for diverse elders.
THE HEALTH AND WELL-BEING OF LATE MIDDLE-
AGED, RURAL-DWELLING HISPANIC ADULTS WITH
ARTHRITIS
S.Schepens Niemiec, C.Vigen, J.Blanchard, J.Martnez, compared to single parents (25.4% vs.16.8%). Although AA
M.Carlson, University of Southern California, Chan
Division of Occupational Science and Occupational
Therapy, Los Angeles, California
Hispanic older adults with arthritis are at high risk for
arthritis-related limitations in daily activities. Moreover,
rural residence is associated with risk for arthritis, poor
health outcomes, and healthcare disparities. This studys pur-
pose is to describe differences in the health and well-being
of late middle-aged (5064 years), rural-dwelling Hispanic
adults with and without arthritis. We conducted a cross-sec-
tional analysis of 40 Hispanic adults (mean age=57.6years,
SD=4.8) who were participating in a feasibility study of a life-
style intervention delivered in a primary care system in rural
California, USA. Participants reported on medical diagnoses,
including arthritis of any type, and various health and well-
being parameters. We analyzed a subset of the measurement
battery that holistically represented health and wellness: sat-
isfaction with social activities, physical activity engagement,
sleep quality, and general well-being. All participants were
Spanish-speaking and 90% were female. Those who reported
arthritis (n=19, 47.5%) showed significantly poorer social
activity satisfaction (p=0.05), physical activity participation
(p=0.04), and general well-being (p=0.04) compared to non-
arthritic participants. Although not statistically significant,
individuals with arthritis also reported poorer sleep quality.
This small cross-sectional study showed that self-reported
arthritis was highly prevalent in a sample of late middle-aged,
Innovation in Aging, 2017, Vol. 1, No. S1
rural-living Hispanics. Similar to previous findings in elders,
the presence of arthritis was associated with poor health and
well-being in multiple domains. While a larger-scale study is
necessary to confirm these preliminary findings, this study
informs efforts to develop lifestyle interventions tailored to
vulnerable, late mid-life Hispanic individuals with arthritis
and who are residing in rural communities nationwide.
AFRICAN AMERICAN CUSTODIAL GRANDPARENTS:
ANATIONAL PROFILE OF HEALTH
CHARACTERISTICS AND BEHAVIORS
D.M.Whitley1, E.R.Fuller-Thomson2, 1. Georgia State
University, Atlanta, Georgia, 2. University of Toronto,
Toronto, Ontario, Canada
The U. S. Census Bureau reports 1.3 million African
American (AA) grandparents reside with their grandchil-
dren; nearly half (47%) have full parenting responsibility
for their grandchildrens care. Despite the expanding litera-
ture on this family group, more information is needed on
solo grandparents who are raising their grandchildren on
their own. Using the 2012 Behavior Risk Factor Surveillance
System survey, we compare the prevalence of medical con-
ditions and health behaviors of 169 AA solo grandparents
raising grandchildren in comparison to 1,635 AA single
parents. Compared to single parents, AA grandparents had
a higher prevalence of several chronic health conditions,
including arthritis (50.3% vs.17.5%), COPD (12.5% vs.
3.6%), diabetes (20.1% vs. 6.9%), and coronary heart dis-
ease (12.6% vs.2.3%). Although a majority of the grand-
parents were enrolled in a health plan (92.9%) and had a
primary medical provider (89.9%), nearly 44% rated their
health as fair or poor. Further, AA grandparents were more
likely to have a diagnosis of depression in their lifetime, as
grandparents were less likely to be overweight (27.9% vs.
33.1%) or obese (36.4% vs.45.8%), they were more likely
to be current smokers (35.3% vs. 21.0%). Logistic regres-
sion analyses suggested that age differences account for most
of the reported variances in chronic conditions between the
parenting groups. However, the data illustrate the serious
health problems of AA solo grandparents. The impact of
the findings on grandparents parenting roles is discussed, as
well as suggestions for promoting community-based support
services.
THE HEALTH STATUS OF OLDER ISLAND PUERTO
RICANS COMPARED TO U.S. WHITE AND LATINO
OLDER ADULTS
C.Perez, J.Ailshire, Gerontology, University of Southern
California, Hialeah, Florida
Discussions about Latino health in the U.S. often over-
look one large population of U.S. Latinos island Puerto
Ricans. Puerto Rico is a U.S.territory and Puerto Ricans are
natural-born citizens of the U.S. Puerto Rico is experiencing
population aging, but little is known about the health sta-
tus of aging island Puerto Ricans, and whether it resembles
that of Latinos in the mainland U.S. Using data on adults
ages 60 and older from the 2002 Puerto Rican Elderly:
Health and Conditions Project (PREHCO) (n=4,389) and
the 2002 Health and Retirement Study (HRS) (10,679
Whites and 1,160 Latinos), we examine differences in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
chronic conditions, disability, and self-rated health by race/
ethnicity and gender. Results from logistic regression models
show that Puerto Ricans have healthier profiles compared
to whites; they have reduced odds of heart disease, stroke,
lung disease, cancer, any ADL limitations, and fair-to-poor
self-rated health (all differences significant at p<.05). Island
Puerto Ricans have health profiles similar to mainland U.S.
Latinos. Further investigation reveals that among island
Puerto Ricans, women have increased odds of hypertension,
lung disease, any ADL limitations, and fair-to-poor self-rated
health compared to men (all differences significant at p<.05).
Our findings suggest older Puerto Rican women experience
a health disadvantage that is consistent with the double-
jeopardy hypothesis. Despite their relatively disadvantaged
social and economic status, island Puerto Ricans report bet-
ter health than whites and have similar health as mainland
U.S. Latinos. However, the Puerto Rican health advantage is
primarily found among men.
SOCIOHISTORICAL CHANGES IN THE EDUCATION
SPECIFIC HEALTH DISPARITIES IN THE U.S.
T.Bhatta, J.A.Kelley-Moore, Sociology, Case Western
Reserve University, Cleveland, Ohio
Many of prior studies have attempted to explain the
widening of educational inequalities in health by focusing
solely on cohort-specific trends associated with educational
attainment, such as health behaviors and economic factors.
Interestingly, this approach treats the distribution of educa-
tion within a particular cohort as a static starting place
for the question of subsequent health disparities. There have
been fewer attempts to explore the substantial sociohistori-
cal changes in opportunity structures in the past century,
which have served to change who is selected into particular
levels of education attainment. This study employs a novel
counterfactual approach to accommodate early life selection
processes that may simultaneously shape educational attain-
ment and health. Synthesizing cumulative dis/advantage and
fundamental cause of disease theory, this study draws from
Health and Retirement Survey (19922012; n=35,692) to
explore potential historical variation (as represented by
birth cohorts) in the influence of education on functional
limitations over the life course. Results from generalized
linear mixed models suggest increase in the average posi-
tive influence of education on functional limitations across
birth cohorts. However, the increase in the influence of edu-
cation across three recent birth cohorts born between 1931
and1953 was found to be statistically insignificant (t=1.32,
p=0.19). We obtained mixed findings (i.e., slight increase or
decrease over time) with regards to educational differences
in average rates of change in functional limitations. This
study extends existing body of knowledge by investigating
the role of changing opportunity structures in modifying
patterns of educational inequalities in health across histori-
cal periods.
THE MEANING OF AGING WELL AMONG
IMMIGRANTS AND REFUGEES IN THE ST. LOUIS
REGION
L.Willoughby1, H.Matsuo1, J.Hale-Gallardo2,
S.Goswami1, 1. Saint Louis University, St. Louis, Missouri,
2. VA Medical Center, Gainesville, Florida
IAGG 2017 World Congress
123
Despite rich literature on the meaning of aging well
and related concepts, such as successful or optimal
aging, the meaning of aging well to foreign-born immi-
grants in the U.S.is relatively understudied and not well
understood. In this paper, we present findings on percep-
tions of aging well among immigrants with differing char-
acteristics including ethnicity, age, gender, mode of entry
to the U.S., and length of stay in the US. The paper is
based upon a mixed methods study on successful aging
conducted in St. Louis, Missouri with a middle-aged and
older adult immigrant/refugee sample (N=320; Bosnian,
Chinese, Vietnamese, Korean, Indian, and Latino/a).
Participant responses to the question What does aging
well mean to you? were qualitatively analyzed and sev-
eral themes emerged related to health, functional inde-
pendence, financial security, and family relations. This
study contributes to a better understanding of the role
of health, demographic and social factors in improving
the reception of programs designed to promote healthful
aging.
ETHNICITY AND SATISFACTION WITH
SOCIAL CARE IN ENGLAND: MEASUREMENT,
DETERMINANTS, AND OUTCOMES
R.Willis1, P.Khambhaita2, P.Pathak3, M.Evandrou1, 1.
Centre for Research on Ageing, University of Southampton,
Southampton, United Kingdom, 2. Pensions Policy Institute,
London, United Kingdom, 3. Sociology, Social Policy and
Criminology, University of Southampton, Southampton,
United Kingdom
Satisfaction with social care services is routinely meas-
ured with Likert scales, and surveys have consistently found
that people from minority ethnic groups are less satisfied
than white people in England. These surveys cannot explain
the reasons for the differences found. Therefore, qualita-
tive interviews (n=121) with South Asian and White British
service users, family carers, and social care staff were car-
ried out to explore reasons for high or low satisfaction.
Thematic analysis focused on three areas: (i) the satisfac-
tion measurement itself, (ii) reasons for satisfaction, and
(iii) how staff coped with working across diversity. People
who gave the same responses to the Likert scale actually
had very different experiences, indicating both that the sur-
veys do not capture the full story and also that individuals
understand the scale differently. People with a clear under-
standing of the social care system were better able to work
collaboratively with care staff to meet their needs, and thus
had a higher satisfaction level. A clear understanding is
facilitated by greater opportunities to become familiar with
the social care system, and so first-generation migrants are
disadvantaged compared to the British-born. Finally, social
care staff who adopted a culturally reflexive working style,
and were comfortable asking questions about cultural or
religious difference, were more confident working with cli-
ents who differed from themselves. Recommendations are
to include a qualitative component in satisfaction surveys,
increase outreach communication about how social care
services work, and to encourage staff to recognise and dis-
cuss diversity.
124
DIVERSE AGING EXPERIENCES OF EAST
ASIAN IMMIGRANTS IN THE UNITED STATES:
ALITERATURE REVIEW
J.Liang1, H.Stohry2, 1. Gerontology, University of
Louisiana at Monroe, Monroe, Louisiana, 2. Miami
University, Oxford, Ohio
Around 12 percent of the immigrant population are aged
65 and older, and Asians are the fastest-growing group among
elders in the United States. In the gerontological literature,
East Asians (Chinese, Japanese and Korean) are often por-
trayed as a homogeneous group due to their shared cultural
heritance (e.g., filial piety as a morality and practice) and
are often stereotyped as the model minority population. In
fact, despite commonalities, there exists great diversity when
it comes to aging experiences, as shaped by varying socio-
cultural factors such as timing and duration of immigration,
historical background of immigration (e.g. professional, polit-
ical refugee, military marriage), English proficiency, cultural
dissonance, and interracial/interethnic marriage, in addition
to demographic characteristics (e.g., gender, education). For
example, Japanese immigrants have the highest rate of mar-
rying Caucasians and are the most assimilated group among
all Asians, thus they may experience old age differently from
their Chinese and Korean counterparts. Also, foreign born
immigrant elders living with children raised in America face
different challenges from those naturalized citizens aging
parents brought to live with their family in terms of cultural
adaptation and intergenerational communication. Such later
life diversity among East Asian immigrant population war-
rants attention, as their needs are often under-met. Therefore,
a comprehensive literature review is critical in educating ser-
vice providers for understanding the socio-cultural factors
that contribute to the heterogeneity within the group of East
Asian immigrant elders and thus delivering culturally con-
gruent and competent services.
MENTAL HEALTH STATUS OF MIDDLE-AGED AND
OLDER HMONG REFUGEES IN THE U.S.
M.S.Yang, J.E.Mutchler, UMASS Boston, Boston,
Massachusetts
Mental health issues have previously been identified as
a major public health problem for Southeast Asians, who
are one of the most rapidly growing populations in the U.S.
Yet heterogeneity exists within the Southeast Asian ethnic
groups in terms of health, socioeconomic resources, and
level of adaptation to the United States. For instance, health
outcomes are less favorable for the Hmong and Cambodian
groups compared to other Southeast Asians and most other
ethnic groups in the U.S. Existing research on mental health
status of older Hmong populations in the U.S. is virtually
absent. We analyze primary data collected from California
for Hmong persons 50years old and older (N=56). Questions
included a short form depression scale (Hopkins Symptom
Checklist-10 items (HSCL-10)) and demographic questions.
In terms of family characteristics, 34% are widowed, 46%
are married, and 66% live in a household including 5 or
more people. Less than 5% have completed high school, and
18% speak or read English average or well. For this sample
in the past 7 days the experience with difficulty in falling
asleep or staying asleep (M=2.91, SD=1.25) and feeling tense
or keyed up (M=2.57, SD=1.32) were the most commonly
Innovation in Aging, 2017, Vol. 1, No. S1
reported depression symptoms. The overall mean HSCL-10
score was 2.34 (SD=.79). The findings are discussed in terms
of the unique migration and adjustment experiences charac-
terizing this population. Findings from this study could pro-
vide a more complete view of their status.
SESSION 480 (POSTER)
AGING IN THE COMMUNITY
ONLINE TRAINING OF LICENSE OFFICE
PROFESSIONALS TO SCREEN APPLICANTS FOR
MEDICAL IMPAIRMENT
J.Stowe2,3, P.Niewoehner1,3, 1. VA Medical Center, St.
Louis, Missouri, 2. Mid-America Regional Council, Kansas
City, Missouri, 3. Missouri Coalition for Roadway Safety,
Jefferson City, Missouri
In states with voluntary reporting of possibly medi-
cally impaired drivers, previous research shows fewer than
expected reports from license office professionals. Medical
conditions that potentially impair driving are fairly com-
mon among older licensed drivers. Therefore, a crucial
opportunity exists in license offices for early identification
of impaired drivers prior to involvement in a traffic crash or
incident. This study explores the development, implementa-
tion, and evaluation of an online training for license office
professionals to identify likely medical impairment among
driver license renewal applicants. Following statewide roll-
out to over 180 privatized license offices, 85.9% of users
found the training helpful and relevant, and 96.8% rated
the training as Very Good or Excellent among trainees
who responded to a survey embedded within the training
(N=183). The challenges of an agency-wide training release
precluded an experimental design, but volume of reports
of potentially impaired drivers was used to gauge training
efficacy. In the 12months prior to the trainings release, 24
reports were made; in the year following release, 20 reports
were made. Although the training was applicable, useful, and
highly rated by trainees, it did not immediately increase the
volume of reports made. In five of the evaluated months after
release of the training zero reports were made. External fac-
tors, such as the impact of the privatization of government
agencies with critical public safety roles should be evaluated
and reported. Stronger policies, training mechanisms, and
structural changes in licensing authorities are likely needed
to improve screening efforts.
AN ANALYSIS OF THE ACCEPTANCE AND ATTITUDE
OF ELDERLY DRIVERS TO THE NEW LICENSING
SYSTEM
C.E.Wu1, Y.Lin3, C.Chen1, P.Tseng2, 1. Transportation
Science, National Taiwan Ocean University, Keelung,
Taiwan, 2. Department of Traffic Science, Central
Police University, Taoyuan, Taiwan, 3. Department of
Transportation and Logistics Management, National
ChiaoTung University, Hsinchu City, Taiwan
Research shows that elderly drivers/ riders are significantly
over-represented in crash statistics and physically changes
associated with ageing (such as vision, memory and reaction
speed) can increase the risk of crash for elderly drivers. In
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Taiwan, elderly people aged 65 or greater comprised more
than 12.5% of the entire population, however, the elderly
drivers accounted for 31.4% of traffic accident fatalities in
the fiscal year 2015.
The Ministry of Transportation and Communications
(MOTC) initiated a campaign to encourage elderly driv-
ers voluntarily surrender their driver license few years ago.
However, this campaign was not favorable by the elderly
and the disproportionate traffic accident fatalities of elderly
remains. Early this year (2016), MOTC enacts a new licens-
ing system to mandate the elderly drivers aged 75years and
over must take a medical and cognitive assessment to retain
their driving license every two years. This study applies the
Technology Acceptance Model (TAM) to investigate the
contributing factors that influence the elderlys perception,
acceptance and attitude toward the new licensing system.
A questionnaire consists of three sections is administrated
to the participants, including the demographic profile, driv-
ing experience, self-assessed fitness to drive, attitude toward
new licensing system, and subjective evaluation of public
transportation. It shows that the majority of participants are
not aware of this new regulations. The acceptance and atti-
tude of the participants are highly affected by their medical
condition.
WORK CONDITIONS AND WORK DESIGN WITHIN
THE HEALTH AND CARING SECTOR: THE CASE OF
OLDER WORKERS
S.Merkel, J.Hilbert, Institute for Work and Technology,
Gelsenkirchen, Germany
Most EU member states have a strong focus on raising
retirement ages and financially incentivising longer work-
ing life. Yet so far these policies have paid little attention to
growing social inequalities which benefit those most able to
work longer and disadvantage those unable to work longer.
In analysing unequally distributed chances and risks of
working longer on the one side and of implications for qual-
ity of life and well-being on the other, our study takes up a
research perspective which so far in retirement research has
been underdeveloped. Against the backdrop of demographic
change, the social service sector is a fast-growing business
sector with rising socio-political and employment-related
significance in particular considering health and care jobs.
Working conditions i.e. physical and psychological stress,
organisation of work, task variety and discretion, employee
involvement and participation, leadership/management strat-
egies, use of assistive technologies etc. are an essential vari-
able influencing the workability of older people. Therefore,
the aim of our study is to examine existing problems and
challenges of working conditions within the social service
sector in Germany. A particular focus is laid on workers
touched by health or social inequalities. To help overcome
inequalities with adequate ways of work design and with
improved working conditions is often seen as an effective
way to generate additional workforce for professional car-
ing jobs. To better understand current challenges for older
workers and also ways to deal with these challenges, we use
qualitative methods (problem centered interviews with the
members of staff and expert interviews with representatives
of national organization).
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125
EXPECTATION AND REALITY OF NEW SHRC
MEMBER: THE RELATED WITH JOB MATCHING
AND SATISFACTION
M.Nakamura1,2, T.Ishibashi1, H.Osada2, 1. The Dia
Foundation for Research on Ageing Societies, Tokyo, Japan,
2. J. F.Oberlin University Graduate School of Gerontology,
Tokyo, Japan
Introduction: Japan has Silver Human Resource Centers
(SHRCs) for elderly working to live a worthwhile life. SHRCs
have many job categories for persons aged 60 or older. This
study examined the relationship between job matching and
satisfaction of SHRCs member.
Methods: We had two surveys on member satisfaction at
2012 and 2013. We use eight questions (<1>Health main-
tenance, <2.>Get to ikigai, <3>Auxiliary of the household,
<4>Exchange with friends, <5>Contribute to the local,
<6>Use of knowledge, <7>Better relationship with family,
<8>Extend the life). The subjects were 152 new members
belonging to the SHRC of the suburban in Tokyo. They were
divided into Higher and Lower groups by comparison of one
year later. We analyzed it by logistic regression analysis, using
job match or job mismatch as objective variable.
Results: The percentage of people that could not get to the
desired job was 45.4% (man 50.9%, woman 31.8%). Next,
the percentage of Lower group was <1>27.6%, <2>32.2%,
<3>48.7%, <4>40.1%, <5>32.2%, <6>45.4%, <7>42.8%,
<8>35.5%. However, change of these satisfactions and job
matching were not related (p>0.05).
Conclusions: Even the new SHRCs members could not get
the job desired, theyd satisfaction is not lowered. For them,
Itself be joining than the matching of the work is probably
important. However, this subjects was higher evaluation of
<1> and <2>. Therefore, there needs to be additional test also
with different SHRCs.
TRAINING OLDER WORKERS IN SMALL AND
MEDIUM-SIZED ENTERPRISES: RESULTS FROM
GERMANY
L.Naegele, F.Frerichs, Insitute for Gerontology, University
of Vechta, Vechta, Lower-Saxony, Germany
Small and medium-sized enterprises (SMEs) represent
99% of all businesses in Europe. In Germany the second
biggest sector - craft trade - alone accounts for more than
one million enterprises, five million workers and an average
company size between 5 and 20 employees. Due to structural
changes (demographic ageing of workforces, skill shortages
or the transition to a knowledge-based society) SMEs in
the German craft sector need to pay closer attention to the
competence development, especially of their older employ-
ees. Research has shown that training activities of SMEs
usually follow a distinct pattern: the smaller a company is
the fewer training opportunities are offered. However this
research is often focused on formal training, neglecting non-
formal work integrated training measurements. Using a
mixed method approach, which combines quantitative and
qualitative methods, this paper researches the importance of
non-formal training measurements in the context of SMEs
from a gerontological perspective. Based on survey data from
the In-K-Ha Project (funded by the Federal Ministry of
Education and Research (BMBF)), we find a similar training
behaviour across smaller and bigger companies. In a second
126
step we conducted 16 qualitative company case studies in
order to identify explanatory factors for the training behav-
iour found in the SMEs we analyzed. Amongst the owners
willingness to invest in training factors such as staff reten-
tion, order volume and a companys degree of (technical)
innovation have shown to be influential regarding the preva-
lence of training opportunities for older workers.
POST RETIREMENT ADAPTATION OF ELDERLY IN
KERALA, INDIA
J.J.Katttakayam, University of Kerala, Trivandrum, Kerala,
India
India is growing old! The stark reality of the ageing sce-
nario in India is that there are 77 million older persons in
India today, and the number is going to grow to 177 mil-
lion in another 25years. Kerala, a relatively small Southern
state in India, is experiencing the last stages of demographic
transition that can be compared to the demographic trend
in many aging European countries. Kerala has the highest
percentage of elderly population (12.6 %), higher than the
national average. Though life expectancy has been increasing
steadily in Kerala for the last four decades, the retirement age
of the state government employees remained at 55years until
2011 when it was increased to 56years. As retirement has
become an essential life-stage in older adults, adapting well
to retired lifestyle is crucial for long term life-satisfaction
of the elderly. Kerala has four lakh pensioners and 12 lakh
social security beneficiaries. Though some welfare measures
have been taken for the aged persons, these measures are
not fool proof. The present paper attempts to capture the
dimensions and issues of post retirement adaptation of the
elderly in Kerala.Quantitative data were collected from 300
retired elderly from the selected households. The problem is
approached from the perspective of changes happening in
their social position and relations within their family. The
majority of the respondents held that they get the expected
care from their spouses after retirement. Though this is a pos-
itive sign, the fact that around one tenth of them do not get
the expected care invites attention to the emerging situation
that the elderly in the state are likely to face more seriously
in the coming days.
RETIREMENT INCOME SYSTEM: ACOMPARISON
BETWEEN CHILE AND THE U.S.
A.E.Diaz-Valdes Iriarte1, S.A.Lopez Bohle2, 1. School of
Social Work, Boston College, Allston, Massachusetts, 2.
Universidad de Santiago de Chile, Santiago, Santiago, Chile
For the last few decades, the worlds retirement systems
have been objects of analysis. For the past century, social
security has played an important role in societyespecially
as populations get older, presenting new challenges to gov-
ernments and their existing policies. Chile and the U.S have
different systems with similar results when it comes to pov-
erty prevention. However, the retirement system in the U.S,
which is public, is facing sustainability problems, and the
retirement system in Chile, which is private, is facing ine-
quality problems. Therefore, the aim of this paper is to make
a comparative analysis of the retirement income systems
between Chile and the U.S.
Despite the accomplishments, new reforms are inevita-
ble, and the cost of the transition of systems in Chile can
Innovation in Aging, 2017, Vol. 1, No. S1
offer new elements to the debate in the U.S. In addition, the
importance and confidence that people have in the system in
the U.S and its redistributive component can show other ele-
ments for the debate in Chile.
SUSTAINING COMMUNITY-BASED HEALTH
INITIATIVES FOR ADULTS AGING WITH
INTELLECTUAL DISABILITIES
N.Spassiani1, B.A.Meisner3, J.Hammel4, T.Heller2, 1.
School of Education, Trinity College Dublin, Dublin 2,
Ireland, 2. University of Illinois at Chicago, Chicago,
Illinois, 3. Dalhousie University, Halifax, Nova Scotia,
Canada, 4. University of Illinois at Chicago, Chicago,
Illinois
Community-based intellectual disabilities (ID) agen-
cies provide services and supports to people aging with ID,
offering these individuals opportunities to participate in
their community and engage in health promoting behav-
iors. However, little is known about the factors involved
with sustaining community-based health initiatives (CBHI)
among ID agencies. The purpose of the current study was
to explore the facilitators and barriers of sustaining CBHI
for people aging with ID living in group homes managed by
ID agencies. Two non-profit ID agencies participated in the
study. Nineteen semi-structured interviews were conducted
with directors, managers, and direct support staff. Interviews
conducted with directors and regional managers provided a
broader systemic perspective, whereas interviews with sup-
port staff provided a front line perspective of the factors that
may be effecting CBHI sustainability within group home
settings. Grounded theory methods, including constant com-
parison, were used for analysis. Findings show that although
ID agencies understand the importance of health and com-
munity participation for their clients and support such ini-
tiatives, agencies lack policies, resources, and ID and health
education to sustain CBHI for their clients aging with ID
over time. It is important to gain a better understanding of
the influencing factors involved in sustaining CBHI that are
being implemented by these agencies to enable individuals
with ID to experience the many positive physical, psycho-
logical, and social health outcomes as they age and to poten-
tially decrease their risk of institutionalization due to poor
health.
ASSESSING OUTCOMES FOR THE
INTERGENERATIONAL ACTIVE AGING FOR L.I.F.E.
PUBLIC HEALTH INITIATIVE
E.Roberts, M.Ruppert-Stroescu, A.J.Bishop, G.Clare,
J.Hermann, K.Struckmeyer, M.Balasubramanian,
M.Kang, Design Housing and Merchandising, Oklahoma
State University, Stillwater, Oklahoma
Active aging involves staying engaged in life in a number
of ways, including maintaining independence, physical and
cognitive fitness,and social engagement across the lifespan.
This investigation highlights the Active Aging for L.I.F.E.
health initiative, an intergenerational pilot program devel-
oped and implemented in northeastern Oklahoma. The pro-
gram framework focused on both the functional and social
systems which are predictors of well-being in older adults,
and the understanding that the trajectory of aging is impacted
by healthy choices and behaviors throughout the life course.
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Innovation in Aging, 2017, Vol. 1, No. S1
Program participants included older adults age 65+ (n=23)
and college students age 1825 (n=20). Participants attended
a four-part speaker series focused in the four domains of lon-
gevity, independence, fitness, and engagement, and completed
a series of pre/post series surveys used to gauge changes in
attitudes and behaviors toward aging. Aseries of paired sam-
ples t-tests were conducted to compare attitudinal responses
before and after attending four events, with college-age stu-
dents showing the most change in their perceptions of their
role and place in the aging process. Statistically significant
differences (p<.05) in responses between genders were also
identified, with female participants showing strong agree-
ment in statements such as I look forward to growing older,
and It is a privilege to grow old. These findings highlight
that emerging adults, particularly females, may adopt more
positive views toward aging with such programming, build-
ing a general acceptance of expected age-associated changes.
This is also significant as women normatively live longer than
men and are vulnerable to negative age-associated changes.
THE AGE-FRIENDLY UNIVERSITY INITIATIVE:
BRIDGING COMMUNITY AND ACADEMY
T.Kennedy1, T.Corrigan2, R.Mark2,3, 1. School of Social
Work, Arizona State University, Phoenix, Arizona, 2.
Dublin City University, Dublin, Ireland, 3. University of
Strathclyde, Glasgow, Scotland, United Kingdom
An age-friendly university movement is transforming tra-
ditional universities into centers of lifelong learning that sup-
port active, healthy aging and include older adults in the core
elements of the university. Initiated by Dublin City University
(DCU), Dublin, Ireland and expanded as a collaboration
between DCU, Arizona State University, United States, and
the University of Strathclyde, Scotland, this international
initiative spawned an inaugural international conference
in 2015. In May 2016, the Association for Gerontology
in Higher Education (AGHE), an educational unit of the
Gerontology Society of America, announced its endorsement
of the ten age-friendly principles which provide a guiding
framework for developing, distinguishing, and evaluating
age-friendly programs and policies. This session will present
the history of the age-friendly university initiative and inter-
national collaboration, present the ten principles of an age-
friendly university, discuss the experiences and challenges
of the founding universities in this growing movement, and
present a model of sustainability for universities considering
joining the age-friendly initiative.
AGE-FRIENDLY COMMUNITY FEATURES:
CAREGIVERS PERCEPTIONS
K.Black1,2, A.Badana3, 1. University of South Florida,
Sarasota-Manatee, Sarasota, Florida, 2. The Patterson
Foundation, Sarasota, Florida, 3. University of South
Florida, Tampa, Florida
As communities strive to create age-friendly accommoda-
tions to best meet the needs of a growing aging citizenry, the
concomitant growth of caregivers provides additional layers
of consideration for planning. Increasingly, persons provid-
ing care are managing their own aging and negotiating their
communitys infrastructure for both themselves as well as on
behalf of their aged loved ones. These dual standpoints pro-
vide a unique perspective for an age-friendly environment.
IAGG 2017 World Congress
127
This study reports on the findings from a global age-friendly
community effort that examined the aspirations of persons
age 50 and older on the importance of community features
across three clustered domains of community life including:
(1) built environment (i.e. outdoor spaces and public build-
ings, housing and transportation); (2) social environment
(i.e. civic participation and employment, social participa-
tion, respect and social inclusion); and (3) community and
health supports (i.e. community supports and health ser-
vices and communication and information). The study sur-
veyed caregivers (n=216) and non-caregivers (n=135) in a
Southeastern United States community in which more than
half of the residents are age 50 and older and one-third are
age 65 and older. Focus group data (n=9) was also analyzed
to further illuminate the findings. Results indicate significant
differences across multiple areas with the greatest magnitude
of differences noted in the areas of housing and commu-
nity supports, suggesting that caregivers are simultaneously
preferring to enhance their own aging and more efficiently
manage the needs of their care recipient. Age-friendly impli-
cations of the findings are discussed.
HOW HOUSING WITH SERVICES WORKS FOR LOW-
INCOME OLDER ASIAN IMMIGRANTS
P.C.Carder, G.Luhr, J.Lee, Institute on Aging, Portland
State University, Portland, Oregon
This paper describes a pre- post-evaluation of a hous-
ing with services intervention, including culturally rel-
evant programs, in 10 publicly-subsidized apartment
buildings in a U.S. city. Twenty-three percent of residents
spoke a Southeast Asian language. Intervention goals were
to increase residents access to health and social services,
decrease ER use and social isolation, and improve quality
of life. Repeated measures analyses examined differences
between Asian language and non-Asian language speakers.
Asian language speakers were more socially isolated than
non-Asian language speakers at both time points. Food
insecurity decreased overall from T1 to T2, with no differ-
ences within or between groups. More non-Asian language
speakers used the ER, were hospitalized, and called 911
than Asian language speakers. No difference were observed
on self-rated health or quality of life over time, within or
between language groups. Culturally relevant services can
improve the lives of Asian immigrants, though inconsistently
across health/social domains.
HOW LIFE EXPERIENCE INFLUENCES FEELINGS OF
EMERGENCY PREPAREDNESS IN OLDER PEOPLE
V.Cornell, School of Social Sciences, University of Adelaide,
Adelaide, South Australia, Australia
Anecdotally, older people are considered under-prepared
for emergency events. However, they are rarely engaged
directly, to understand their knowledge and experience of
emergencies and their feelings regarding preparedness.
This presentation will discuss research that explored how
the life experience of older people influences their prepar-
edness for emergencies. In-depth interviews were held with
eleven people aged over 70 years, to explore emergency
events experienced; the meaning and understanding drawn
from the events; and participants beliefs about emergency
preparedness.
128
Participants did not view emergency preparedness as a
one-off activity, such as completing an emergency plan or
checklist; or packing an emergency toolkit or go bag. It is
a process of experiencing a variety of events over a lifetime
and learning to create a feeling of mental preparedness and
the ability to cope. While they might not define themselves as
being prepared, they certainly considered themselves to be
resilient; they accept their limitations and feel confident they
can cope.
These findings are critical in terms of how older people
are engaged in preparedness planning; and have implications
for developing well informed emergency management and
aged care policy and practice. Older people are not vulner-
able per se; rather they may have some specific needs, but
also a wealth of positive attributes in terms of knowledge,
experience and sense of community.
By understanding that being prepared is less important
than being resilient, policy-makers can establish how best to
assist older people in the face of emergencies.
EFFECTS OF NATURAL DISASTER ON RURAL
PEOPLE CHOICE OF OLD-AGED CARE MODEL
BASED ON BAOJI CASE
M.Guo, Y.Jin, H.Mi, Zhejiang University, Hangzhou,
China
Chinese population is aging at an unprecedented speed,
meanwhile China also suffers a lot from disasters. Those
areas suffering most from natural disasters are often rural
areas, facing even serious aging problem and population
vulnerability.
The hypothesis of this study is that peoples choice of
old-aged care model, once underwent natural disasters, may
change to seek a higher-level ability of withstanding disas-
ters, which differs a lot from those choices from who havent
suffer loss from disaster.
This study use data collected by our research team through
survey from Shanxi Baoji and the account of the data is 854.
Old-aged care model is dependent variable (0= traditional
home-based care, 1=non-traditional home-based care) and
whether they have suffered property losses (0=No, 1=Yes)
is independent variable. To analyze the relativeness between
the two variables, and the dependent variable is two-valued
variable, logit model is available.
According to the regression result, the possibility of peo-
ple who suffering property losses in a disaster choose non-
traditional home-based care is 414.32% higher than the
one who havent suffered. Specifically, the significance of the
parameter is 2%. Preference of old-aged care model among
people who have suffered property losses in natural disasters
have apparently changed.
One of our implication is that once traditional home-
based care way be chosen, it means that at least a kinship
has to take care of him and sacrifice working time or even
a better work opportunity, which is of less possibility would
one who have suffered property losses in a disaster choose.
RATIONAL AND AFFORDABLE LTC FOR TOTALLY
DISABLED ELDERS
J.Song, H.Pi, Chinese General Hospital, Beijing, China
Background: China is experiencing a foreseeable pressure
from an increasing aging population. The problem on the
Innovation in Aging, 2017, Vol. 1, No. S1
cost control of long-term care for totally disabled elders is
a principal contradiction which hinders the development of
the long-term care in China. However, no previous study has
explained what effects the rationality and affordability of
long-term care for disabled elders can make.
Aim: This study explores whether a rational an affordable
long-term care for totally disabled elders can enhance qual-
ity of life and reduce pulmonary infection and pressure ulcer
and other complications.
Methods: 100 totally Chinese totally disabled elders were
included and randomly divided into two groups. One group
accepted a rational an affordable long-term care service
through individual assessment while the other accepted the
ordinary long-term care service. Additionally, we evaluated
the differences between two groups after 6months through
the quality-of-life evaluation instrument and the incidence of
the pulmonary infection and pressure ulcer.
Results: Compared to those who are entitled to an ordi-
nary rational an affordable long-term care service, the life
quality of elders accepting rational an affordable long-term
care service is remarkably high (P<0.05). However, the ratios
of pulmonary infection and pressure ulcer in elders accepting
rational an affordable long-term care service have a remark-
able decreased (P<0.05).
Conclusions: We demonstrate that the rationality and
affordability of long-term care through individually control-
ling can help totally disabled elders get an increasing quality
of life. Furthermore, pulmonary infection and pressure ulcer
can exert a significantly attenuated influence on them.
SESSION 485 (POSTER)
ARTHRITIS
ATTACHMENT STYLE, PAIN, AND PSYCHOLOGICAL
WELL-BEING IN OLDER ADULTS WITH KNEE
OSTEOARTHRITIS
A.M.Ingram1, B.S.Cox1, D.M.Smith2, P.A.Parmelee1, 1.
The University of Alabama, Tuscaloosa, Alabama, 2. Stony
Brook University, Stony Brook, New York
BACKGROUND: Previous research has shown that
adults with an insecure vs. a secure attachment style are
more likely to have worse pain, rate their life satisfaction
lower, and have more depressive and anxious symptoms.
This study examined linkages of attachment style with pain
and well-being in persons with knee osteoarthritis (KOA).
METHODS: In-person interviews with 256 older adults
(mean age = 64.3, SD = 9.26), with KOA assessed attach-
ment style, knee pain, depression, anxiety, and life satisfac-
tion. All data came from a larger study examining daily
quality of life with KOA. RESULTS: Multiple regression
analyses examined effects of pain and attachment style on
depression, anxiety, and life satisfaction. We categorized
attachment as secure (close or dependent) and insecure
(anxious). Results indicated that both close and anxious
attachment styles and knee pain significantly predicted anxi-
ety, p<.05, Rsquare=.337. However, dependent attachment
had no significant effect. Lower life satisfaction was signifi-
cantly predicted by dependent attachment and knee pain,
but not close or anxious attachment, p<.05, Rsquare=.321.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Both dependent and anxious attachment predicted depres-
sive symptoms, p<.001, Rsquare=.511. Furthermore, signifi-
cant interactions of KOA pain and dependent attachment on
depression p<.01, and life satisfaction, p<.05, reflected buff-
ering effects of attachment on the relationship between pain
and psychological well-being. DISCUSSION: The results
provide support to the importance of attachment style on
older adults physical and mental health when dealing with
chronic pain. Implications for research and treatment are
discussed. (Supported by R01-AG041655, P. Parmelee &
D.Smith, PIs).
RACIAL/ETHNIC DIFFERENCES IN TEMPERATURE-
BASED TREATMENT FOR KNEE OSTEOARTHRITIS
PAIN
C.M.Pierpaoli1, B.S.Cox1, D.M.Smith2, P.A.Parmelee1, 1.
The University of Alabama, Tuscaloosa, Alabama, 2. Stony
Brook University, Stony Brook, New York
Background: Racial/ethnic differences in experimental
heat and cold pain sensitivity have been observed among
adults with knee osteoarthritis (KOA). However, little is
known about how these differences influence the use of
temperature-based treatments (TBTs) for pain. This research
therefore examined differential use of heat vs. cold to man-
age knee pain among African Americans (AAs) and non-
Hispanic Whites (NHWs) with KOA. Methods: 228 older
adults (mean age = 64.5, SD = 9.42) reported their use of
various arthritis treatments as part of an ongoing study
of everyday quality of life with osteoarthritis. Heat treat-
ments were assessed quantitatively (yes/no). Additionally,
numerical codes were assigned to open-ended, qualitative
data according to use of hot, cold, combined, or other non-
temperature related treatments. Chi-square tests were per-
formed to examine the relationship between racial group and
the application of heat, cold, or their combination. Results:
African Americans were more likely to report using specific
heat treatments than non-Hispanic Whites, X2 (1)=19.898,
p < .001. Reported use of cold, combined, or non-TBTs did
not differ across groups. Discussion: Although previous find-
ings indicate that AAs display lower heat pain threshold and
tolerance than NHWs, these differences may not extend to
modalities for managing OA pain. Implications for treatment
are discussed. (Supported by R01-AG041655, P. Parmelee
and D.Smith, PIs)
PATIENTS EXPECTATION, QUALITY OF CARE
TRANSITION, AND HEALTH OUTCOMES AMONG
OLDER ADULTS UNDERGOING HIP AND KNEE
ARTHROPLASTY
S.Aree-Ue, I.Roopsawang, Ramathibodi School of
Nursing, Mahidol University, Bangkok, Bangkok, Thailand
Total joint arthroplasty is commonly surgical procedure
that reduces chronic joint pain and improves function as
well as quality of life among older adults with osteoarthri-
tis. These patients may be discharged with a short hospital
stay due to limited resources. Since patients expectations is
important issue resulting in improving the quality of the ser-
vices and health outcomes, the present study aimed to exam-
ine the patients expectation, quality of care transition, and
functional outcomes among Thai older adults undergoing
hip and knee arthroplasty.
IAGG 2017 World Congress
129
Ninety-five samples who underwent hip or knee arthro-
plasty participated in this study. The measures included the
Expectation Questionnaire, the Care Transition Measure,
the Modified Barthel Activities of Daily Index, and the
Complication Record Form. Data analysis was performed
using descriptive, Pearsons correlation coefficient, and mul-
tiple regressions.
Improvements in daily activities, ability to climb up and
down stairs, and daytime pain were the most important
expectations. The participants perceived the overall moder-
ate level of quality of care transition with the highest score
on the dimension of empowerment to assert preferences
following by information transfer. The lowest score was
found on patient and caregiver preparation. Urinary tract
infection was the most common complication. Expectations
and quality of care transition showed a positive correlation
to functional outcomes, and quality of care transition was
the most powerful predictor of functional outcomes.
A better understanding of the association among expecta-
tions, quality of care transition, and outcomes may improve
the process of care and outcomes among older adults under-
going hip and knee arthroplasty.
GLOBAL VS. MOMENTARY ARTHRITIS PAIN
AND EMOTIONAL DISTRESS: EMOTIONAL
INTELLIGENCE AS MODERATOR
P.A.Parmelee1, B.S.Cox1, M.Scicolone1, A.M.Ingram1,
F.J.Keefe2, D.M.Smith3, 1. The University of Alabama,
Tuscaloosa, Alabama, 2. Duke University, Durham, North
Carolina, 3. Stony Brook University, Stony Brook, New
York
Osteoarthritis pain affects emotional well-being in terms
both of momentary mood states and of global, long-term
mental health. Though emotional awareness and regulation
strategies are known to affect these dynamics, there have
been few direct comparisons of momentary and long-term
linkages of pain, distress, and emotional regulation. This
research therefore examined short- and long-term associa-
tions among emotional dynamics, pain, and distress among
171 older adults with knee osteoarthritis (OA). Respondent
interviews yielded self-report data on global pain, depressive
symptoms, and trait-level emotional intelligence (EI; atten-
tion, clarity, and repair). Respondents then completed an
experience sampling method (ESM) protocol comprising 4
calls/day for 7days, tapping momentary pain and negative
affect. In global (person-level) regression analyses, all three EI
subscales predicted lower depression, controlling for global
pain, demographics and general health. Mood clarity was the
strongest predictor; it also moderated the pain-distress link-
age, such that persons high in mood clarity showed a weak-
ened association of pain with depression Parallel multilevel
models for ESM negative affect yielded significant Level 2
effects of mood clarity and repair, and both person-level and
momentary pain. Here, mood repair (vs. clarity) buffered
effects of momentary pain, such that persons with stronger
mood regulation skills displayed a weaker association of pain
with negative mood in the moment. These findings suggest
that awareness and regulation of ones emotions can be a
powerful tool for coping with OA pain. However, dynamics
appear to differ between immediate, momentary affect vs.
long-term well-being. Implications for clinical intervention
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are discussed. (Supported by R01-AG041655, P.Parmelee &
D.Smith, PIs.)
SELF-EFFICACY FOR PAIN COMMUNICATION IN
OSTEOARTHRITIS PATIENTS AND THEIR SPOUSES
A.Stanford, L.M.Martire, Human Development and
Family Studies, Penn State University, University Park,
Pennsylvania
Spouses greater understanding of the pain experience
of older patients has shown to be beneficial for both mem-
bers of the dyad. However, spouses tend to over-estimate
patients pain, which may be explained by variations in self-
efficacy for understanding pain (spouse) or communicating
pain (patient). Although previous work suggests that patient
and spouse self-efficacy for pain communication may ben-
efit emotional well-being, to our knowledge, no work to
date has examined how these constructs may influence the
relational outcomes of married couples. The current study
sought to examine how self-efficacy for understanding the
pain of patients with knee osteoarthritis (OA) is related to
marital satisfaction and depressive symptoms of both mem-
bers of the dyad. This study involved OA patients and their
spouses (N = 152 couples) and examined reports of self-
efficacy for understanding the patients pain (spouse) and
the self-efficacy for having ones pain experience understood
by his or her spouse (patient). Consistent with hypotheses,
regression analyses showed that self-efficacy for pain com-
munication significantly predicted higher marital satisfaction
in both patients (p < .001) and their spouses (p < .001). Self-
efficacy for pain communication did not significantly predict
fewer depressive symptoms for patients (p = .262) or their
spouses (p=.138). These findings highlight the critical role
that understanding pain can have in a couples relationship.
SESSION 490 (POSTER)
ATTITUDES ABOUT AGING
VIOLENCE AGAINST OLD FROM AGGRESSORS
PERSPECTIVE
V.Bohm1, J.Doll2, 1. Psicologia, Universidade de Caxias
do Sul, Caxias do Sul, Rio Grande do Sul, Brazil, 2.
Universidade Federal do Rio Grande do Sul, Porto Alegre,
Rio Grande do Sul, Brazil
Violence against the elderly is a practice found through-
out the history of civilization, however, with increasing
longevity, is gaining greater visibility and concern of many
countries. To this, authors like Foucault, Elias and Scotson
and Faleiros gave theoretical support to the exploratory
qualitative research was carried out by listening to stories
of the attackers. Thus, the main objective of this research is
to analyze the factors that led to violence against the elderly
through the perspective of the perpetrators, in order to pre-
pare a discussion that subsidizes educational interventions in
the field of violence. To this end, it has specific objectives a)
know the stories of the lives of elderly offenders; b) identify
the possible triggers that triggered the aggression; c) under-
stand the structural aspects that may have relationships
with the practice of violence and d) provide elements for
educational interventions in the field of violence. The results
Innovation in Aging, 2017, Vol. 1, No. S1
analyzed from the content analysis) were organized into two
broad categories, namely: multidimensionality of violence,
subdivided into Construction of family relationships,
Consumption of illicit drugs and alcohol and unemploy-
ment, and the second category, named Social Mechanisms
of Attention to Violence. The results point to the complex-
ity of violence against old people, characterized as a multidi-
mensional process of relationships, which is not possible to
identify a single cause as generating the event.
THE VALUE OF EXPERIENCE IN INCREASING
UNDERGRADUATES CAREER INTEREST IN
WORKING WITH OLDER ADULTS
H.Obhi, Y.Su, J.A.Margrett, S.L.Francis, Y.Lee,
D.Crawford, W.Franke, Iowa State University, Ames, Iowa
A well-trained workforce is key to meeting the demands
of an aging population that is expected to nearly triple by
2030 (CDC, 2015). Ageist stereotypes and lack of knowledge
about the aging process among younger adults are two promi-
nent hurdles to meeting these demands. Undergraduates may
have more gerontology-related career interest if they have
had more contact with older adults and aging course work
(Kalisch, etal., 2013). Gerontology-focused career interests
of 816 undergraduate students were assessed by employing
logistic regression with three blocks of predictors: past expe-
rience, knowledge, and attitudes. Results suggest that females
were 1.52 times more likely to have career interest in work-
ing with older adults compared to males (p=.02). Individuals
who had course experiences (practicum/internships) with
older adults were 2.34 times more likely to have career inter-
est in working with this population than those who did not
have such experience (p<.001). Undergraduate students who
participated in classes which offered aging-related content
were 1.29 times more likely to express interest in working
with older adults (p=.003). These results suggest that inter-
est in working with older adults is related to educational
opportunities and knowledge about aging. Educational poli-
cies should reflect these findings to achieve the well-trained
workforce needed to meet the need of the aging population.
LONG-TERM EFFECT OF ATTITUDE TOWARD OWN
AGING ON COGNITIVE FUNCTIONING
J.Siebert, H.Wahl, Heidelberg University, Heidelberg,
Germany
Attitude Toward Own Aging (ATOA) has been shown
to affect a variety of important developmental outcomes
in old age, including memory. We extend previous research
by examining differential long-term effects of ATOA on a
broader range of cognitive abilities in later life relying on
data of the German Interdisciplinary Longitudinal Study of
Adult Development and Aging (ILSE). Using the older birth
cohort of ILSE followed for 12years across three measure-
ment points (193032; nt1=489, nt2=438, nt3=408), we first
present findings addressing the relationship between ATOA
and change in fluid vs. crystallized abilities based on over-
all and gender-specific latent change score models, while
controlling for education and objective health. As expected,
ATOA predicted change in fluid functioningbut not in
crystallized performanceover 12 years. Gender-specific
analyses revealed a stronger association between ATOA and
decline in fluid abilities for men, even after controlling for
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
objective health and education. Further, with data collection
of the fourth measurement occasion just recently completed,
we are in a position to prolong the association between
ATOA and cognitive trajectories up to a 20-year observa-
tional period. Preliminary analyses support that the pattern
of findings also holds for this 20-year interval. Moreover, the
role of behavioral and psychological pathways linking ATOA
and cognitive aging are discussed. Overall, our results add
to the understanding of long-term implications of ATOA for
cognitive decline trajectories and show that negative ATOA
is a risk factor for age-vulnerable cognitive abilities.
THE RELATIONAL NATURE OF CHILDRENS
PERCEPTIONS OF PARENTAL AGING: FINDINGS
FROM AJAPANESE SAMPLE
K.Nakazato, R.Hirayama, T.Wakui, C.Shimada, Human
Care Research Team, Tokyo Metropolitan Institute of
Gerontology, Tokyo, Japan
Although gerontological research has directed close atten-
tion to the components of peoples views on aging in general,
relatively little is known about how people perceive the aging
of their family members, such as parents, as well as psychoso-
cial correlates of such perceptions. In this study, from a social
constructionist perspective, which presumes that individuals
perceptions are shaped through interactions with others, we
sought to identify whether and how Japanese adult childrens
perceptions of parental aging are linked with the nature of
the ties that they have built with their parents. Specifically,
we focused on how much adult children perceived their par-
ents as young for their age, and examined the association
between such perceptions and structural (e.g., geographical
proximity, contact frequency) and functional (e.g., exchanges
of different forms of support) aspects of the relationship with
parents. Using online survey data from 1,010 Japanese adult
children with at least one living parent aged 65 or older, we
conducted regression analysis, which revealed that children
were more likely to perceive their parents as young for
their age when finding it easier to self-disclose to parents;
when having received greater amounts of tangible aid from
parents; and when having provided fewer amounts of such
aid for parents. Note that these results were obtained while
controlling for parents age and age disparity between par-
ents and children. Our findings suggest that functional rather
than structural aspects of parent-child relationships matter
for Japanese adult childrens perceptions of parental aging.
KOREAN BABY BOOMER COUPLES SELF-
PERCEPTION OF AGING AND FUTURE TIME:
EFFECTS OF FAMILY LIFE EVENTS
Y.Kim1, K.Kim1, K.Boerner1, G.Han2, 1. Gerontology,
University of Massachusetts Boston, Boston, Massachusetts,
2. Seoul National University, Seoul, Korea (the Republic of)
Korean Baby Boomers (born between 1955 and
1963) comprise the largest segment of the population
approaching old age in Korea, and the majority (94%) are
currently married or partnered. Since studies have exam-
ined self-perception of aging at the individual level, little is
known about how couples share perspectives on aging and
future time. Using 727 couples (individual N=1,454) from
the Korean Baby Boomer Panel Study Wave 3, we examined
three aspects of aging perceptions: aging anxiety and two
IAGG 2017 World Congress
131
types of future time perspective (i.e., limitation and opportu-
nity). In particular, this study investigated the effects of own
and spouses negative events (e.g., health disruption, job loss,
parent loss) on perceptions of aging and future time, using
Actor-Partner Interdependence Models (APIM). Given that
husbands and wives age together and share most of family
events, we expected similarity in aging perceptions among
spouses. Due to gendered roles, however, we expected differ-
ential effects of family events on aging perceptions between
husbands and wives. In line with our hypotheses, we found
that Korean Baby Boomer couples shared similar perceptions
on aging and future time (Intraclasscorrelations ranged from
.45 to .56). For both husbands and wives, own health dis-
ruption was associated with more limited sense of time, but
health disruption of wifes parents was associated with more
positive aging perception. Experience of childs health prob-
lem was associated with more negative aging perception for
wives only. Findings demonstrated both shared and unique
effects of family events on aging perceptions of Korean baby
boomer couples.
AN AGING STATE OF MIND: THE ASSOCIATION
BETWEEN AGE IDENTITY AND SELF-RATED
MEMORY
A.E.Barrett, C.Gumber, R.Douglas, Florida State
University, Tallahassee, Florida
Age identity is associated with a wide range of health
indicators, with younger identities predicting better physical
functioning and self-rated health, fewer depressive symptoms,
and lower risk of mortality. Recent research also reveals that
younger identities predict better performance on memory
tests and less decline over time. However, research focuses on
objective measures of memory, with limited attention given to
self-rated memory. The strong association between age iden-
tity and other perceptions of health and functioning, such as
self-rated health and physiological change, suggests that age
identity also may influence self-rated memory. We examine
this possibility using the first wave of the National Health
and Aging Trends Study (2011). The results of regression
analyses reveal that younger identities are associated with
better immediate and delayed recall, a finding in line with
prior research. However, results also indicate that younger
identities are associated with better self-rated memory. In
fact, this association is among the strongest observed among
other predictors examined, including sociodemographics
and physical health. We discuss several directions for future
research, including a consideration of the bidirectional rela-
tionship between age identity and self-rated memory, the
mechanisms underlying the association, and potential impli-
cations for health and behavior.
MEASURING INTERGENERATIONAL
RELATIONSHIPS: CONTEXT RULES
S.E.Jarrott1, R.H.Weaver2, N.Bowen1, 1. College of Social
Work, The Ohio State University, Columbus, Ohio, 2.
Virginia Tech, Columbus, Ohio
Intergenerational contact contributes to a range of health
outcomes, including greater social and psychological engage-
ment and lower levels of depression. Contact measures are
limited. Informed by Allports contact theory, the Queens
University Scale (Knox, Gekoski, & Johnson, 1986)measures
132
contact with the general elder population and a familiar elder.
We administered the survey to young adults (N=606) to iden-
tify factors of intergenerational contact that may optimize
intervention programming and enhance health of young peo-
ple as they age. Factor analyzing the general elder items, only a
second-order factor model achieved an acceptable fit. Absence
of a simple factor structure reflects challenges to measur-
ing intergenerational contact with this scale. First, multiple
dimensions must be measured to fully represent relationships;
items consistently grouped along dimensions of develop-
mental periods, context of the intergenerational contact, and
nature of the exchange (e.g., cooperating with, assisting, or
receiving help). Second, items comprising the Queens scale
reflect relevant constructs but are limited in interpretability
because many items reflect multiple dimensions, resulting in
items double-and triple-loading and necessitating the second-
order factor structure. For example, an item about quality of
contact with older adults when the child was 04years old
confounds dimensions of quality and developmental stage. To
understand the impact of intergenerational contact, research-
ers must move away from 1- and 2-item global measures of
contact. Careful construction of items needs to capture sin-
gular constructs. Next steps include development and testing
of a scale that captures dimensions of context, developmental
periods, and the nature of the contact.
INTER-GENERATIONAL COHESION AND ELDER
INCLUSION: ACROSS-CULTURAL PERSPECTIVE ON
ATTITUDES TO AGEING
N.Ginnivan1,2, 1. Australian National University, Canberra,
Australian Capital Territory, Australia, 2. Centre of
Excellence in Population Ageing, Sydney, New South Wales,
Australia, 3. Yale Public School of Health, New Haven,
Connecticut
Expanding our perspectives of how we age is important
because focusing on age as a category is not very helpful
given that ageing is a continual process of events - biologi-
cal, psychological and social. That is, what accompanies the
biological reality of growth and then decline is the psycho-
social reality of managing transitions through the various
stages of life. Different social landscapes exist from culture
to culture which give rise to diverse social relationships
between peers, family members and inter-generational ties.
The present study used mixed methods to examine two dif-
ferent cultures -Australia and the Philippines and different
generations (young 2035 and older 6096year olds). Focus to feelings of incompetence or helplessness. Fear of looking
groups were held in both countries to explore how congruent
or incongruent perceptions of the ageing self are at differ-
ent stages of the life course. Asurvey with older participants
recruited from Australia and the Philippines (5279 years
of age) explored whether growing up within, or being influ-
enced by a collectivist culture creates more of a psychological
buffer towards the negative aspects of ageing than those who
are more individualist in their cultural orientation. Evidence
from both the qualitative and quantitative studies showed
that being part of a collectivist culture where there is a higher
degree of inter-generational contact, social cohesion and
elder respect does provide a buffer; this supports previous
literature and theories which speculates that the surround-
ing culture can have a significant impact on how we view
ourselves as we age.
Innovation in Aging, 2017, Vol. 1, No. S1
ANALYSIS OF THE SITUATION (NOT) TO GIVE UP
ONES SEAT TO AN ELDERLY PERSON ON PUBLIC
TRANSPORTATION
A.A.Smolkin1,2, 1. Department of humanities, Russian
Academy of National Economy and Public Administration,
Moscow, Russian Federation, 2. The Moscow School of
Social and Economic Sciences, Moscow, Russian Federation
Usually to give up a seat to an elderly person is under-
stood by participants as a display of respect as opposed
to following the rules for using public transportation. This
research is based on interviews and materials from partici-
pant observation of passengers behavior on public transpor-
tation in 20092015 in Russia.
Any person who suddenly appears to fell ill will be likely
to be given a seat unconditionally. Nevertheless, a 60-year-
old person not exhibiting signs of frailty or physical distress,
is unlikely to be given a seat. The logic of giving up seats in
practice is based not so much on the principle of respect for
the aging, but more on compassion for the ailing elderly.
Conflicts are generally based on different understandings of
legitimate reasons for giving up a seat the vigorous behav-
ior of an elderly person might seem to belie any declaration
of frailty. On the one hand, giving up ones seat is still a
socially expected norm; on the other, the rule is regularly
broken. There are two main strategies for breaking it:
1. Feigning urgent business a strategy of pretending
to be occupied with something important. This strategy can
be short-term (a passenger plays for time) and a long-term
(showing no intention of getting up).
2. Inattention The seated passenger pretends to be
not really included in the situation to avoid being accused
of disrespect. Methods include looking out of the window;
falling asleep; listening to music, and being distracted by
a cell phone.
FEAR OF DEPENDENCY AS APREDICTOR OF
DEPRESSION IN OLDER ADULTS
C.E.Adams-Price, Psychology, Mississippi State University,
Mississippi State (Starkville), Mississippi
There is evidence that older adults who subscribe to nega-
tive stereotypes of aging tend to have higher morbidity and
mortality rates than similarly aged individuals who reject
negative stereotypes of aging (Levy etal., 2002). This paper
examines the stereotype that older adults are dependent
on others. Baltes (1996) linked the dependency stereotype
dependent in others eyes has made some older adults refuse
to use helpful assistive devices that would actually increase
their independence (Resnick etal., 2009). In addition, some
older people stay home all the time because they do not
want to look like they need help when they are out in public
(Adams-Price & Morse, 2009). This paper introduces a new
measure of fear of dependency. The fear of dependency scale
was developed from a sample of 1424 adults across the US
between ages of 45 and 99. In a separate sample of 91 older
adults, regression analyses were conducted that indicated
that fear of dependency was a strong predictor of depression,
even after health, disability, and age were taken into account.
In addition, fear of dependency correlated negatively with
life satisfaction and generativity, and positively with the
Fears subscale of the Personal Longevity scale (Adams-Price
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Innovation in Aging, 2017, Vol. 1, No. S1
etal., in press). The implications of Fear of Dependency for
well-being in later life will be discussed.
UNDERGRADUATE MEDICAL STUDENTS
ATTITUDES TOWARDS OLDER ADULTS IN NEPAL
R.Gautam, Nursing, University of Massachusetts Lowell,
Lowell, Massachusetts
Life expectancy and other measures of human develop-
ments have improved over the past few decades in Nepal
resulting in aging of the population. Research on aging is
limited in Nepal in spite of a continued growth of older
adults population. The objective of the study was to explore
the nursing and medical students and attitude towards older
adults and ageism in Nepal. One hundred eighty-four under-
graduate nursing and medical students responded to a cross-
sectional survey about aging in Nepal. Study protocol was
approved by the Institutional Review Board of the University
of Massachusetts Lowell. Demographic information (age,
gender, level of education, frequency of interaction with
older adults, interest in career in aging, currently live with
an older adult) was collected. Attitude towards older adults
was measured by Behavioral Attitudes Towards Aging Scale
(BATAS) and Fraboni Scale of Ageism (FSA). Medical stu-
dents attitudes towards older adults and ageism were moder-
ate and it varied by students frequency of interaction with
older adults and living arrangement. Psychometric properties
of the scales are also discussed in relational to its use in a
third-world country like Nepal. The study results indicate a
need for developing scales that are culturally sensitive and
appropriate in the Nepalese context. Also, it is recommended
that nursing and medical schools incorporate courses on
aging in Nepal and around the globe to debunk the myths
of aging.
COMPARING AMERICAN AND CHINESE COLLEGE
STUDENTS ATTITUDES, ANXIETY, AND
KNOWLEDGE ABOUT AGING
G.Q.Zhan, S.M.Pearcey, R.Radomski, D.R.Moodie,
Kennesaw State University, Kennesaw, Georgia
The current study addresses a cross-cultural research ques-
tion: how similar and different are Chinese and American
young people in their attitudes toward aging, anxiety, and
knowledge about aging? Seven hundred seventy-nine col-
lege students (434 Chinese, 345 American) filled out a ques-
tionnaire that included Kogans attitudes toward old people
scale, a modified aging anxiety scale, and Palmers aging
facts, as well as some background information. Cronbachs
alphas indicate satisfactory internal consistency of all three
scales for both groups. Results show that the American par-
ticipants scored significantly higher on the attitudes toward
aging scale than the Chinese participants, indicating they
hold more positive aging attitudes. The Chinese participants
on the other hand scored significantly higher than their
American counterparts on the anxiety scale, indicating they
are more anxious about aging. The two cultural groups did
not differ significantly on the aging knowledge scale. We also
found that for both groups, all three aspects examined in
this study are significantly correlated. Specifically, aging atti-
tudes is positively related to aging knowledge but negatively
related to aging anxiety; and aging anxiety is also negatively
related to aging knowledge. There are also gender differences
IAGG 2017 World Congress
133
within and across the two groups. We hope these findings
will contribute to literature on cross-cultural research of
young peoples views on aging and the elderly. We will dis-
cuss the effects of globalization regarding whether Chinese
young people are able to hold onto a core traditional value
filial piety that has been essential in preserving intergen-
erational families in Chinese history.
SEXY SENIORS ARENT GEEZERS: REDRAWING THE
BOUNDARIES OF OLD AGE
S.Giles, T.M.Calasanti, Sociology, Virginia Tech, Salem,
Virginia
Using survey data from the American Perceptions of
Aging in the 21st Century, this study explores how the inter-
section of age and gender influences perceptions of sexuality
and old age. Age as a gendered performance informs both
the questions in this paper as well as the interpretation of
the data in terms of how masculinity and femininity are con-
structed in later life. This study, looking at 3048 men and
women (N=3048) ages 18 99, examined how whether or
not the belief that old people can be sexy influenced opinions
of the age at which a person would be in order to be consid-
ered old, controlling for respondents age and self reported
age category. A multiple regression analysis found that age
uniquely intersected with masculinity and perceptions of
sexuality to draw boundaries between middle and old age.
Significant results showed that men who thought that old
people could be sexy tend to perceive old age as occurring
chronologically older than men who did not think that old
people could be sexy. Thus, men perceive old age as a status
that may be staved off so long as a successful performance of
youthful sexuality can be maintained.
WHEN ARE PEOPLE TOO OLD TO MARRY? NEVER,
ACCORDING TO MOST AMERICANS
E.Wethington, R.Donoso, Cornell University, Ithaca,
New York
The impact of increasing life expectancy on older adults
expectations for starting new sexual partnerships and mar-
rying remains a relatively unexplored area in gerontology. In
this study we examine the sociodemographic and attitudinal
correlates of beliefs about the appropriateness of marrying
at later ages, specifically whether Americans believe that
women and men may become too old to marry. We use
original data from the Cornell National Social Survey 2015,
a national telephone survey of 1000 Americans (age range
1896, M= 48.9; 50% female; 82% White, 13% Black, 11%
Hispanic). Participants were asked When does a (woman/
man) become too old to marry? Following research on age-
ism, predictor variables examined were participant age, edu-
cation, income, sex, race/ethnicity, discrepancy between ones
actual age v.felt age, physical fitness, marital status, house-
hold composition, religious attendance, social/political ideol-
ogy, and beliefs about when (woman/man) enter old age.
Findings: 77% reported that they believe men and women
never become too old to marry (r=.91), thus dichotomous out-
comes and logistic regression were used. Older (OR= 1.02),
female (OR=1.21), more educated (OR=1.16), white and
more liberal participants (1.09) were significantly more likely
to state that women were never too old to marry. Reports of
when old age begins significantly predicted never too old
134
to marry but not when age was controlled. Beliefs regarding
men showed a consistent pattern. Data on participant health
were not available in this dataset, which may be a limitation.
These findings are interpreted using theories of ageism, beliefs
about longevity, and other societal trends.
TIME PERSPECTIVE AND QUALITY OF LIFE
IN INDIVIDUALS WITH MULTIPLE CHRONIC
CONDITIONS
P.Gellert1, J.Ziegelmann4, M.Steko1, C.Ernsting1,
J.Wienert3, M.Kanzler2, A.Kuhlmey1, 1. Institute of
Medical Sociology, Charit Berlin, Berlin, Germany, 2.
Pfizer Deutschland GmbH, Berlin, Germany, 3. University
of Lbeck, Lbeck, Germany, 4. Freie Universitaet Berlin,
Berlin, Germany
To examine whether future time perspective (FTP) is asso-
ciated with quality of life (QoL) in older adults and whether
this relation varies as a function of the number of chronic
conditions of a person, a longitudinal study (study 1; N=479)
over six months and a population-based cross-sectional sur-
vey (study 2; N=1681) in German individuals over the age of
65years were conducted. FTP, QoL and chronic conditions
(i.e., cardiovascular diseases, cancer, respiratory diseases,
and conditions of the musculoskeletal system, depression,
diabetes, and hypertension) were assessed with question-
naires. Fixed-effects models (with correlated residual errors
in the longitudinal study) with interaction terms between
FTP and conditions were applied. FTP (study 1: =.11; study
2: =.23) and chronic conditions (study 1: =-.29; study
2: =-.28) were significantly related to QoL in both stud-
ies. Significant interactions occurred in both studies, where
individuals with a lower number of chronic conditions had
generally higher levels of QoL compared to individuals with
a higher number of conditions; although generally showing
lower levels of QoL, the later had a stronger and more posi-
tive FTP-QoL relation with higher levels of FTP being related
with higher levels of QoL. The protective buffering value of
having a more open-ended time perspective can be used to
inform future interventions.
SESSION 495 (POSTER)
BIOLOGY OF AGING
PEROXIREDOXIN 2 DEFICIENCY AGGRAVATES
AGING-ASSOCIATED INSULIN RESISTANCE IN MICE
S.Park1,2, H.Cha1,2, 1. College of Medicine Yeungnam
University, Daegu, Korea (the Republic of), 2. Smart-aging
Convergence Research Center Yeungnam University, Daegu,
Korea (the Republic of)
Aging is associated with increased insulin resistance and
oxidative stress may play a role. Peroxiredoxin (Prx) com-
prises recently characterized antioxidant family but the asso-
ciation of Prx2 with insulin resistance is not determined yet.
In this study we examined the role of Prx2 in aging associated
insulin resistance in Prx2 knockout and wild-type littermate
mice. Insulin sensitivity was measured using hyperinsuline-
mic-euglycemic clamp in young mice at 2-month and in old
mice at 22-month old. Plasma glucose and insulin levels
were not significantly different among the groups. Glucose
Innovation in Aging, 2017, Vol. 1, No. S1
infusion rate to maintain euglycemia at ~6mM was reduced
in old groups of mice compared to respective young group of
mice. Glucose infusion rate of Prx2 knockout old mice was
significantly lower than that of wild-type old mice. Whole
body glucose turnover and skeletal muscle glucose uptake
were reduced in old mice compare to respective young mice
in both wild-type and Prx2 knockout mice. Whole body
glucose turnover and skeletal muscle glucose uptake were
significantly lower in Prx2 knockout mice compare to wild-
type mice in old group, while they were similar between two
genotypes in young group. Insulin stimulated-hepatic glucose
production tended to be lower in old mice but it was not
significantly different among the groups. Oxidative stress
was increased with aging in both genotypes and deficiency
of Prx2 gene aggravates the oxidative stress in skeletal mus-
cle. These results suggest that Prx2 prevents aging-associated
insulin resistance in skeletal muscle.
ASSOCIATION OF THE PROTECTIVE FOXO3
LONGEVITY VARIANT WITH TELOMERE DYNAMICS
DURING AGING
P.Davy1, B.Willcox3, D.Willcox4, M.Shimabukuro5,
R.Chen3, T.Donlon3, B.Morris2, R.Allsopp1, 1. University
of Hawaii, Honolulu, Hawaii, 2. Universiy of Australia,
Sydney, New South Wales, Australia, 3. Kuakini Medical
Center, Honolulu, Hawaii, 4. Okinawa International
University, Naha, Japan, 5. UMIN Center, Okinawa, Japan
Telomere attrition in proliferative tissues is a hallmark fea-
ture of human aging. To date, identification of genetic influ-
ence on the rate of telomere attrition is poorly understood.
The two genes with the most robust effect on human longev-
ity are FOXO3 and APOE. Notably, we discovered a genetic
variant of the FOXO3 gene that is strongly associated with
human longevity. This observation has now been reproduced
in independent studies of over a dozen different populations
around the world. In the present study, we sought to assess
the effect of the longevity associated variant of FOXO3
(rs2802292 - G allele) as well as variants of APOE on tel-
omerase activity and the rate of telomere attrition during
aging. The preliminary results from a cohort of Okinawan
Japanese (N=120) ranging in age from 25 90years, indi-
cates no substantial effect of the variants for either FOXO3
or APOE on telomerase levels in peripheral blood leukocyte
(PBL) samples. Analysis of the rate of telomere attrition dur-
ing aging as a function of the different variants of APOE also
revealed no significant effect. In contrast, carriers of 1 or 2
copies of the rare longevity-associated G allele of FOXO3
showed markedly reduced rates of telomere loss in PBL dur-
ing aging, as compared to carriers of the more common vari-
ant of FOXO3 (TT). Interestingly, no loss of telomere length
was observed as a function of age for G allele carriers. These
results mark the first report on genetic influence on slowing
the rate of telomere attrition in humans.
H3K36ME3 PROMOTES LONGEVITY BY
SUPPRESSING AGE-ASSOCIATED INTRAGENIC
CRYPTIC TRANSCRIPTION
W.Dang, Huffington Center on Aging, Baylor College of
Medicine, Houston, Texas
Epigenetic effects are mediated by reversible DNA methyla-
tion, histone post-translational modifications, as well as changes
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in nucleosome and chromatin conformation. These reversible
alterations have been shown to involve in nearly all nuclear and
cellular functions; their misregulation has been linked to aging
and attributed to many age-related diseases. Through an unbi-
ased lifespan screen in the budding yeast S. cerevisiae using a
systematic histone mutant library, we identified that methyla-
tion of H3 lysine 36 (H3K36) promoted longevity. Eliminating
this modification by either mutating H3K36 or deleting the
methyltransferase Set2 shortened lifespan; whereas loss of the
demethylase Rph1 extended lifespan. The levels of H3K36 tri-
methylation (H3K36me3) decreased as cells age, commensurate
with a genome-wide increase in intragenic cryptic transcription
in old cells. This is consistent with the function of H3K36me3
in suppressing such cryptic transcription mediated through dea-
cetylation of histones in gene body by recruiting histone deacety-
lase complex RPD3S. Deleting components of RPD3S shortened
lifespan, supporting this model. The increased levels of cryptic
transcription were suppressed by RPH1 deletion, suggesting that
its longevity effect is mediated by improved genome-wide con-
trol of cryptic transcription. Furthermore, increases in intragenic
cryptic transcription were also detected in aged C.elegans and
mammalian cells. Knocking down the H3K36me3 demethylase
JMJD-2 extended worm lifespan. Finally, decreased levels of
H3K36me3 and increases in H3K4me1, H3K27ac, and RNA
polymerase II were detected toward the 3-ends of genes show-
ing age-associated cryptic transcription in human mesenchymal
stem cells.
ANALYSES OF LEUKOCYTE TELOMERE LENGTH IN
THE BERLIN AGING STUDY II (BASE-II)
A.Meyer1, D.Saenroth2, B.Salewsky1, D.Spira1,
E.Steinhagen-Thiessen1, K.Norman1, I.Demuth1, 1.
Charite - Universitaetsmedizin Berlin, Berlin, Germany, 2.
German Institute for Economic Research, Berlin, Germany
Physical activity and sports have repeatedly been reported
to be associated with telomere length. While this association
is well investigated in the cross-sectional setting, very few
longitudinal data are available on this topic. We studied the
association of different types of sports across different stages
of life on relative leukocyte telomere length (rLTL, measured
at one time point) in advanced age. 815 participants from
the Berlin Aging Study II (BASE-II) aged over 61years were
included in the analysis. Similarly, we studied the association
between lean mass and rLTL. Telomere length was measured
by real time PCR, physical activity was determined retro-
spectively by questionnaire and lean mass was estimated by
dual X-ray absorptiometry. An overview on rLTL analyses in
BASE-II with a focus on its association with physical activity
and muscle mass will be presented. The results will be dis-
cussed with respect to possible mechanisms linking rLTL and
physical activity on the molecular level.
CELLULAR STRESS RESPONSE GENES IN
ALZHEIMERS DISEASE: INSIGHTS FROM GENOME-
WIDE ASSOCIATION STUDIES
A.I.Yashin, I.Akushevich, F.Fang, M.Kovtun, D.Wu,
K.Arbeev, A.Kulminski, S.V.Ukraintseva, Duke University,
Durham, North Carolina
Recent molecular-biological studies provide compelling
evidence that genes involved in cellular stress response play
crucial roles in the late onset Alzheimers disease (AD). These
IAGG 2017 World Congress
135
genes, their properties, and possible mechanisms of their joint
action that lead to AD are widely discussed in the literature.
The genetics of AD is also investigated in the genome wide
association studies (GWAS) using data from the case-control/
longitudinal studies. Genes detected in these studies influence
vulnerability of neurons to cellular stressors. Surprisingly, the
results obtained in GWAS and in molecular-biological studies
of AD rarely overlap, so the genetics of AD is not consistently
described in the two types of studies. We hypothesized that
such inconsistency in the research findings may be caused by
heterogeneity in the AD-related genetic mechanisms of cel-
lular stress response that reduces strength of genetic associa-
tions in traditional GWAS of this disorder. This means that
if stress-related genes do influence AD they are likely to be
found among those whose SNPs have low levels statistical
significance. To test this hypothesis we performed GWAS of
AD using Late Onset Alzheimer Disease Family Study data.
We showed that substantial number of SNPs, linked to genes
involved in cellular response to various stressors can be found
in the results of GWAS with a nominal level of statistical
significance. Together with traditional GWAS findings these
results indicate that genetics of AD includes genes affecting
vulnerability/resistance to AD-related cellular stresses as well
as stress response (resilience) genes influencing cellular
ability to repair damage and restore homeostasis.
CELLULAR SENESCENCE DRIVES FIBROTIC
PULMONARY DISEASE
M.Schafer1, T.White1, K.Iijima1, D.Mazula1, J.Passos2,
J.L.Kirkland1, H.Kita1, N.LeBrasseur1, 1. Mayo Clinic,
Rochester, Minnesota, 2. Newcastle University, Newcastle
upon Tyne, United Kingdom
Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal
disease characterized by interstitial remodeling, leading to
severely compromised lung structure and function. Cellular
senescence, a stress-induced state of replicative arrest, is caus-
ally implicated in numerous age-related diseases. Markers of
senescence are detectable within parenchyma of chronologi-
cally aged and IPF lung tissue. Whether and how senescent
cells mechanistically regulate IPF or if their removal may be
an efficacious intervention strategy is unknown. Through
examination of IPF tissue and transcriptome datasets, we
discovered elevated abundance of senescence effectors and
senescence associated secretory phenotype (SASP) factors,
with select markers increasing concordantly with disease
severity. Leveraging intratracheal administration of bleomy-
cin to replicate aspects of IPF, we demonstrate that suicide
gene-mediated ablation of p16Ink4a-expressing senescent
cells in Ink-Attac mice improves pulmonary function, body
composition, and physical performance. Senolytic DQ treat-
ment replicates several benefits of transgenic clearance. Thus,
our findings demonstrate for the first time that fibrotic pul-
monary disease is mediated in part by senescent cells, which
can be pharmacologically targeted to improve physical health
and function.
ANALYSIS OF THE METABOLIC AND
ANTIOXIDATIVE EFFECTS OF TAURINE
T.Chiba1, Z.Wang1, Y.Ohata1, S.Serizawa1, Y.Watanabe1,
S.Nishizono2, 1. Waseda University, Tokorozawa, Japan, 2.
Sojo University, Kumamoto, Japan
136
Calorie restriction (CR) extends lifespan and delays the
onset of a number of age-related diseases in multiple lab-
oratory organisms. These anti-aging effects of CR may be
mediated by increased lipid metabolism and oxidative stress
resistance. Taurine (2-aminoethylphosphonic acid) is an
amino acid that has been suggested to function as a regulator
of both osmosis and lipid metabolism, and as an antioxidant.
In this study, we aimed to evaluate the potential of taurine
as a CR mimetic using rats and mice. Sprague Dawley (SD)
rats were fed a diet supplemented with 0% (control), 0.5%,
1.0%, 3.0% or 5.0% (w/w) taurine for 2 weeks. SD rats fed
a 5% taurine diet displayed a significant reduction in white
adipose tissue mass compared with rats fed control diet (p
< 0.05). Plasma and liver cholesterol and triglycerides were
also significantly decreased in taurine-fed rats compared
with controls (p < 0.05). Liver gene expression analysis
showed decreased mRNA expression of fatty acid synthase
and increased mRNA expression of carnitine palmitoyl-
transferase 1A, a key mediator of beta-oxidation (p < 0.05).
Furthermore, C57BL/6 mice fed a 5% taurine diet for 16
weeks showed increased survival under the oxidative stress
induced by injection of 3-nitropropionic acid versus mice
fed control diet (p < 0.05). These results suggest that taurine
might have CR-mimetic effects through modulation of lipid
metabolism and induction of oxidative stress resistance.
MICRORNA PROFILES OF IN VITRO CELLULAR
SENESCENCE OF HUMAN OSTEOBLASTS
K.Wang1,2, Y.Hsu3, P.Kuo4, M.Huang5,6, 1. Division
of Geriatrics and Gerontology, Kaohsiung Medical
University Hospital, Kaohsiung, Taiwan, 2. College of
Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan, 3. Graduate Institute of Medicine, College of
Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan, 4. Institute of Clinical Medicine, College of
Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan, 5. Division of Chest Medicine, Department of
Internal Medicine, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan, 6. Lipid Science and Aging Research
Center, Kaohsiung Medical University, Kaohsiung, Taiwan
Introduction: Osteoporosis is characterized by loss of
bone tissue while age is considered as the common risk fac-
tor. There is an impaired osteoblastic bone formation in com-
parison with osteoclastic bone resorption during aging. One
of the possible cellular mechanisms of age-related bone loss
is osteoblast senescence. MicroRNAs (miRNAs) regulate the
expression of mRNA/protein targets and play an important
part in cellular senescence. The purpose of this study was to
investigate alternations in the miRNAs that are expressed in
replicative senescence of human osteoblast cells.
Methods: Osteoblasts were grown in vitro and cultivated
to the eighth generation cells. We then employed immu-
nohistochemical techniques to identify the expression of
senescence markers of senescence-associated -galactosidase
(SA--gal) activity. RNA isolation, small RNA library con-
struction and deep sequencing were performed. The gener-
ated next-generation sequencing (NGS) data were analyzed
using the miRSeq software package.
Results: In vitro aging model showed the positive cell
number of SA--gal stained osteoblasts were enhanced in
the eighth generation senescent cells. Morphological changes
Innovation in Aging, 2017, Vol. 1, No. S1
of large, flat and multinucleated than earlier young cells
(first generation cell as the control group) were observed.
In the NGS profiles, 168 miRNAs demonstrated over 2-fold
changes. For those read counts over 10 reads per million
(RPM), 29 of these miRNAs (including 10 upregulated and
19 downregulated miRNAs) were detected in the senescent
group.
Conclusions: We demonstrated differentially expressed
miRNAs detected between senescent and young human oste-
oblast cells. Further studies to identify candidate miRNA-
regulated genes regulating pathways of replicative senescence
are required.
POSSIBLE LINK BETWEEN AGING AND
MESENCHYMAL STEM CELL EXOSOMAL MIRNA
A.Leszczynska1,2, L.Florea2, T.Ashvetiya2, P.Johnston2,
J.Green2, J.D.Walston2, G.Gerstenblith2, C.Hwang2,
1. Regenerative Medicine Institute, Cedars-Sinai, Los
Angeles, California, 2. Johns Hopkins University, Baltimore,
Maryland
Aging is a complex phenomenon with the number of con-
tributing biological factors. Recently, important links have
been reported between microRNAs (miRNA) and aging.
miRNAs are short, non-coding RNAs that induce mRNA
degradation or repression post-transcriptionally and thus
affect a number of biological processes including stem cell
maintenance, proliferation and metabolism. It is well estab-
lished that for cell-cell and cell-tissue interaction, miRNAs are
transported as cargo in exosomes. To identify specific differ-
ences between miRNA from young-adult (6 week C57BL/6
mice) and aged (78 week) mesenchymal stem cells (MSCs),
we performed microarray analysis of exosomal miRNAs and
found that a number of biologically relevant miRNAs were
differentially expressed. miR-370 was overexpressed (4.49
fold) in exosomes from the older animals. miR-370 has been
implicated in cholesterol homeostasis, fatty acid metabolism
and lipogenesis. miR-214 was overexpressed (2.7 fold) in
exosomes of old MSCs. miR-214 represses Wnt signaling
which regulates adipogenesis. This may explain the possible
shift of MSCs differentiation tendency from the osteoblast to
the adipocyte lineage; such a shift is also reported in aging-
related diseases.
In addition, we investigated the effect of aging on the
function of exosomes. MSCs from young-adult and aged ani-
mals were exposed to hypoxic (2% oxygen) conditions and
exosomes isolated. Under hypoxic conditions, tubule forma-
tion induced by exosomes from young-adult animals was
greater than that from the older group (p=1e-7). Thus, age-
associated differences in miRNA expression may account, in
part, for age associated differences in fatty acid metabolism,
body composition, and the ability to respond to a hypoxic
stress.
DNA DAMAGE RESPONSE IS ESSENTIAL FOR THE
MAINTENANCE OF INTESTINAL HOMEOSTASIS
WITH AGE
P.JoungSun, J.Pyo, H.Jeon, Y.Kim, M.Yoo, Pusan
National University, Busan, Korea (the Republic of)
The stem cell genomic stability forms the basis for robust
tissue homeostasis, particularly in high-turnover tissues.
For the genomic stability, DNA damage response (DDR) is
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
essential. This study was focused on role of the MRN com-
plex (Mre11, Rad50, and Nbs1), two major DDR-related
factors, ataxia telangiectasia-mutated (ATM) and ATM- and
RAD3-related (ATR) kinases, and two transducer, Chk1 and
Chk2 in the maintenance of intestinal stem cells in the adult
Drosophila midgut. We explored the role of DNA damage
response-related factors, utilizing immunostaining with an
anti-pS/TQ antibody as an indicator of ATM/ATR activa-
tion, -irradiation as a DNA damage inducer, and the UAS/
GAL4 system for cell type-specific knockdown of DNA
damage response-related factors, or both during adulthood.
Here we show that DDR is activated in the intestinal stem
cells and enterocytes by DNA damage. ISCs or ECs-specific
knockdown of DDR factors caused ISC or EC cell death. and
induced intestinal stem cell proliferation. The results showed
that the pS/TQ signals got stronger with age and after oxi-
dative stress. The pS/TQ signals were found to be more
dependent on ATR rather than on ATM in ISCs/enteroblasts.
Furthermore, an ISC/EB-specific knockdown of DNA damage
response-related factors decreased the number of ISCs and
oxidative stress-induced ISC proliferation. EC-specific knock-
down of DNA damage response-related factors increased
ISC proliferation and centrosome amplification. These results
indicate that DNA damage response-related factor is essential
for the maintenance of intestinal homeostasis with age.
THE GENETICS OF FRAILTY: SUMMARY OF THE
RESULTS OF THE GENETICS WORK IN THE FRAILL
PROJECT
K.Mekli1, A.Marshall2, B.Vanhoutte1, G.Tampubolon1, Pseudo-females recapitulated the female-specific pattern of
J.Nazroo1, N.Pendleton1, 1. University of Manchester,
Manchester, United Kingdom, 2. University of St Andrews,
St Andrews, United Kingdom
Fraill Project (Frailty Resilience and Inequality in Later
Life) is concerned with examining causal processes relating
to frailty, examining social, psychological, metabolic and
genetic processes. We present the results of the genetic work
done so far: the results of the hypothesis-driven candidate
gene association analysis, the hypothesis-free genome wide
association analysis, and examine the proportion of pheno-
typic variance explained by the genome-wide genetic mark-
ers. We use the English Longitudinal Study of Ageing survey
of individuals aged over 50 years and assess their frailty
status using the two main methods, the Frailty Phenotype
(Fried etal. 2001)and the Frailty Index (Searle etal. 2008).
We chose 87 genes involved in cholesterol transport, cortisol
metabolism and inflammation, analysed with linear regres-
sion against the Frailty Phenotype and the Frailty Index,
using age and sex as covariates. Then we extend the analy-
sis to 7000 individuals with 2.5 million genotyped variants,
using the same phenotypic measures and covariates. Finally,
for explained variance estimation we use a well-accepted
genome-wide complex trait analysis (Yang etal. 2011). The
candidate gene association results support that inflamma-
tory pathways are implicated in frailty, whereas the genome-
wide scan results reveal further pathways, such as the ones
implicated in stress-response. The estimation of proportion
of phenotypic variance explained by these common genetic
variants will be available by the time of the presentation. Our
results advance understanding of the genetic determinants of
frailty and associated biological pathways.
IAGG 2017 World Congress
137
IMPORTANCE OF AGE AND SEXUAL DIMORPHISM
IN ADAPTIVE HOMEOSTATIC RESPONSES TO
OXIDATIVE STRESS
K.Davies, Leonard Davis School of Gerontology, the
University of Southern California, Los Angeles, California
Previously we reported transient expansion of the home-
ostatic range of oxidative stress resistance, involving induc-
tion of Proteasome and the Lon protease, by low, signaling,
levels of hydrogen peroxide (H2O2) in young Drosophila
melanogaster flies (3 days). We described this physiologi-
cal plasticity as Adaptive Homeostasis (Davies, K.J.A.
Adaptive Homeostasis. Molecular Aspects of Medicine. 49:
17, 2016)to differentiate it from damage-repair pathways.
Now exploring potential sex differences in adaptation, we
find both the inducible synthesis of Proteasome and Lon, and
the transient increase in oxidative stress resistance caused by
H2O2 only occur in female flies, whereas males are unable
to adapt at any level of H2O2 exposure. In contrast, males
adapt to very low levels of the redox-cycling agents paraquat
or 2,3-Dimethoxy-1,4-napthoquinone (DMNQ), whereas
young females do not adapt to these agents. Importantly, the
adaptive response to H2O2 is lost in 60day old female flies,
and adaptation to paraquat and DMNQ is lost in 60 day
old male flies (as is oxidative stress adaptability in older
C57BL/6J mice and older Caenorhabditis elegans worms).
This appears to be part of a broader abrogation of Adaptive
Homeostasis that occurs with age. We next transformed
young males into pseudo-females through over-expression
of the female-specific transformer splicing factor (TraF).
Proteasome and Lon induction and oxidative stress resist-
ance with H2O2 exposure, and lost the ability to adapt to
paraquat or DMNQ. These studies allow us to begin to dis-
sect interactions between sexual dimorphism and Adaptive
Homeostasis in aging.
USING POISSON-NORMAL MODEL TO ASSESS LINK
BETWEEN MICRORNA COUNTS AND PHENOTYPES
IN CLUSTERED DATA
T.Trmkangas, 1. Gerontology Research Center,
University of Jyvskyl, Jyvaskyla, Finland, 2. Qufu Normal
University, Qufu, Jining, China
Modeling epigenetic effects underlying the aging process
requires data processing models that are fast and account
for multiple hypothesis testing simultaneously. The array
data collected from MicroRNA provide high-throughput
data which need specialized statistical analysis strategies for
drawing proper conclusions. The aim of this study was to
investigate potential of Poisson-normal model on real data
and to identify microRNA markers related to phenotype
groups in clustered (twin) data. As a live data example, the
method was applied to the outcome hormone replacement
therapy (HRT).
The real data consisted of 241 microRNA target counts
from 11 select monozygotic female twin pairs discordant for
HRT-use and a control group of 10 young unrelated women
of the SAWES study. The test groups included 11 HRT-
users and 11 non-users and 8 controls. TMM-normalized
read count data was considered Poisson-distributed with
normal-distributed random effects accounting over-dis-
persion and familial dependency within twin pairs, and we
138
compared the average read counts across the three groups.
False discovery rates computed to account for multiple test-
ing. Simulations were conducted to investigate optimality
of the model under two random effect distributions: normal
and gamma.
HRT-users were found significantly different from users
in 14 microRNAs. Users differed from the controls in 10
targets, and non-users differed from controls in 10 tar-
gets. Differences in hsa-miR-126-5p, hsa-miR-142-5p, hsa-
miR484 and hsa-miR10b-5p were significant between all
groups (p < 0.001).
Read counts differed in relation to HRT-use and age.
Simulations confirmed that the Poisson-normal model pro-
vides a useful framework for analysis of clustered data.
AGE-RELATED CHANGES OF IRISIN LEVELS IN
PLASMA AND CEREBROSPINAL FLUID OF HUMANS
Q.Ruan1, L.Yang5, J.Ruan3, W.Gu2, Y.Zhang4,
Z.Bao1,4, Z.Yu1, 1. Shanghai Institute of Geriatrics
and Gerontology, Shanghai Key Laboratory of Clinical
Geriatrics, Department of Geriatrics, Huadong Hospital,
and Research Center of Aging and Medicine, Shanghai
Medical College, Fudan University, Shanghai 200040,
China., Shanghai, China, 2. Department of anesthesiol-
ogy Huadong Hospital, Shanghai Medical College, Fudan
University, Shanghai, China, 3. Tongji medical college,
Huazhong University of Science & Technology, Wuhan,
China, 4. Department of Gastroenterology, Huadong
Hospital, Shanghai Medical College, Fudan University,
Shanghai, China, 5. Department of anesthesiology
Huadong Hospital, Shanghai Medical College, Fudan
University, Shanghai, China
Background: Irisin, exercise-inducible myokine, is pro-
posed to interact with other tissues, such as fat and brain to
regulate the balance of metabolism, increase energy expendi-
ture, weight loss and neurogenesis. Here, we investigated
age-related changes of Irisin levels in CSF, and relationship
to paired plasma and adiposity.
Methods: Irisin levels were measure in paired plasma
and cerebrospinal fluid (CSF) of 77 normal human subjects
(18 females and 59 males, age from 17 to 82) by ELISA
assays.
Results: Using multiple linear regression analysis, we
found Irisin levels in CSF and plasma gradually increased
from young to high-aged stage and the levels of males were
higher than that of females. Irisin levels in CSF and plasma
were associated with gender and age, but not BMI. CSF
Irisin levels were not associated with plasma levels. The rela-
tionship between plasma levels and CSF:plasma ratio was
a quadratic curve. 19.7% of CSF:plasma ratio variance can
be accounted for by plasma levels. No significant relation-
ship between CSF:plasma ratio and age. The lowest value of
CSF:plasma ratio were found in the age stage of 5065years
old.
Conclusions: The levels of Irisin in CSF and plasma were
increased with the increase of age. Males have higher Irisin
levels in CSF and plasma. There is a saturable mechanism
that regulates CSF irisin transport.
Innovation in Aging, 2017, Vol. 1, No. S1
EFFECTIVE INTEGRATION OF BIOLOGICAL
RESEARCH IN MEDICAL EDUCATION AND POLICIES
IN AGING.
S.Murakami1, L.A.Bordisso2, 1. Touro University, Vallejo,
Armed Forces Pacific, 2. Early-Stage Advisory Group/
Alumnus, National Alzheimers Association, Chicago,
Illinois
This paper is to explore a potential feedback loop from
patients to biological research proposed with an early-stage
Alzheimers patient previously (Murakami, S.and Halperin,
SA. 2014 Frontiers in Genetics of Aging. Front. Genet. 5:269.
doi: 10.3389/fgene.2014.00269). Medical education has
been undergoing a major change towards a single accredita-
tion system for graduate medical education, which merges
two types of medical schools, allopathic medical schools
(MD schools) and osteopathic medical schools (DO schools).
When implemented in 2020, medical education will share
common competencies. Of them, scientific competencies
have a highest priority, though it has a large gap in incorpo-
rating biological evidence into education. Research focuses
on establishing specific evidence and may miss a wide vari-
ety of implications seen in the human systems. For example,
our conversation between a researcher and a patient have led
us to re-highlight early signs of behavioral problems in the
Alzheimers disease, which are otherwise considered as late
phase problems. In addition, we expect routine communi-
cation with patients can provide beneficial discussion about
medical education and policies that are otherwise not con-
sidered. This paper will seek for suggestions for better use of
biological evidence for education and policies.
SESSION 500 (POSTER)
CAREGIVING I
CAREGIVING ASSISTANCE PROVIDED TO OLDER
ADULTS WITH AND WITHOUT DEMENTIA AND
DISABILITY
C.Riffin1, P.H.Van Ness1, J.L.Wolff2, T.R.Fried1,3, 1. Yale
University School of Medicine, New Haven, Connecticut,
2. Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, 3. Veterans Affairs Connecticut
Healthcare System, West Haven, Connecticut
Studies examining the relationship between informal car-
egiving and caregiver burden have largely focused on sam-
ples defined by disease or disability, and on the provision
of disability-related assistance. This study characterizes a
broad range of caregiving activities provided to a nationally-
representative sample of community-dwelling older adults.
Participants were the primary caregivers (N=1,342) of indi-
viduals enrolled in the 2011 National Health and Aging
Trends Study (NHATS) who responded to the associated
National Study of Caregiving (NSOC). We estimated the
prevalence of and associations between the number of tasks
within three domains of assistance (instrumental activities
of daily living (IADL)-related, health management, health
systems logistics) and caregiver burden among caregivers of
four groups of older adults: those with dementia and disabil-
ity (n=261), dementia but not disability (n=230), disability
but not dementia (n=229), no dementia or disability (n=622).
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Caregiver burden was a composite measure of caregivers
emotional, physical and financial difficulties (dichotomized
into any vs. no burden). Within each group, caregivers pro-
vided assistance with at least one task across domains of
IADL-related assistance (>98%), health systems logistics
(>78%), and health management (>54%). Unadjusted analy-
ses using the Mantel-Haenszel trend test showed a significant
linear association (p<.05) between the number of tasks pro-
vided and a higher risk of burden across the four groups for
all but one domain in one group. These findings underscore
the need for future research that addresses the full scope of
assistance provided by caregivers to a broad spectrum of
older persons, and call for an expanded conceptualization of
the caregiver role.
ETHNIC DIFFERENCES IN POSITIVE ASPECTS
OF CAREGIVING IN DEMENTIA CAREGIVER
DEPRESSION AND BURDEN
M.Gonzalez Catalan, F.Ma, M.Huddleson, A.Harley,
S.Paulraj, L.M.Brown, T.Tormala, R.G.Gomez, PhD
Program in Clinical Psychology, Palo Alto University, Palo
Alto, California
Previous literature shows the relation between resources
available for caregivers and the number of stressors with
higher levels of caregiver burden and depression in car-
egivers, being mediated or moderated by ethnicity (e.g.,
Pearlin, Mullan, Semple, & Skamp; Skaff, 1990; Pinquart
& Srensen, 2005). Moreover, positive aspects of caregiving,
such as learning new skills and getting more meaning to life
are associated with better mental health outcomes in caregiv-
ers (Kramer, 1997; Lin, Fee, & Wu, 2012). The present study
examined ethnic difference in the relationships between
positive aspects of caregiving, and caregiver depression and
burden. This study sample included 643 elderly caregivers of
patients with Alzheimers Disease, including 321 Caucasians,
101 Latinos, and 214 African Americans. Two-tailed Pearson
correlations indicated that positive aspects of caregiving
were negatively associated with depression severity for all 3
ethnic groups (r=-.204, p=.041 for Latinos; r=-.233, p=.001
for African Americans; r=-.273, p<.001 for Caucasians).
However, the relationship between positive aspects and car-
egiver burden was less strong for Latinos (r=-.262, p=.008)
compared with African Americans (r=-.408, p<.001) and
Caucasians (r=-.409, p<.001). Additionally, fewer positive
aspect items (e.g., feeling needed and feeling appreciated)
were correlated with depression and burden in Latinos com-
pared to the other two ethnic groups. These results suggest
that mental health professionals working with caregivers of
dementia should consider ethnic differences when including
the positive aspects of caregiving as a way to reduce caregiver
depression and burden that ethnic minorities may encounter.
THE ROLE OF RELIGION IN CAREGIVER BURDEN
AND DEPRESSION FOR FAMILY CAREGIVERS OF
DEMENTIA PATIENTS
S.Shin, M.Huddleson, L.M.Brown, T.Tormala,
R.G.Gomez, PhD Program in Clinical Psychology, Palo
Alto University, Palo Alto, California
Family members who care for people with dementia may
develop both negative and positive coping strategies due
to caregiver burden that can influence mood (Raggi et al.,
IAGG 2017 World Congress
139
2015). This study examined ethnic differences in how reli-
gion as a coping strategy was related to caregiver burden
and depression. From a larger study, 101 Latino, 214 African
American, and 321 Caucasian caregivers were administered
the Center for Epidemiological Studies Depression Scale,
the Burden Interview, and Religiosity and Spiritual Coping
Questionnaire. Multiple regressions found significant inter-
actions between ethnicity and positive religious coping on
caregiver depression and burden. Correlational analyses by
ethnicity indicated that positive religious coping was related
to lower caregiver burden and depression for Caucasians and
African Americans, but not Latinos. In particular, African
Americans who participated more in religious activities and
used religion as positive coping reported less caregiver bur-
den and depression. Furthermore, African Americans who
used more negative religious coping endorsed more burden
and depression. Similarly for Caucasians, the more they par-
ticipated in religious activities and used religion to positively
cope, the less depressed and burdened they felt. Negative
religious coping also was related to greater depression in
Caucasians. For Latinos, only religious negative coping was
related to greater caregiver burden. These findings suggest
that religion can have both positive and negative impacts on
caregiver burden and depression, but these religious influ-
ences appear greater for Caucasians and African Americans,
and less so for Latinos.
EFFECTS OF CHARACTERISTICS OF CARE
RECIPIENT AND CAREGIVERS ON CAREGIVER
BURDEN
S.Kaewma1, J.K.Schneider1, C.Geneus2, S.Prakobchai1,
1. School of Nursing, Saint Louis University, Saint Louis,
Missouri, 2. Tulane University, New Orleans, Louisiana
Objective: Caregiver burden has been associated with
poor outcome for care-recipients and caregivers. This study
examines caregiver and care-recipient characteristics associ-
ated with caregivers burden. The caregiver stress model was
used in this study. Methods:The data from the 2015 National
Alliance of Caregiver the United States were examined for
this secondary data analysis. The sample sizes included 1,404
survey participants who were caregivers for older adults.
Multivariate logistic regression was used to analyze caregiver
and care-recipient characteristics predicting caregivers bur-
den. Results:The burden predictor was 60.3% among 846
caregivers. After adjusting for covariates, care recipients with
short term physical condition, long term physical conditions,
emotional or mental health problems, and currently care
providing had .38(95% CI:.26.57), .39(95% CI:.26.60),
1.55(95% CI:1.00 2.41), and 2.50 (95% CI:1.77 3.54)
times higher odds of burden compared to those without the
mentioned conditions,respectively. Caregivers who reported
a primary caregiver, physical strain, and provide care 08
hours had 1.72(95%CI:1.242.38), 1.70(95% CI: 1.20
2.41), and 9.51(95%CI:7.2412.48) times higher odds of
burden compared to those who did not report the mention
condition. Discussion: Findings suggest that recipients with
short term-long term physical condition, emotional or men-
tal health problems, and currently care providing contrib-
uted to greater caregiver burden. As the number of physical
strain increased, burden increased. Alzheimers and demen-
tia people were found not to be associated with caregiver
140
burden. Future researchers might investigate factors such as
care-recipients in difference of illness and caregivers social
support. Nurse practitioner should assess for these character-
istics to intervene reducing caregivers burden.
LIVING ARRANGEMENT AND TIME ASSISTANCE TO
NON-CO-RESIDENT ELDERLY PARENTS IN CHINA
Y.Hou, A.L.Janus, Sociology, University of Edinburgh,
Edinburgh, United Kingdom
Family eldercare provided by children in China is fac-
ing more and more challenges nowadays as an increasing
proportion of adults and elderly parents are living inde-
pendently. Using data from the 2013 China Health and
Retirement Longitudinal Study, we firstly test the media-
tion effect of norms in predicting actual living arrangement.
Next, we examine how time assistance to elderly parents liv-
ing alone is related to childrens geographic proximity, chil-
drens competing roles, type of relationship to parent, and
several family characteristics including parents severity of
need and sibship size. We use generalized linear models with
random effects to take into account the nesting of parents
within children. Results confirm that effects of education
and economic resource in predicting living arrangement are
significantly mediated by norms. Parents need, sib-ship size,
geographic proximity and relationship type have significant
effects on time assistance. The finding helps to understand
the new patterns of eldercare in China as a consequence of
arising neo-familism and individualization. Understanding
such mechanism helps to impact Chinas future policy for-
mulation, which should satisfy the needs of both individuals
and elderly parents to better maintain the crucial role of fam-
ily in eldercare provision.
E-HEALTH INTERVENTION FOR
INTERGENERATIONAL CAREGIVERS OF
CHRONICALLY ILL OLDER ADULTS
A.M.Steffen1, J.Epstein1,2, K.Arenella1, 1. Department of
Psychological Sciences, University of Missouri - Saint Louis,
St. Louis, Missouri, 2. Missouri Institute of Mental Health,
St. Louis, Missouri
Family-clinician communication is important for chronic
disease self-management and improves outcomes for older
adults and their family caregivers. In this e-health program
based on principles from Social Cognitive Theory, adults
assisting a parent with medical appointments and medica-
tion management were randomly assigned to one of two
internet-based education interventions: (I.) Written didactics
and video clips from medical experts, or (II.) Multimedia
vignettes depicting actors responding to common healthcare
challenges. Participants (N=136) had access to these mate-
rials for one month and completed pre- and post-interven-
tion assessments. Post-intervention hierarchical regression
analyses showed an intervention effect after controlling for
pre-intervention scores. Relative to the didactics compari-
son group, the vignettes intervention reduced perceptions of
caregiving role overload (F change (1, 133)=4.68, p.05).
The ethnicity X condition interaction was also significant,
with African American caregivers showing stronger reduc-
tions in perceptions of role overload in the vignettes condi-
tion compared to other caregivers (F change (1, 132)=4.88,
p.05). When elders were identified as more physically
Innovation in Aging, 2017, Vol. 1, No. S1
unhealthy (> 15 days in the past month), caregivers in the
vignettes condition reported improved communication with
the relatives health provider. When in the didactics condi-
tion, caregivers of comparably ill relatives described post-
intervention decreases in effective communication (F change
(1, 129)=3.64, p .05). These data suggest that the interven-
tion holds most promise for caregivers of physically ill/frail
elders. In keeping with Social Cognitive Theory, exposure to
vignettes showing others successfully overcoming caregiving
difficulties led to improved outcomes compared to informa-
tion presented in didactic formats.
INFORMAL CAREGIVING AND HEALTH:
LONGITUDINAL FINDINGS FROM THE HEALTH,
WORK, AND RETIREMENT STUDY
F.Alpass, A.Szabo, J.Allen, C.Stephens, Massey University,
Palmerston North, New Zealand
The present longitudinal study investigated changes in
the mental and physical health of older caregivers over a
6-year period. Differences between patterns of caregiving
were also examined. Data were collected in 2008, 2010,
2012, and 2014 from a sample of older New Zealanders
(N = 803, 54% female) aged between 56 and 72 as part
of the Health, Work, and Retirement study. Of participants,
n=258 were caregivers and n=545 never provided care.
Females were more likely to be caregivers. Analyses indicated
that mental health declined over time for both caregiver and
non-caregiver groups with the decrease being substantially
larger for caregivers. There was also a gender effect sug-
gesting that male caregivers mental health declined to a
greater extent. Non-caregivers reported more doctor visits
over time and hospital admission increased for both groups
but this increase was larger for caregivers. Male caregivers
were admitted to hospital more often than female caregiv-
ers. Analyses were conducted to differentiate among differ-
ent patterns of caregiving over the 6year period (continued
caring, stopped caring, on-and-off caring). There was no dif-
ference between caregiving groups in terms of gender, age,
smoking and drinking behaviour. However, on-and-off car-
ers had poorer mental health than those who provided care
continuously. In sum, caregivers experienced more mental
health problems over time, visited their doctors less but were
more likely to be admitted to hospital. Male caregivers were
more vulnerable to health decline. Furthermore, transition-
ing in and out of the caregiver role had a negative impact
on wellbeing.
BURDEN AMONG CAREGIVERS OF OLDER ADULTS
WITHOUT DEMENTIA OR DISABILITY: WHO IS AT
RISK?
C.Riffin1, P.H.Van Ness1, J.L.Wolff2, T.R.Fried1,3, 1. Yale
University School of Medicine, New Haven, Connecticut,
2. Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, 3. Veterans Affairs Connecticut
Healthcare System, West Haven, Connecticut
The empirical literature on caregiver burden has been
dominated by a focus on dementia and disease-specific
samples, and the risk associated with providing disability-
related assistance. In this study, we analyzed data from
611 community-dwelling older adults without dementia
or severe disability who participated in the 2011 National
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Health and Aging Trends Study (NHATS) and their primary
caregivers who responded to the linked National Study of
Caregiving (NSOC). Multivariable logistic regression mod-
els examined the relationship between the number of health-
related tasks caregivers provided within three domains
(instrumental activities of daily living (IADL), health sys-
tems logistics, health management) and caregiver burden, a
composite measure of caregivers self-reported emotional,
physical, and financial difficulties associated with providing
care (dichotomized into any vs. no burden). After adjust-
ing for older adults and caregivers sociodemographic and
health characteristics, separate models for each domain
demonstrated that providing assistance with a greater num-
ber of IADL-related tasks (adjusted odds ratio(aOR)=3.5;
95% CI, 1.86.4), health systems tasks (aOR=1.8; 95% CI,
1.13.0), and health management tasks (aOR=1.6; 95% CI,
0.92.7) was associated with a higher risk of burden. In the
full model including all domains of assistance, only IADL-
related assistance remained significantly associated with
burden; caregivers who reported poor health (aOR=2.0;
95% CI, 1.03.6), anxiety (aOR=2.4; 95% CI, 1.15.3),
and cared for an older adult with self-reported depression
(aOR=1.8; 95% CI, 1.03.0) were more likely to experi-
ence burden. Findings suggest that burden is associated
most strongly with IADL-related assistance and with the
physical and psychological well-being of caregivers and
older adults.
CAREGIVER WORKSHOPS MAKE ADIFFERENCE IN
THE LIVES OF RURAL ARKANSAS FAMILIES
R.McAtee, S.White, L.Roy-Rasheed, Geriatrics, University
of Arkansas, Little Rock, Arkansas
The challenges of family caregivers that reside in rural
areas differ on many fronts than those who live in urban or
microurban areas. Resources are scarcer and when available
are harder to find and more difficult to access. Obtaining
common services such as home health, home assistance,
meals on wheels, or respite care can be difficult if not impos-
sible in some of the most rural areas. Training is also harder
to find and attending available caregiver education programs
can be very difficult due to lack of transportation and alter-
native support systems.
The Schmieding Home Caregiver training program has
trained over 1442 family caregivers since 2009 in 8 microur-
ban and rural areas throughout Arkansas. In 2016, a phone
survey study was completed with family caregivers who had
attended a Schmieding caregiver workshop between 2009
and 2015. Family caregiver participants were first asked
basic demographic questions about themselves and their care
recipient. These questions were followed by open-ended yet
focused questions on issues like length of time they were a
caregiver, what skills and knowledge they had learned in the
training that helped them the most, and what major chal-
lenges they faced as a caregiver. The participants were also
asked about what factors were most important to them in
their ability to keep their loved one in the home for as long as
possible. Data was collected and a pragmatic process of the-
matic content analysis completed. Key findings and examples
under each theme will be presented and linked to existing
research.
IAGG 2017 World Congress
141
A TYPOLOGY OF SPOUSE CAREGIVER QUALITY OF
LIFE EXPERIENCES ACROSS NEURODEGENERATIVE
DISEASE GROUPS
K.Roland, N.L.Chappell, University of Victoria, Victoria,
British Columbia, Canada
There are few comparative studies of spousal caregiver
experiences across neurodegenerative disease groups. This
study used the Stress Process Model to (1) compare qual-
ity of life (QOL) experiences of Alzheimers disease (AD),
Parkinsons disease (PD) and PD dementia (PDD) caregiv-
ers; and (2) determine whether distinct care experiences are
accounted for by disease diagnosis alone, or whether experi-
ences are defined through a unique combination of symp-
tom presentation, care demands, support across disease
groups. Caregivers were recruited from community (PD=43,
PDD=21) and a larger study examining Cholinesterase
Inhibitor effectiveness (AD=43). Caregivers were English-
speaking and provided 3+ hours of care per week for 1+ year
to community-dwelling spouses. 105 questionnaires were
completed on characteristics, symptoms, demands and sup-
ports. QOL experience of caregivers was measured as life
satisfaction, burden, and depression. A hierarchical cluster
analysis using Wards method and squared Euclidean dis-
tances allocated every case to one cluster. Four caregiver
experiences were revealed: Succeeding, Coping, Getting by
with Support, and Struggling. Results demonstrated problem
behaviours and expressive support had a greater influence
on clustering of caregiver experiences than diagnosis. Life
satisfaction was similar across groups, demonstrating that
caregivers can be burdened without impacting how satisfied
they feel about life.
This expands on knowledge of spouse caregiver QoL by
revealing different types of experiences that go beyond dis-
ease diagnosis and take into consideration presenting stress-
ors and available supports. Our findings have implications
for community organizations that serve these diverse groups;
notably, not all caregivers in the same group have the same
needs for support.
PREDICTORS OF CARE-RELATED EMOTIONAL
DISTRESS AMONG CAREGIVERS FOR INDIVIDUALS
WITH DEMENTIA
A.Leggett1, D.Maust1,2, H.Kales1,2, 1. Psychiatry,
The University of Michigan, Ann Arbor, Michigan, 2.
Department of Veterans Affairs, Ann Arbor, Michigan
In the United States, 15 million adults serve as informal
caregivers for a person with dementia (PWD). While caregiv-
ing has many rewards, reports of burden and mental health
concerns are common. Pearlins Stress Process Model pos-
its both primary stressors relating to the PWDs impairment
and secondary strains resulting from care predict health out-
comes for caregivers. Using the National Study of Caregiving
(NSOC), we examine contextual factors of the PWD and car-
egiver as well as caregiver health and intrapsychic strains as
predictors of emotional distress related to the caregiving role.
We also examine whether PWD level of functional impair-
ment (categorized as low, moderate, or high) moderates the
effect of other PWD and caregiver characteristics. Our sam-
ple included 1063 caregivers for 717 PWDs. The caregiving
role was found to be very emotionally difficult by 17% of
the sample. Two-level hierarchical linear models (caregivers
142
nested within PWDs) were run with PWD and caregiver level
contextual factors, caregiver health and psychological well-
being, and interactions entered consecutively. High PWD
functional impairment, being female, higher education, more
pain, sleep difficulty, and lower psychological well-being
were associated with higher levels of care-related emotional
distress. When testing for the moderating effects of PWD
level of functional impairment, the association between pro-
viding routine (as opposed to as-needed) care and increased
emotional difficulty was strongest for caregivers of PWD
with moderate impairment. Caregivers with greater feel-
ings of psychological well-being (control/adjustment) were
less likely to report care-related distress, even controlling for
PWD functional impairment and caregiver health.
BUILDING SOCIAL SUPPORT IN ADULT CHILD
CAREGIVERS OF PERSONS WITH DEMENTIA: THE
NYUCI-AC
J.E.Gaugler1, M.Reese1, M.S.Mittelman2, 1. Center
on Aging, School of Nursing, University of Minnesota,
Minneapoils, Minnesota, 2. New York University School of
Medicine, New York, New York
Psychsocial interventions for families of people with
Alzheimers disease or related dementias often focus on build-
ing coping skills, providing respite, or building social support
to mitgate the potential negative effects of care provision. The
NYU Caregiver Intervention (NYUCI), a multi-component
psychosocial intervention that offers individual and family
counseling, support groups, and ongoing consultation origi-
nally tested for spousal caregivers, was adpated for adult child
dementia caregivers in Minnesota (NYUCI-AC). The current
study examined whether the NYUCI-AC was effective in
improving perceptions of social support among adult child car-
egivers of persons with dementia who received this interven-
tion, a key clinical objective of this intervention. Asingle blind,
randomized controlled study design was used, and 107 adult
child caregivers participated up to a 3years. Based on our prior
analyses of NYUCI-AC outcomes, a series of individual growth
curve models will suggest the complex effects of a multi-com-
ponent intervention over time on various domains of social
support. Adocumented mechanism of benefit of the NYUCI is
its ability to build social support among spousal dementia car-
egivers; the present study is anticipated to demonstrate that the
NYUCI-AC will exert similar effects, but also deviate in impor-
tant ways from the parent NYUCI. Process evaluation data as
well as a counselor case study will further document how the
NYUCI-AC did or did not enhance social support among adult
child caregivers of persons with dementia.
MEASURING BURDEN WORRY: DEVELOPMENT OF
CARE RECEIVER BURDEN WORRY SCALE
R.V.Shippee-Rice, P.DiNapoli, S.Kelly, G.Harkless,
D.Pelletier, S.Fox, University of New Hampshire, Durham,
New Hampshire
The concept Burden Worry is described as anxiety or
unease arising from feelings related to becoming a physical,
emotional, spiritual or financial drain on a caregiver leading
to altered or strained relationships and the potential for loss
of ongoing care. Burden worry can contribute to caregiver
burden by limiting care receiver-caregiver communication,
shared decision making, and satisfying care engagement. By
Innovation in Aging, 2017, Vol. 1, No. S1
measuring effects of burden worry on the dyadic relation-
ship, interventions can be designed to maintain or enhance a
positive care receivercare giver dynamic to promote higher
quality care, improved decision making, enhanced relation-
ship satisfaction, and extended length of caregiving. Few
tools measuring care receiver burden worry are available for
research or clinical use. The Care Receiver Burden Worry
Scale guided by Life Transition and Social Ecology theories
was developed from interviews with older adults receiving
care from adult children. The original 24-item scale focused
on four dimensions emerging from the interviews. This was
later reduced to 18 items (=.87) explaining 58.2% of the
variance. Factor analysis led to three factors: burden worry,
maintaining self, and minimizing feelings of burden. The
purpose of this presentation is to describe the original study
and item development, testing procedures with older care
receivers, correlations with demographic data and activities
of daily living, and discussion of potential benefits of tool to
examine effects of care receiver burden worry on caregiver
burden, care receiver-caregiver communication, and decision
making processes related to care needs of older adult.
PLANNING FOR AGING IN THE MIDST OF
ENDURING CAREGIVING FOR PARENTS OF ADULT
CHILDREN WITH ASD
C.Marsack1, A.Weisz2, 1. Eastern Michigan University,
Ypsilanti, Michigan, 2. Wayne State University, Detroit,
Michigan
Despite the growing wave of children diagnosed with
autism spectrum disorder (ASD) reaching adulthood, very
little is known about adults with ASD and their parental
caregivers. These adults with ASD often require some form
of lifelong reliance, often necessitating parents to continue
their caregiving duties for their adult children. For many
older parents, their parental duties become an enduring role
as they simultaneously undergo their own aging processes.
To date, there is a lack of information regarding the needs of
parental caregivers of adult children with ASD as they, too,
age. This study is the follow up to a larger, quantitative study
(n=320) which seeks to examine the experiences of parents
(50+) of adult children (18+) with ASD. Using semi-struc-
tured interviews, 51 interviews were conducted nationally to
understand parent perspectives, including those surrounding
service availability, utilization, and satisfaction. Interviews
were transcribed and analyzed using grounded theory and
line-by-line analysis. Amajor finding of the study uncovers
serious deficits in availability, accessibility, accommodation,
and affordability of services. For many of the parental car-
egivers, a lack of service options inhibited them in planning
for future care of their adult child. This presentation includes
recommendations for next steps to improve supports and
service delivery for aging parents of adult children with ASD
who must balance their own aging and potential care needs
with the demands of caregiving obligations.
FORMAL OR INFORMAL? THE IMPACT OF
INFORMAL CAREGIVING ON FORMAL HOME CARE
C.Wu2, F.Huang1, 1. Institute for Advanced Research,
Shanghai University of Finance and Economics, Shanghai,
China, 2. School of Statistics and Management, Shanghai
University of Finance and Economics, Shanghai, China
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
As the rapid growth of aging populations in both devel-
oped and developing countries, public long-term care poli-
cies become increasingly important. Much of long-term
care is provided informally. As needs expand and expenses
rise, understanding the role of informal care in meeting
this escalating demand becomes crucially important. To
develop and refine long-term care policies, we investigate
the substitutability of informal for formal care. We set up
the theoretical framework according to the work of Van
Houtven and Norton (2004, 2008). We use latest three
waves of Chinese Longitudinal Healthy and Longevity
Survey (CLHLS 2005, 2008 and 2011) to investigate the
effects of family informal caregiving on the utilization and
expenditure of the formal care. Using the classical Two-
part Model, we find that informal care reduces formal
home health care. The reductions are heterogeneous across
the physical function level and lifetime. Therefore, public
policies should encourage and support family caregivers,
rather than replace or attenuate the role of informal care.
Public long-term care must be provided when informal
care is not available.
JOB SATISFACTION AND PSYCHOSOCIAL WORK
CONDITIONS: GENERATIONAL DIFFERENCES
AMONG HEALTHCARE WORKERS
J.Miller, E.Sabbath, Boston College, Chestnut Hill,
Massachusetts
Previous research in the area of healthcare workers has
demonstrated associations between job satisfaction and psy-
chosocial conditions of work. Psychosocial conditions of
work include co-worker/supervisor support, bullying, job
flexibility, and job demands and control. There is a grow-
ing body of literature in the aging and work domain that
points to the unique factors of the psychosocial work envi-
ronment that are valued distinctly by different generations.
Despite the strong foundations of these two bodies of lit-
erature, there is relatively less empirically-driven research
about the ways in which job satisfaction is associated with
psychosocial working conditions for different age groups.
From this lack of information, the research question arises:
Is job satisfaction driven by different psychosocial working
conditions or work organizational factors depending on the
workers age?
All data have been collected and analyses are forth-
coming. We will use data from a cross-sectional study of
1,596 patient care workers at two large East Coast hos-
pitals. Linear regression models will examine associations
between several psychosocial work characteristics (people-
oriented culture, work flexibility, supervisor/co-worker
support, workplace harassment, and job demands and
control) and job satisfaction, and then we will test for sta-
tistical interaction between these work characteristics and
worker age. We will then stratify analyses by age group
to test whether the direction, magnitude, and significance
of predictors of job satisfaction is different for younger,
middle-aged, and older workers. Based on findings, par-
ticipants will have a basis for understanding methods for
optimizing job satisfaction and managing and retaining an
age-diverse workforce.
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143
SESSION 505 (POSTER)
CHRONIC CONDITIONS
OSTEOPOROSIS PREVENTIVE BEHAVIORS AND
BONE MINERAL DENSITY AMONG OLDER WHITE
AND ASIAN WOMEN
Y.Du, L.Zhao, Q.Xu, H.Deng, Tulane University, New
Orleans, Louisiana
Background and Purpose: With the growing aging popu-
lation, osteoporosis has become an increasing public health
problem. White and Asian women are at greater risk of
developing osteoporosis/low bone mineral density compar-
ing to black women. This study is to explore: 1)differences
of Osteoporosis Preventive Behaviors and 2) Bone Mineral
Density (BMD) among non-Hispanic White and Asian
Women Age 50 and over.
Methods: 2816 subjects from Louisiana Osteoporosis
Study are included in this study. Bivariate analysis is used to
examine differences of osteoporosis relevant behaviors and
BMD. Multiple linear regressions are adopted to explore hip
and spine BMD differences considering physiological and/or
behavioral factors.
Results: White women have both higher hip and spine
BMD than Asians. Meanwhile, whites are more likely to
engaging in milk consumption, Vitamin/calcium supplements
use, sun exposure, and smoking. No exercise difference is
found between the two groups. Hip BMD difference disap-
pears when controlling for either physiological or behavioral
factors. While, spine BMD difference still exists after adjust-
ing for either physiological or behavioral factors, but disap-
pears when controlling for both.
Conclusions and Implications: Bone health disparity
exists between white and Asian women, with different mag-
nitude in different bone sites. Though physiological factors
play an important role in BMD, engaging in healthy behav-
iors can largely decrease this disparity. More interventions to
improve bone health are needed in Asians. In addition, the
relevant contributions of physiological and behavioral fac-
tors to different bone sites needs to be further studied.
FACTORS RELATED TO THE RELATIONSHIP
BETWEEN URINARY INCONTINENCE AND
HOMEBOUNDNESS IN OLDER-ADULTS
L.Jorge, J.Rocha, B.Rauber, G.Guimaraes, B.B.Neves,
A.Bos, Catholic University of Rio Grande do Sul, Porto
Alegre, RS, Brazil
Psychosocial effect generated by urinary incontinence (UI)
might be a contributing factor related to homeboundness.
The aim of the study was to determine whether there was
a significant association between the UI and homebound-
ness older-adult and what factors influenced this association.
The aim of the study was to determine whether there was
a significant relationship between homeboundness and the
presence of UI in the elderly, and what factors could influ-
ence this correlation. The dependent variable was reporting
leaving the home less than twice a week in the last 6months
and the independent variables were UI, sex, marital status,
age, health perception, cognition, and number of morbidi-
ties. Of the participants, 51.8% were women and 3.7% had
144
UI. UI increased the risk of homeboundness in 2.66 times in
the simple model and 1.9 after controlling for co-variables.
Being man was a protective factor (confidence interval 0.66
to 0.86). Single older-adult, divorced in relation to mar-
ried had the marital status as a protective factor (p <0.01).
Increasing age was an independent risk factor (p <0.01). Poor
and regular self-perception of health were also considered
a risk factor (p <0.01) when comparing with good status.
The number of comorbidities showed no significant correla-
tion. We conclude that older-adult with UI has greater risk of
being restricted to home especially when female, older age,
low perception of health. Having good cognition and living
without a partner were protective factors.
SIGNS OF EXACERBATION DETECTED BY FAMILY
CAREGIVERS OF DEMENTED ELDERLY WITH
CHRONIC HEART FAILURE
S.Hara1, M.Taguchi2, 1. Shimane University Faculty of
Medicin, Izumo-shi, Japan, 2. Shimane Prefectural Central
Hospital, Izumo-shi, Japan
The purpose of the present study is to clarify the signs
of exacerbation of heart failure detected by family caregiv-
ers of the demented elderly suffering from chronic heart
failure. Semi-structured interviews were conducted with 10
family caregivers living with demented elderly persons suf-
fering from chronic heart failure. The details of the inter-
views were analyzed in a qualitative and descriptive manner.
Consequently, as the signs of exacerbation of heart failure
detected by the family caregivers, the following three cat-
egories were extracted: presence of visible physical changes,
having difficulty in speaking, dressing and moving, and
appearance of physical disorder in the patients own man-
ner. Family caregivers living with patients who were having
difficulty in recognizing and indicating their intentions could
detect signs of exacerbation of heart failure. These signs were
minor changes or subtle differences that only the family car-
egivers knowing the patients daily speech habits and living
conditions could notice. Taking a collaborative approach
with family caregivers, we should confirm the patient-spe-
cific signs of exacerbation of heart failure detected by fam-
ily caregivers. In this manner, we should provide appropriate
support that prompts patients to visit a hospital and prevent
aggravation of heart failure.
PHENOTYPIC CHARACTERISTICS AND RISK
FACTORS ASSOCIATED WITH EXACERBATOR-
PRONE ASTHMA IN OLDER ADULTS
M.D.Opina1,2, E.R.Bleecker2,3, A.T.Hastie2,3, H.Li2,3, tive functioning, the multidisciplinary research team of the
D.A.Meyers2,3, W.C.Moore2,3, 1. Wake Forest School of
Medicine, J Paul Sticht Center on Aging, Winston Salem,
North Carolina, 2. Wake Forest School of Medicine, Center
for Human Genomics, Winston Salem, North Carolina, 3.
National Heart, Lung, and Blood Institutes Severe Asthma
Research Program, Bethesda, Maryland
Preventing asthma exacerbations is a goal of National
Asthma Guidelines, but identification of at-risk individu-
als is difficult, especially in older asthmatics. We aimed to
characterize exacerbation-prone asthma in older adults to
identify characteristics and predictive biomarkers associ-
ated with high-risk phenotypes to facilitate precision medi-
cine approaches. 70 non-smoking subjects 60years old in
Innovation in Aging, 2017, Vol. 1, No. S1
the Severe Asthma Research Program underwent charac-
terization (comprehensive questionnaires, lung function with
bronchodilator reversibility, atopy assessment, biomarker
collection). Using patient-reported exacerbations two phe-
notypes were defined; Exacerbation Prone Asthma (EPA,1/
past year) and Very Frequent Exacerbations (VFE,3/past
year). Risk and biomarker associations were assessed with
odds ratios (OR) using logistic regression. 44% of older
asthmatics had EPA. Healthcare utilization and treatment
with higher corticosteroid doses were more frequent in EPA
compared to non-exacerbating subjects (p<0.02). Female
gender (OR=2.90), respiratory infections (OR=2.90), and
post-bronchodilator FEV1<65% (OR=2.72) were associated
with EPA (p<0.05). In contrast, sinusitis (OR=5.42), treat-
ment with long-acting beta-agonists (LABA,OR=5.37), and
pre-bronchodilator FEV1<68% (OR=3.48) were associated
with VFE (p<0.04) compared to subjects with fewer exacer-
bations. While sputum eosinophils 3% was associated with
VFE (OR=6.19,p=0.027), blood eosinophils and exhaled
nitric oxide were not associated with either phenotype. In
conclusion, the EPA phenotype was associated with less
reversible airflow obstruction, greater steroid use and res-
piratory infections. Persistent airway eosinophilia was asso-
ciated with the VFE phenotype suggesting a role for targeted
therapy with anti-IL5 immunomodulators in these patients.
The association of LABA treatment with the higher-risk VFE
phenotype suggests a possible adverse outcome of this drug
classin older asthmatics that requires further investigation.
ACCELERATED PHYSICAL AND COGNITIVE AGING
IN ACHRONIC PAIN CONDITION VS. NORMAL
AGING
L.A.Zettel-Watson1,3, J.Tessler3, J.Kircher3, L.Islas3,
J.Aquino4, K.L.Fisher5, F.Cortez2, B.J.Cherry1,3, 1.
Gerontology, California State University, Fullerton,
California, 2. North Dakota State University, Fargo,
North Dakota, 3. Psychology, California State University,
Fullerton, California, 4. Health Science, California State
University, Fullerton, California, 5. Kinesiology, California
State University, Fullerton, California
Chronic pain conditions affect more Americans than dia-
betes, cancer and heart disease combined. Individuals with
chronic pain disorders such as Fibromyalgia (FM) often
experience declines in both physical and cognitive function-
ing, but for aging individuals, whether declines are a result of
the chronic condition or senescence is unclear. To tease apart
the impact of age and chronic pain on physical and cogni-
Fibromyalgia and Chronic Pain Center at California State
University, Fullerton, conducted a longitudinal study across
five data collection waves (every two years for 8 years).
Participants included 222 men and women (82% female)
aged 5087 years (M = 63.4, SD = 8.9) with and without
FM (56% FM). Participants completed several physical
performance measures (e.g., Senior Fitness Test, Fullerton
Advanced Balance scale, 30-ft walk) and cognitive tasks (e.g.,
Digit Span Forward and Backward, Stroop Color-Word test,
Trails Aand B, Digit Symbol Substitution Task). Controlling
for age, a multilevel model indicated that having FM was a
significant predictor of physical and cognitive decline across
time. Those with FM showed poorer performance across
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
both physical and cognitive domains, but over time, the FM
group also experienced significantly more accelerated rates
of decline compared to their healthy counterparts. Findings
suggest that chronic pain conditions like FM exacerbate
declines in physical and cognitive performance beyond nor-
mative aging changes. Understanding issues related to aging
with chronic pain may help reduce disability and medical
costs, improve physical and cognitive performance, and
enhance quality of life.
SARCOPENIA IN PERIPHERAL ARTERIAL DISEASE:
PREVALENCE AND IMPACT ON FUNCTIONAL
STATUS.
O.Addison1,2, S.J.Prior1,2, R.Kundi3, A.W.Gardner4, modeled continuously. Hearing was assessed using pure tone
A.S.Ryan2,1, 1. University of Maryland, Baltimore,
Baltimore, Maryland, 2. Department of Veterans Affairs
and Veterans Affairs Medical Center Baltimore, Geriatric
Research, Education and Clinical Center (GRECC).,
Baltimore, Maryland, 3. Department of Surgery, Division
of Vascular Surgery, University of Maryland, Baltimore,
MD, Baltimore, Maryland, 4. Reynolds Oklahoma Center
on Aging, Donald W.Reynolds Department of Geriatric
Medicine, University of Oklahoma Health Sciences Center
(OUHSC), Oklahoma City, Oklahoma
Peripheral arterial disease (PAD) results in ischemic
related pathological changes in the affected muscles. To
alleviate exertional leg symptoms, those with PAD decrease
physical activity resulting in a vicious cycle of decreased
activity and accelerated mobility decline. These changes
may place individuals with PAD at greater risk for sarco-
penia. Sarcopenia has a prevalence in other clinical popula-
tions of ~122% and increases the risk for disability. This
study sought to 1)determine the prevalence of sarcopenia
in males with PAD and 2)compare the functional status of
individuals with PAD with and without sarcopenia. Sixty-
three participants with PAD (38% African American, age:
70.10.7 years, BMI: 28.10.5kg/m2, ABI:0.650.01 4. Kyoto University, Kyoto, Japan
XSEM) underwent DXA scans to assess appendicular
lean mass (ALM), and performed a six-minute walk test to
determine six-minute walk distance(6MWD) and a tread-
mill test to measure claudication onset time (COT) and
peak walking time (PWT). Sarcopenia was defined as ALM/
ht2 of less than 7.4kg/m2. Independent t-tests were used to
compare 6MWD, COT and PWT. Sarcopenia prevalence
in our PAD cohort was 17%. Individuals with sarcopenia
(N=11) had lower 6MWD (p<0.05; 34521 vs 39210 68.597.5) living in Bossou, Nzerekore prefecture, Guinea
meters) and COT (p<0.05; 10610 vs 18319 seconds) in 2009. They were screened by the self-reported question-
compared to individuals without sarcopenia (N=52). There
was no difference in PWT between the groups (p=0.4;
34521 vs 39210) Men with PAD demonstrate a prev- serum and hemoglobin simply. SRH was assessed with the
alence of sarcopenia consistent with other clinical popu-
lations and those with sarcopenia and PAD demonstrate
decreased function.
ASSOCIATION OF MIDLIFE HYPERTENSION WITH
LATE-LIFE HEARING LOSS
N.Reed, J.A.Deal, F.Lin, A.Sharrett, Johns Hopkins low SRH group.
University, Baltimore, Maryland
The contribution of hypertension to hearing impairment
(HI) in older adults is poorly understood. Hypertension
could plausibly contribute to impaired circulation in the
IAGG 2017 World Congress
145
cochlea and thereby disrupt metabolic activity related to
hearing. However, results from previous epidemiologic stud-
ies of the association of hypertension and hearing loss have
been inconsistent, and the relative importance of midlife ver-
sus late-life hypertension is unknown.
We analyzed data from 248 men and women (45
64years at baseline, 19871989) in the Atherosclerosis Risk
in Communities (ARIC) Study to quantify the relationship of
mid- and late-life hypertension with late-life HI. Blood pres-
sure was measured over5 visits that were interspersed from
19972013. Hypertension was defined as systolic blood
pressure (SBP) 140mmHg, diastolic blood pressure (DBP)
90mmHg, or antihypertensive use. SBP and DBP were also
audiometry in 2013. A better-hearing ear pure-tone aver-
age (PTA) in decibels hearing level (db HL) was calculated
using thresholds from 0.54kHz and modeled continuously
The difference in PTA associated with hypertension was esti-
mated using multivariable linear regression.
47 participants (19%) had hypertension at Visit 1(1987
89) compared to 183 (74%) at Visit 5(2013). In analyses
adjusted for demographic and clinical covariates, midlife SBP
was associated with HI, but late-life SBP was not (difference
in PTA per 10mm Hg SBP measured at Visit 1(198789):
1.43 dB HL (95% CI: 0.32,2.53) vs. Visit 5(2013): -0.43 dB
HL (95%CI: -1.41,0.55).
Our results demonstrate that midlife, but not late-life, SBP
was independently associated with poorer hearing.
SELF RATED HEALTH IS ASSOCIATED WITH SERUM
GLUCOSE AMONG ELDERLY LIVING AT RURAL
AREA IN GUINEA
Y.Kasahara1, M.Hirosaki2, Y.Ishimoto3, M.Nakatsuka4,
M.Fujisawa4, K.Matsubayashi, 1. Shonan University of
Medical Science, Yokohama, Japan, 2. Fukushima Medical
University, Fukushima, Japan, 3. Mie University, Tsu, Japan,
Aim: SRH is an important outcome measure along with
mortality, morbidity, and clinical outcomes. To our knowl-
edge, however, little is known about the association between
SRH and comprehensive geriatric functions in Guinea. We
examined the association between SRH and comprehensive
geriatric functions in rural area in Guinea.
Methods: The study population consisted of 129 peo-
ple aged 60 and older (men=42, women=87, mean age
naire contain SRH, basic ADL, moods, life styles and medi-
cal conditions. Furthermore, medical doctor checked blood
following question, How would you rate your current health
status? using a 100-mm visual analogue scale (worst=0 to
best=100). Mood was assessed with the following question,
Do you often feel discourage yourself? Using the median
SRH score of 43, we defined participants with a SRH score
>43 as the high SRH group and those with a score 43 as the
Result: Elderly people with low SRH had significantly
higher glucose serum, lower scores for each ADL item, func-
tional reach length and self-rated happiness compared to
those with low SRH.
146
Conclusion: Our findings demonstrated that SRH is asso-
ciated not only physical disabilities but also serum glucose
among the community-dwelling elderly in Guinea.
This suggests that SRH reflects some unperceived medi-
cal conditions especially diabetes. Medical examinations are
useful for detecting early unperceived medical conditions
and prevention of disease.
HEARING AID ACCLIMATIZATION BY OLDER
ADULTS; THE EFFECT OF NOISE REDUCTION ON
LISTENING EFFORT
D.Wright1,2, J.Gagn1,2, 1. School of Speech Pathology
and Audiology, University of Montreal, Montreal, Quebec,
Canada, 2. Centre de Recherche de lInstitut Universitaire
de Montral, Montreal, Quebec, Canada
The objectives of this study is to investigate acclimatiza-
tion of older adults (OA) listeners with hearing loss (HL)
to hearing aids (HA) using listening effort measures with
and without noise reduction algorithms (NRA). The dual-
task paradigm was used to measure the effort to understand
speech in noise. The primary task will be the Hearing In
Noise Test (HINT). The HINT is an adaptive speech percep-
tion in noise test that identifies the Signal-to-Noise (SNR)
necessary for a performance of 50%. The second task will
be a tactile pattern-recognition task (TPRT) in which par-
ticipants have to identify the three pulse combinations (i.e.
short-short-short, short-short-long, etc.). There will be 8 test-
ing sessions over a period of 16months to measure the effect
of acclimatization. The participants, aged between 60 and
75 years of age, will have a bilateral mild to moderately-
severe sensorineural hearing loss. 30 participants will be new
HA users (sub-divided in two groups; with NRA and with-
out NRA) and the other 15 participants will be experienced
hearing aid users who will be our control group. Cognitive
skills, including working memory and the processing speed
will be evaluated using the Reading Span Test (RST) and the
Digit Symbol Substitution Test (DSST), respectively. Our
hypotheses are that acclimatization as measured by listening
effort will be significant for all new HA users and that it will
be correlated with cognitive abilities. Moreover, we believe
that the presence of NRA will extend the acclimatization
period since it distorts the auditory signal.
ASSOCIATION OF CARDIOVASCULAR AND NEURO-
PSYCHIATRIC MULTIMORBIDITY WITH MOBILITY
AND DISABILITY
D.Vetrano1,2, D.Rizzuto1, A.Caldern-Larraaga1, date defined by the first day of prescription.
G.Onder2, A.Welmer1, R.Bernabei2, A.Marengoni1,3,
L.Fratiglioni1, 1. Aging Research Center - Karolinska
Institutet, Stockholm, Sweden, 2. Dept. Geriatrics, Catholic
University of Rome, Rome, Italy, 3. Department of Clinical
and Experimental Sciences, University of Brescia, Brescia,
Italy
Cardiovascular (CV) and neuro-psychiatric (NP) diseases
are highly prevalent in the elderly and frequently co-occur.
Which is the impact of their combination on mobility limita-
tion and disability is not known. We here assess the longitu-
dinal association between CV and NP multimorbidity and
mobility limitation and disability in older adults.
Population-based study involving 3353 60+ year-old par-
ticipants from the Swedish National Study of Aging and Care
Innovation in Aging, 2017, Vol. 1, No. S1
(SNAC-K). Multimorbidity was defined as the presence of 2+
diseases. We used linear mixed models to assess the impact
of CV and NP multimorbidity on walking speed (m/s) and
6 activities of daily living (ADL), over a 9-year follow-up
period. Trajectories of walking speed and ADL are provided.
In our sample, (mean age 75 years; 65% females), par-
ticipants with one CV disease (-0.14 m/s; 95%CI -0.22 to
-0.06) and those with CV multimorbidity (-0.12 m/s; 95%CI
-0.22 to -0.01) presented the highest decrease in walking
speed after 9years, as compared with participants free from
CV and NP diseases. Conversely, participants with NP mul-
timorbidity, alone (-1.58 ADL; 95%CI -1.09 to -2.08) or in
association with CV diseases (-1.70 ADL; 95%CI -1.15 to
-2.24) presented the highest decrease in ADL after 9years, as
compared with participants free from CV and NP diseases.
Cardiovascular and neuro-psychiatric multimorbidity
affect differently mobility and functional ability of older
adults.
USE OF ANTI-GOUT AGENT AMONG CHRONIC
KIDNEY DISEASE PATIENT WITH HYPERURICEMIA
H.Chou1, C.Wen1,2, H.Chiu1, H.Huang1, C.Kuo3,4,
C.Huang4, 1. Clinical Research Outcome and Training
Center, Big Data Center, China Medical University Hospital,
Taichung, Taiwan, 2. Department of Family Medicine,
National Taiwan University Hospital, Taipei, Taiwan, 3. Big
Data Center, China Medical University Hospital, Taichung,
Taiwan, 4. Kidney Institute, China Medical University
Hospital, Taichung, Taiwan
Background: Chronic kidney disease (CKD) and hyper-
uricemia are mutually aggravating conditions worldwide.
Very little is known of the use of antigout agents among
CKD patients with hyperuricemia.
Objectives: To describe the use of antigout agents
and concomitant medication among CKD patients with
hyperuricemia.
Methods: We conducted a retrospective study using the
electronic medical records from an integrated CKD care
program of a tertiary teaching hospital from January 2003
through December 2015. Patients who developed hyper-
uricemia (serum uric acid concentrations > 7mg/dL in men
and > 6mg/dL in women) at baseline and within 3years of
enrollments and treated by allopurinol, febuxostat, benzbro-
marone, colchicine or sulfinpyrazone were included in this
study. We excluded patients who were <20 or >90years of
age or treated with multiple antigout agents on the index
Results: During the study period, we identified 1,460
patients prescribed antigout agents in the final analysis. The
range of mean age at index date was 66.071.2 in the five
antigout agent groups. Compared to other antigout drug
groups, patients in the benzbromarone group tended to
have a higher estimated glomerular filtration rate (P=0.001).
Patients in the allopurinol group exhibited greater con-
comitant use of oral hypoglycemic agents (p=0.006),
fibrate (p=0.008), angiotensin-converting enzyme inhibitors
(p=0.001) and calcium channel blocker (p<0.001). Users of
febuxostat were more likely to receive acetaminophen.
Conclusion: To further evaluate the role of antigout
agents in predicting CKD progression, researchers need to
consider these unbalance potential confounding factors.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
CARDIOVASCULAR AND NEUROPSYCHIATRIC
MULTIMORBIDITY AND 11-YEAR
HOSPITALIZATION AND DEATH
D.Vetrano1,2, D.Rizzuto1, A.Caldern-Larraaga1,
G.Onder2, R.Bernabei2, A.Marengoni1,3, L.Fratiglioni1, 1.
Aging Research Center - Karolinska Institutet, Stockholm,
Sweden, 2. Dept. of Geriatrics, Catholic University of
Rome, Roma, RM, Italy, 3. Department of Clinical and
Experimental Sciences, University of Brescia, Brescia, Italy
Cardiovascular (CV) and neuro-psychiatric (NP) diseases
are the most prevalent chronic conditions in the elderly and
frequently co-occur. Which is the prognostic value of their
different combinations is not known. We aim to investigate
the prognostic role, in terms of hospitalization and mortality,
of CV and NP multimorbidity in older adults.
Population-based study involving 3353 60+ year-old par-
ticipants from the Swedish National Study of Aging and Care
(SNAC-K). Multimorbidity was defined as the presence of
2+ diseases. Hazard ratios (HRs) for 11 years overall sur-
vival and proportional sub-distribution hazard ratios (sHRs)
were calculated for the first hospitalization and competing
risk mortality according to different combinations of CV and
NP diseases.
Among the study participants (mean age 75years; 65%
females), 70% experienced at least 1 hospitalization and
38% died during the follow-up time. Participants with CV
multimorbidity (sHR 1.52 95% CI 1.271.82) had higher
risk of hospitalization, which increased (sHR 1.64 95%CI
1.322.03) if they had also NP diseases, as compared with
those without CV and NP diseases. Similarly, the highest
mortality rate was detected among participants with mixed
(CV+NP) multimorbidity (HR 2.21 95%CI 1.742.81).
Consistent results were obtained when a composite outcome
of hospitalization plus death was considered.
In conclusion, CV and mixed multimorbidity are associ-
ated with the highest risk of hospitalization and death in the
elderly.
MEDICARE PART DCOST BURDEN OF INHALED
DRUGS FOR CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
C.Tseng1,2, J.Yazdany3, R.Dudley3, C.Dejong3, D.Kazi3,
R.Chen2, G.Lin3, 1. Family Medicine and Community
Health, University of Hawaii John A.Burns School of
Medicine, Honolulu, Hawaii, 2. Pacific Health Research
and Education Institute, Honolulu, Hawaii, 3. University of
California, San Francisco, San Francisco, California
Chronic Obstructive Pulmonary Disease (COPD) causes
significant morbidity worldwide and affects 1 in 8 elderly
persons in the U.S. Inhaled drugs are highly effective, but cost
hundreds of dollars. Since high cost can lead to medication
nonadherence, we studied out-of-pocket costs for COPD
inhalers for the 39 million beneficiaries covered by Medicare
Part D.
Cross-sectional analysis using the June 2015 Centers for
Medicare and Medicaid Services Prescription Drug Plan
Formulary and Pharmacy Network Files. We examined
2,652 Part D plans nationwide and their coverage for short
acting beta agonists (SABA), short acting muscarinic antag-
onists (SAMA), combination SABA/SAMA, long-acting
muscarinic antagonists (LAMA), long-acting beta agonists
IAGG 2017 World Congress
147
(LABA), inhaled corticosteroids (ICS) and combination
LABA/ICS.
Between 93% to 100% of plans covered at least one
inhaler in each class but required patients to pay $30 to $105
per inhaler. Under a standard 2015 Part D plan, beneficiar-
ies would pay $494 to $1197 annually to fill one inhaler
per month. Patients with moderate to severe COPD needing
two or three inhalers would average $1622 to $2811yearly
in cost-sharing. It will be critical to examine how such high
cost-sharing impacts COPD treatment adherence and health
outcomes. Policymakers need to consider whether Medicare
Part D, which provides drug coverage to 70% of the elderly
and disabled persons in the U.S, can still adequately protect
elderly persons from financial burden in the face of rising
drug prices.
DEVELOPMENT OF QUALITY INDICATORS FOR
CONTINUITY AND COORDINATION OF CARE IN
ELDERS IN JAPAN
H.Masaki2, N.Kawai1, K.Matsumoto3, M.T.Musgrave2,
Y.Yamashita2, K.Kobayashi2, T.Ishikawa2, K.Yokote2,
1. Osaka University, Osaka, Japan, 2. Chiba university,
Chiba, Japan, 3. Kawasaki University of Medical Welfare,
Kurashiki, Japan
This study is a part of a larger study on development of
quality indicators (QIs) for continuity and coordination of
care in elders and establishing a system that embodies qual-
ity. The study aimed to develop QIs for continuity and coor-
dination of care in elders in Japan.
The QIs were developed based on systematic literature
reviews. First, we searched CINAHL (19822013) using
keywords elderly, quality, transition of care, and con-
tinuity of care. We extracted care contents and make indi-
cators as form of IF, THEN, and BECAUSE referred to QIs
of ACOVE-3. Thereafter, we reviewed Japanese literatures to
make indicators suited to Japanese care situations, such as
insurance system, policy, and care guidelines. We assembled
an expert panel (home-care doctor, pharmacists, home-visit-
ing nurse, policymakers) that provided suggestions on mak-
ing the QIs relevant with the current situation.
Consequently, 16 QIs in 9 categories were developed.
These categories were (1) identification of the source of care,
(2) guaranteeing elders and their family participation in con-
sultation of care, (3) providing information for care transi-
tion, (4) communication for continuity of care, (5) sharing
information for continuity of care, (6) continuity and proper
use of medication, (7) utilizing means for assisting with lan-
guage barriers, 8)acquiring fundamental knowledge of care
providers, and (9) developing tools for sharing information.
The QIs thus developed not only ensured continuity of
medical regime, but also assured the quality of care provided
to elders helping them live life on their own terms despite of
changes in their physical condition.
POOR SLEEP NEGATIVELY IMPACTS PAIN, MOOD
AND QUALITY OF LIFE IN ADULTS WITH AND
WITHOUT FIBROMYALGIA
B.J.Cherry1,2, M.Ruiz1, P.Langmesser2, J.Trevitt2,
J.Aquino3, D.Rutledge4, L.A.Zettel-Watson1,2, 1.
Gerontology, California State University, Fullerton,
California, 2. Psychology, California State University,
148
Fullerton, California, 3. Health Sciences, California State
University, Fullerton, California, 4. School of Nursing,
California State University, Fullerton, California
More than 100 million Americans suffer from chronic
pain, with an estimated 50% also experiencing poor sleep
quality. Fibromyalgia (FM) is a chronic pain condition char-
acterized by widespread pain and fatigue, often accompa-
nied by sleep, mood, and cognitive disturbances. Despite a
great deal of evidence documenting the existence of sleep
and fatigue issues in FM, few studies have attempted to
link these symptoms with psychosocial outcomes, and
even fewer include a healthy comparison group. The cur-
rent investigation utilizes data from both FM and healthy
control participants from a longitudinal study conducted
by a multidisciplinary research team at the Fibromyalgia
and Chronic Pain Center at California State University,
Fullerton. Participants included 222 adults (82% female)
aged 5087 years (M = 63.4, SD = 8.9) with and without THE BURDEN OF CHRONIC SYMPTOMS ON
FM (n=122 and 100, respectively). Sleep variables included
trouble falling asleep, staying asleep, and feeling rested.
Outcome measures included pain, anxiety, depression, and
quality of life. Hierarchical regression analyses controlling
for age and gender revealed significant results (p<.05) for
both sleep and FM status; poorer sleep and having FM were
related to higher levels of pain, anxiety, and depression, as
well as lower quality of life. For anxiety, FM status mod-
erated the impact of sleep, where those with FM who also
reported poorer sleep quality had significantly higher anxiety
levels than their counterparts. Poor sleep quality appears to
exacerbate the impact of FM across a variety of psychosocial
outcomes; clinical implications and the possibility of symp-
tom clusters are discussed.
REAL WORLD SAFETY AND EFFICACY OF SGLT-2
INHIBITORS IN ELDERLY TYPE 2 DIABETIC
PATIENTS
C.Trescoli Serrano, C.J.Fajardo, J.Arazo, F.J.Tarazona- vertigo, skin problems, stomach/intestine problems, urinary
Santabalbina, Geriatric Medicine, Hospital Universitario de
la Ribera (Alzira, Valncia, Spain), Alzira, Valncia, Spain
We would like to evaluate the real world experience in
safety and efficacy of adding SGLT-2 inhibitors to Elderly
DM2 patients with an inadequate glycemic control. Elderly
patients are frailer, have been diabetics for longer, have more
diabetic complications, comorbidities and polypharmacy and
therefore might be more susceptible to the effect of SGLT-2
inhibitors.
We studied 67 elderly DM2 patients who had been
treated with SGLT-2 inhibitors for more than 6 months in
our Health Department during 2015. Safety data was col-
lected on most frequent and harmful events in this frail
group as recorded in the computerized Primary and Hospital
Care Medical Records. Patients data: mean age: 67 years,
39% women, mean period diabetes: 12,5 years. 79% had
hypertension, 81% had Hypercholesterolemia, 51% had a
BMI > 30 and, 33% had a previous cardiovascular event.
Antidiabetic treatment: 36% on insulin, 75% on Metformin,
45% on sulphonilurea (SU), 37% on DPP-IV inhibitors,
12% on pioglitazone and 13% on GLP-1 analogues. Mean
treatment period was 8months
Results before and after SGLT-2 inhibitors treatment
were: HbA1c. 8,48 (SD 1,1) vs 7,44 (SD 0.8) % (p < 0,01);
Innovation in Aging, 2017, Vol. 1, No. S1
(37% achieved HbA1c < 7%) Weight: 91,0 (SD 18) vs
88,8 (SD 17)kg (p< 0,01); Systolic BP: 134 (SD 9)vs 131
(SD 8) mmHg (P: 0,04). There were no statistical signifi-
cant changes in e-GFR, lipid profile, hematocrit, diastolic
BP and heart rate. No severe hypoglycemia, falls, diabetic
ketoacidosis, or fungal infections were recorded during this
period. Only 3 patients were treated for urinary tract infec-
tions. Two patients had thiazide treatment withdrawal dur-
ing summer period because of symptomatic hypotension.
No new cardiovascular events during treatment period.
Hypoglycemia records were associated to insulin and SU
treatment.
SGLT-2 inhibitors are safe and effective in not well con-
trolled elderly DM2 patients in a real world experience.
Effect on systolic BP should be considered as antihyperten-
sive treatment might need to be reviewed.
DISABILITY AND QUALITY OF LIFE IN OLD AGE
Y.Henchoz, B.Santos-Eggimann, University of Lausanne
Hospital Centre (CHUV), Institute of Social and Preventive
Medicine (IUMSP), Lausanne, Switzerland
The impact of multiple diagnoses on disability and qual-
ity of life (QoL) is well documented in older people, but less
is known about chronic symptoms the submerged part of
the iceberg. This study aimed to determine the prevalence
of chronic symptoms in community-dwelling older people,
their associations with disability in basic activities of daily
living (BADL) and QoL, and their public health impact. Data
were compiled from the Lc65+ cohort study and two addi-
tional, population-based, stratified random samples of com-
munity-dwelling older people (N=5,300). Participants were
asked whether they were disturbed for more than 6months
by 14 chronic symptoms (joint pain, back pain, chest pain,
dyspnea, persistent cough, swollen legs, memory gaps, diffi-
culty concentrating, difficulty in making decisions, dizziness/
incontinence, and impaired sexual life). Only 17.1% of par-
ticipants were not disturbed by any of these chronic symp-
toms. The weighted prevalence ranged from 3.1% (chest
pain) to 47.7% (joint pain), with substantial gender differ-
ences. Similarly, chronic symptoms that were significantly
associated with BADL disability or unfavorable QoL, adjust-
ing for socio-demographic characteristics and the number of
other chronic symptoms reported, varied between genders.
The number of chronic symptoms was significantly associ-
ated with BADL disability and unfavorable QoL, with dose
response relationships. For both outcomes, joint pain and
back pain had the highest population attributable fractions.
In conclusion, chronic symptoms are associated with BADL
disability and unfavorable QoL, particularly when they accu-
mulate. Due to their high public health impact, musculoskel-
etal chronic symptoms are good candidates for preventive
interventions.
CARDIO-CEREBROVASCULAR COMPLICATIONS IN
OLDER DIABETICS WITH ARTERIAL HYPERTENSION
G.Prada1,2, R.Nacu1,2, L.Lungu1,2, A.Ilie3, I.Alexa3,
A.Prada2, A.Herghelegiu1, 1. Clinical department,
National Institute of Gerontology and Geriatrics Ana
Aslan, Bucharest, Romania, 2. University of Medicine and
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 149

Pharmacy Carol Davila, Bucharest, Romania, 3. Gr.T. about their role. Potential for enhancing HHA roles were
Popa University of Medicine and Pharmacy, Iasi, Romania identified in: observing patients health condition; coaching
Introduction: Both diabetes mellitus (DM) and hyper- patients and family on positioning, ambulation, and nutri-
tension (HTA) are often encountered in elderly and impact tion; assisting health care providers; and reporting to the
on quality of life and morbidity. Aim of the study was to interdisciplinary team, patients and caregivers. In conclu-
compare cardio-cerebrovascular risk and complications in sion, the HHAs could play more important role in pressure
elderly and adults diagnosed with DM and HTA. ulcer prevention in homecare. Further research is recom-
Material and method: We analyzed 2 randomly selected mended to create interventions with increased engagement
groups of adults (5064 years) and elderly (>75 years) diag- of HHAs and explore their efficacy.
nosed with both DM and HTA, total 600 subjects, 150 men
and 150 women in each group; 2/3 resided in urban areas.
THE RELATED FACTORS OF SUCCESSFUL
37% adults had higher education and 63% elderly medium
CATHETER REMOVAL IN ACHINESE HOME CARE
education.
POPULATION
Results: Longstanding DM combined with HTA was a
I.Liu1, M.Wu2, J.Fu2, Y.Lin1, C.Lin1, R.Huang1, 1.
significant factor for complications. Insulino-dependent DM
Department of Family Medicine, E-DA Hospital, Kaohsiung
was more prevalent in elderly and correlated with duration
City, Taiwan, 2. Home Care Unit, E-DA Hospital,
of disease. Almost half of elderly had high cardiovascular
Kaohsiung City, Taiwan
risk, while most adults had low risk. More elderly (58%) as
In Taiwan, home visit and long term care for the disable
compared to adults (43%) had over 10 complications and
have been implemented for decays. However, functional pres-
comorbidities concomitantly. Chronic kidney disease was
ervation and catheter removal rate are still far from satisfac-
significantly more prevalent in adults (p<0.01), possibly due
tory. The aim of our study is to clarify the independent factors
to impact of this complication on survival. Adults had sig-
asscoiated with sucessful catheter removal and also the detri-
nificantly lower prevalence of left ventricular hypertrophy
mental factors related to mortality of home care patient.
(p<0.001) and heart conduction abnormalities (p<0.01).
In this cross-sectional study, 514 home care subjects aged
More elderly had chronic atrial fibrillation, and conges-
from 40104 with mean age of 83years old were enrolled
tive heart failure was statistically significant more preva-
at a home care unit of a southern Taiwan teaching hospital
lent in elderly (p<0.01) who also had higher NYHA classes.
(January, 2011to December, 2015), after excluding subjects
Moreover, heart rhythm disorders were more prevalent in
diagnosed as terminal cancer and life span <6months.
elderly (p<0.01). Neurocognitive disorders, stroke, periph-
Data were analyzed using SPSS (version 17.0; SPSS,
eral arterial obstructive disease and neuropathy were more
Chicago, IL). In multivariate analysis, caregiver educa-
prevalent in elderly (p<0.001).
tion <6years vs. education beyond college (OR:3,33, 95%
Conclusions: Chronological age has an important impact
CI:1.16~9.52) and ADL (OR: 1.07 95% CI:1.04~1.10)
on cardiocerebro-vascular complications in diabetics with
were positively associated with successful catheter removal
hypertension. This highlights the importance of early diag-
after adjustment for other clinical variables. Cancer (OR:
nosis and monitoring.
0.30, 95% CI: 0.11~0.86) and underweight (OR:0.43,
95% CI: 0.20~0.95) had detrimental effects on catheter
HOME HEALTH AIDES ROLE IN PRESSURE ULCER
removal. There is an insignificant association between cath-
PREVENTION AMONG THE ELDERLY AT HOME:
eter removal and patient age,sex, number/type of catheters,
ASCOPING REVIEW
diseases, caregiver(relatives/local caregiver/foreigner car-
M.Sultana, A.Zecevic, Health and Rehabilitation Sciences,
egiver), etc. Age(OR: 1.05, 95% CI: 1.02~1.08), cancer(OR:
Western University, London, Ontario, Canada
4.49, 95% CI: 1.98~10.17), cardiovascular disease(OR:
The purpose of this scoping literature review was to
6.91, 95% CI: 1.46~32.64), foreign caregiver(OR: 2.99,
explore current knowledge about the role of home health
95% CI: 1.32~6.77) were independently associated with
aides (HHAs) in pressure ulcer prevention among the
mortality, whereas ADL was inversely associated with
elderly receiving homecare. HHAs are unregulated care
mortality.
providers that constitute 70% of the home care work
In conclusion, age, disease categories and foreign car-
force in Canada. They are part of the patients circle of
egiver increased the risk of mortality in home care subjects.
care but not members of the interdisciplinary pressure
Caregiver education and functional status of the patient were
ulcer prevention team. The literature review was used to
important correlates of successful catheter removal.
identify sources of evidence, map key concepts, and deter-
mine research gaps. Key search terms homecare services,
pressure ulcers, home health aides, and aged were IMPACT OF DIABETES ON THE PREVALENCE OF
used to search 11 databases. Eight sources were retrieved: MALNUTRITION AND SARCOPENIA IN AGED
one textbook chapter and seven peer-reviewed journal HOSPITALIZED PATIENTS
articles. All documents were charted and analyzed using F.R.Herrmann2, D.Zekry2, V.Lachat2, R.Rizzoli1, 1.
a descriptive summary and qualitative content analy- Division of Bone Diseases, Department of Internal
sis. The results suggest that HHAs role in pressure ulcer Medicine Specialties, Geneva University Hospitals and
prevention at home is unclear. Five themes emerged from University of Geneva, Geneva, Switzerland, 2. Division of
literature: need for training and education, nurse as an Geriatrics, Internal Medicine, Rehabilitation and Geriatrics,
educator, interdisciplinary care approach, relationship Geneva University Hospitals and University of Geneva,
between HHAs patient and family, and beliefs of HHAs Geneva, Switzerland

IAGG 2017 World Congress

150
The prevalence of diabetes is expected to rise sharply
worldwide in the coming decades, due not only to obesity
and sedentary lifestyles, but also to aging per se. Diabetes is
associated with a higher incidence of decreased skeletal mus-
cle mass (sarcopenia) and physical disabilities. Sarcopenia
and physical disabilities may be due to the combined effects
of reduced physical activity, inflammation, obesity and insu-
lin resistance. Further, malnutrition may be frequent in very
old diabetic patients, and contribute to the risk of sarcopenia
and physical disabilities. At the same time it may paradoxi-
cally lead to a false improvement in insulin sensitivity and
glycemic control, in a phenomenon of reverse causality.
Results were prospectively collected during a case-con-
trol study involving 580 consecutively hospitalized patients
with a bioimpedance assessment. Age ranged from 70.2 to
101.8years (84.86.2), with 184/396 male/female.
The prevalence of malnutrition, assessed by the Mini
Nutritional Assessment (MNA), was similar in diabetic
(13.1%) and control patients (11.2%).
Sarcopenia, was previously defined by a Fat Free Mass
Index <15.1kg/m2 and 17.5kg/m2 in European women and
men, respectively. Its prevalence in our cohort amounts to
57.2% in the 383 control versus 34.5% in the 197 diabetic
patients (p < 0.0001). Diabetics were 2.7years younger and
counted more men, but even after adjusting for age and sex
in a logistic regression model the odds ratio of sarcopenia
remained unchanged at 0.41 (95% CI: 0.28 - 0.59).
COPD IN COSTA RICAN ELDER OLDER ADULTS AND
ITS ASSOCIATION WITH SARCOPENIA
M.G.Borda1, M.U.Perez-Zepeda2, C.Cano1, 1. Instituto de
envejecimiento, Pontificia Universidad Javeriana, Bogot,
Bogot, Colombia, 2. Geriatric Epidemiology Research
Department, Instituto Nacional De Geriatra, Mexico City,
Mexico, Mexico DF, Mexico
Background: Sarcopenia is associated with to multiples
comorbidities, including moreover those with some degree of
inflammation. Chronic inflammatory states generate hyper-
catabolism and replacement of lean muscle mass for adipose
tissue, decreasing muscle strength, power and function lead-
ing to disability and dependence. Here we study COPD as an
important chronic inflammatory disease Strong associations
have been reported between COPD and sarcopenia. The aim
of this study is to evaluate the associations of COPD and
sarcopenia with clinical outcomes, pulmonary function and
health status and mortality.
Methods: Data was taken of the CRELES- retirement
cohort survey, a longitudinal study taken place in Costa Rica
with a representative sample of 2820 elder adults born before
1945. Starting in 2010 with a second wave starting in 2012.
The variable presence of sarcopenia in patients with COPD
was used to identify associations with independent variables
(sociodemographic factors, self-rated health, comorbidities,
functional status, cognitive status, pulmonary function, hos-
pitalizations and mortality).
Results: From a total of 2,827 60-year or older adults,
9.83% (n=278) were categorized as sarcopenic. A total
of 18.09% referred as having a lung disease, from which
24.82% had sarcopenia (p=0.002). When grouping with
Innovation in Aging, 2017, Vol. 1, No. S1
sarcopenia and lung disease status, 74.24% did not had
any of the conditions, 15.56% had just lung disease with-
out sarcopenia, 7.67% had only sarcopenia without having
lung disease and 2.53% had both conditions. The only group
that had a higher risk of mortality was that having both
conditions, with a hazard ratio of 1.81 (95% CI 1.272.58,
p=0.001), after adjusting for age and sex.
Conclusions: Older adults with lung disease have a sig-
nificant higher prevalence of sarcopenia and a higher risk
of mortality, than either any of the conditions alone. Special
care to older adults with lung disease is important in order to
detect sarcopenia and emphasize on those interventions that
could impact this condition along with the regular treatment
of the lung disease.
This in turn could ameliorate prognosis of older adults
with both conditions.
CARDIOVASCULAR AND NON-CARDIOVASCULAR
MULTIPLE CHRONIC CONDITIONS AND
OUTCOMES IN OLDER ADULTS
H.Sheriff1, C.Arundel1, M.R.Blackman1, Q.Zeng1,4,
C.S.Ritchie2, T.E.Edes3, R.Allman3, A.Ahmed1, 1. VA
Medical Center, Washington, District of Columbia, 2.
UCSF, SF, California, 3. Veterans Health Administration
Geriatrics and Extended Care Services, Washington, District
of Columbia, 4. GW University, Washington, District of
Columbia
Background: Multiple chronic conditions (MCC) are
common in older adults and often underlie poor health and
outcomes. 14% of Medicare beneficiaries with 6 MCCs
account for 70% of readmissions. We examined impact of
cardiovascular (CV) and non-CV MCCs on outcomes in
community-dwelling older adults.
Methods: Of 5795 Cardiovascular Health Study (CHS)
participants age 65years, 375, 955, 1409, 1253, 858, 536,
245, 115, 35, 10 and 4 had 0 to 10 MCCs, respectively based
on 8 CV and 7 non-CV MCCs. Multivariable Cox regres-
sion models were used to estimate HRs associated with any
MCCs, CV MCCs, and non-CV MCCs, adjusting for 25
baseline characteristics.
Results: One-year hospitalization occurred in 7%, 11%,
14%, 17%, 21%, 30%, 31%, 40%, 46%, 50%, and 25%
of those with 0 to 10 MCCs (HR associated with each
MCC increase, 1.20; 95% 1.151.25). Respective rates for
one-year mortality were 0.3%, 0.2%, 0.7%, 1.0%, 2.8%,
3.7%, 5.3%, 7.0%, 20.0%, 20.0%, and 25.0% (HR associ-
ated with each MCC increase, 1.41; 95% 1.251.59). HRs
for one-year hospitalization and mortality associated with
each CV MCC increase were 1.16 (95% 1.091.22) and
1.31 (95% 1.121.54), respectively. HR for one-year hospi-
talization and mortality associated with each non-CV MCC
increase were 1.19 (95% 1.121.26) and 1.50 (95% 1.26
1.79), respectively.
Conclusion: Among community-dwelling older adults,
number of MCCs had a significant independent association
with both hospitalization and mortality. CV and non-CV
MCCs generally had similar associations with hospitaliza-
tion, though non-CV MCCs appeared to have stronger asso-
ciation with mortality.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 510 (POSTER)
COGNITION I
THE VALUE AND EXTENT OF ENGAGED LIFESTYLE
ACTIVITY AND COGNITIVE PERFORMANCE IN
LATER LIFE
B.Hayslip1, R.J.Maiden2, 1. Psychology, University of
North Texas, Murrells Inlet, South Carolina, 2. Alfred
University, Alfred, New York
The meaning assigned to as well as ones predisposi-
tion toward an engaged lifestyle in later life in concert with
the extent of participation in such activities has yet to be
explored as each relates to cognitive functioning. Seventy-
seven community-residing older adults completed measures
of crystallized and fluid ability, rated the extent of their par-
ticipation in a variety of 84 everyday activities, rated each
activity regarding the extent to which they found it mentally
stimulating, and completed a 20-item measure of the extent
to which they were predisposed to lead an engaged lifestyle.
Lifestyle predisposition, lifestyle activity participation, and
the stimulating quality of such participation were moder-
ately related (p < .05). Lifestyle predisposition was weakly
but reliably (p < .01) related to vocabulary and letter sets per-
formance, while lifestyle enrichment related more strongly
to letter sets and letter series (p < .01) performance. Rated
lifestyle activity was also related, but more weakly to such
performance (ps < .02) and was weakly related to abstruse
analogies performance (p < .02). Regression analyses indi-
cated that both attitudinal, activity-related, and enrichment
predicted both letter series and letter sets performance most
powerfully relative to abstruse and common analogies and
vocabulary performance (p > .05). They also indicated that
enrichment was more important in this respect than either
predisposition or participation. These findings suggest that
not only engaged lifestyle participation, but also the per-
ceived enrichment value of such participation and ones
lifestyle predisposition may predict cognitive (fluid ability)
performance in later life.
THE EFFECTS OF CULTURE, LIFE DOMAIN, AND
AGE-RELATED ATTITUDES ON SUBJECTIVE AGING
E.OBrien, T.M.Hess, North Carolina State University,
Raleigh, North Carolina
Cross-cultural differences in aging attitudes may lead to
variability in how people feel about and experience their
own aging in specific contexts. These differences could con-
sequently result in variability in specific age-related behav-
ioral and health outcomes associated with subjective aging
(SA) experiences. We explored how SA varies across domains
of functioning in three different cultures and factors, such
as perceptions about the age of being old and the situation
of older people in society, that explain might observed vari-
ability. American (n=573), Hong Kong Chinese (n=495),
and German (n=827) adults aged between 26 and 95years
(M=58.17, SD=14.5) in the Aging as Future Project com-
pleted a questionnaire designed to capture subjective percep-
tions of aging, including general attitudes and SA, in eight
different domains of functioning (e.g., family, work, health).
Factor analyses showed consistency in the domain-specificity
IAGG 2017 World Congress
151
of SA across cultures, but differences in the amount of vari-
ance shared between domains. GLM-based tests indicated
that country moderated the effect of age group on per-
ceptions of older adults situations, with Chinese young
adults reporting more negative perceptions than same-aged
Americans and Germans. Additionally, perceptions of the age
of being old explained unique variance in SA within each
domain and was found to diminish the effects associated
with culture on SA in some domains but not others. Initial
results suggest that context-specific differences in age-related
attitudes can account for cross-cultural variability in felt age.
Findings may have important implications for adaptive aging
within cultures.
THE ROLE OF AGE, INTEREST, AND COGNITION ON
MIND WANDERING DURING READING
R.Mathews, M.Shake, E.Massy, Psychological Sciences,
Western Kentucky University, Bowling Green, Kentucky
Previous research has suggested that age differences in
mind-wandering during reading may be partly explained
by interest in the text; however, those studies relied on
post-hoc ratings of interest. In the present study, the
authors directly manipulated interest and examined
how that influenced age differences in mindless reading.
Participants included 26 younger adults (Mage=19.15) and
27 older adults (Mage=68.43) who completed a battery of
cognitive tests, and also read two computerized texts for
30 minutes each. The texts were based on topics they had
previously rated as the most boring and the most interest-
ing on a survey of various book topics. While reading the
texts, they were randomly probed (every 24 minutes) by
the computer to report their current thoughts. Participants
reported being on-task or off-task; if the latter, they chose
from several types of off-task thought categories (e.g.,
daydreaming, hungry, worried, etc.). A main effect of
Age showed that older adults (M=0.31, SE=0.05) mind-
wandered less than younger adults (M=0.57, SE=0.05),
F(1,51)=16.32, p< 0.01, p2=0.24. There was also a main
effect of Interest, which showed that texts rated as bor-
ing (M=0.55, SE=0.04) engendered greater mind wander-
ing than texts rated as interesting (M=0.33, SE=0.03),
F(1,51)=27.55, p< 0.01, p2=0.35. The interaction between
age and interest was not significant, F(1,51)=0.20, ns.
Participants also reported more cases of daydreaming
when the text was boring, F(1,51)=4.10, p<0.05, p2=0.07.
These data suggest that age differences in mindless reading
exist; however, topic interest seems to be much more influ-
ential on mind-wandering frequency.
REDUCED VARIABILITY DURING TIME ESTIMATION
IN OLDER ADULTS THROUGH TRANSCRANIAL
MAGNETIC STIMULATION
W.Ren1,2, Z.Zhang2, J.Ma2, P.Liu2, M.Wang3, 1. Institute
of Psychology, Chinese Academy of Sciences, Beijing,
China, 2. College of Education, Hebei Normal University,
Shijiazhuang, Hebei, China, 3. Key Laboratory of Brain
Aging and Cognitive Neuroscience, Hebei Province,
Shijiazhuang, China
Accurate time estimation abilities are important to proper
performance of many daily activities. Previous study sug-
gested a significant correlation between ability to measure
152
time passing and ability to execute independent activities
of daily living. The scalar timing theory proposes that the
ability to perceive time is underlay by a biological internal
clock. Normal aging is commonly associated with reductions
in the speed and increased variability in the internal clock, as
a result of impairments in attention and memory as well as
other cognitive functions.
The repetitive transcranial magnetic stimulation (rTMS)
is one of the commonly used brain stimulation methods,
which could modulate memory and executive function of the
older adults. Here we were interested in whether the rTMS
could modulate the perception of time in older adults. We
applied ten sessions of rTMS to the right dorsolateral pre-
frontal cortex (DLPFC) of the participants in a randomized,
double-blind, placebo-controlled design study. An interval
production task was conducted, which included three differ-
ent intervals of 2, 5 and 8 seconds, respectively. The mean
time estimates, absolute error values (ABS) and the coefficient
of variance (CV) were measured before and after the rTMS
or sham stimulation. Results showed that rTMS reduced the
ABS and CV of longer intervals (5 and 8 seconds), however, it
didnt modulate the estimation of 2 seconds, indicating that
rTMS modulate the estimation of longer intervals through
reducing the variability caused by aging. These findings sug-
gested that rTMS is a promising technique to ameliorate cog-
nitive aging.
BASELINE INTERLEUKIN-6 AND LONGITUDINAL
PROCESSING SPEED CHANGE IN THE ELDERLY
M.Wynn1,2, R.Saloner1, J.H.Kramer1, 1. Neurology,
University of California, San Francisco, Berkeley, California,
2. Washington University in St. Louis, St. Louis, Missouri
Inflammation is suspected to play a role in neurodegen-
eration and is associated with worse memory and smaller
medial temporal volumes in controls. Many of the stud-
ies, however, have been cross-sectional and little is known
about longitudinal changes in cognition due to inflamma-
tion. Our objective was to determine if baseline levels of
inflammation predicted a steeper slope of cognitive decline
longitudinally. Participants were cognitively normal, com-
munity dwelling, older adults (mean age=73.28) followed
over multiple visits spanning 4 to 6 years. Participants
underwent a fasting blood draw and had their plasma
analyzed for interleukin-6 (IL-6) using the Mesoscale plat-
form. At each timepoint, participants completed a series
of computerized reaction time tests that yielded a single
composite processing speed score. The IL-6 values were
log transformed and slope values of the processing speed
scores were calculated using linear mixed models. 199 par-
ticipants were included in this analysis.
Higher baseline IL-6 levels predicted greater increases in
processing speed slope (p<.01), while controlling for age and
baseline processing speed. These findings suggest that higher
levels of systemic inflammation are associated with increased
rates of cognitive slowing over time in healthy older adults.
These results highlight the importance of inflammation in
cognitive aging and the need for further research to elucidate
the exact relationship between markers of inflammation and
cognitive decline.
Innovation in Aging, 2017, Vol. 1, No. S1
ACTIVE MEMORY WORKSTM: WEB-BASED MEMORY
TRAINING FOR OLDER ADULTS
G.W.Rebok, J.M.Parisi, M.Tzuang, A.P.Spira, Mental
Health, The Johns Hopkins University, Baltimore, Maryland
Mounting evidence suggests that cognitive training inter-
ventions can improve cognitive performance in older adults.
This randomized pilot trial tested a new web-based interven-
tion, ACTIVE Memory WorksTM (AMW), an online version
of the evidence-based ACTIVE (Advanced Cognitive Training
for Independent and Vital Elderly) memory intervention.
Participants were cognitively normal, community-dwelling
older adults age 65 and older (N=211, M age=71.1, range
6589 yrs) and were randomly assigned to one of three
conditions: 1) AMW; 2) ACTIVE classroom-based train-
ing; or 3)wait-list control. Participants completed measures
of memory, executive function, and speed of processing at
baseline,immediately following training, and 6months later.
The AMW and ACTIVE training groups both showed pre-
post test improvements on memory performance (AVLT
immediate recall and Rivermead paragraph recall), and main-
tenance of training gains at 6months, but Treatment Group
X Time interactions fell short of significance (ps=0.16 and
0.53, respectively). Consistent with previous findings, train-
ing effects were target-specific and showed little transfer to
non-trained executive (Word Fluency, Animal Naming, Word
Series, Digit Span Backwards) and speed of processing (Digit
Symbol Substitution Test) abilities (ps > 0.05). Over 96%
of participants in the two intervention groups were satis-
fied with the assignment, compared to 76% in the control
condition. Results suggest that web-based training programs
like ACTIVE Memory WorksTM may be viable alternatives
to traditional in-person, cognitive training programs. Online
cognitive-training programs extend the public health reach
of cognitive interventions, are cost efficient, and hold prom-
ise for improving cognitive abilities in community elderly.
THE EFFECTS OF AGING BELIEFS AND PERCEPTIONS
OF EFFORT ON TASK ENGAGEMENT UNDER
COGNITIVE FATIGUE
C.Growney, E.OBrien, T.M.Hess, North Carolina State
University, Raleigh, North Carolina
Normative, age-related declines in cognitive ability
can increase the costs associated with task engagement,
and thereby increase the importance of motivation to
deploy cognitive resources (Hess, 2014). Additionally,
beliefs about aging related to different domains of func-
tioning may differentially influence perceptions about
the costs associated with engagement, affecting effort
expenditure. We examined the impact of age-related
attitudes and perceptions of effort on engagement in
a cognitively-demanding task. A sample of 153 older
adults aged 6481 completed a computerized memory
scan task that was designed to induce fatigue by increas-
ing in difficulty across four trial sets. During a fatigue
phase which followed, they completed a five-minute
letter comparison task. Participants rated their percep-
tions of task load and motivation to engage in the task,
and completed a questionnaire about their aging-related
beliefs. Systolic blood pressure responsivity (SBP-R) was
also recorded continuously throughout the course of the
study in order to obtain an index of effort expenditure.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
GLM-based analyses examining performance revealed an
age by SBP-R interaction. High responsivity predicted
strong performance across all ages, but low responsivity
was a better predictor of poor performance for old-old
than young-young individuals. Additionally, endorsing
beliefs that cognitive declines happen as a normal part
of aging predicted better performance among those who
perceived high levels of mental demand in the task, but
predicted worse performance among those who perceived
less demand. Preliminary results suggest that expecta-
tions regarding aging in combination with perceptions
of task demand may affect motivations to engage in co
gnitively-demanding and potentially beneficial activities.
POSITIVE EMOTION BOOSTS MEMORY TRAINING
EFFECTS: ARANDOMIZED CONTROLLED TRIAL
S.Yin1, X.Zhu2, J.Li2, W.Ren2, L.Huo2, 1. Hubei was cross validated in a community sample of older adults
University, Wuhan, China, 2. Institute of Psychology,
Chinese Academy of Sciences, Beijing, China
Older adults with subjective memory complaints (SMC)
have high risk of dementia. Although plasticity of aging brain
is well-established, relatively little is known about the effi-
cacy of memory training for elderly with SMC. Positive emo-
tion is supposed to boost training effects. This randomized
controlled trial examined (1) the effects of a memory training
program for elderly with SMC and (2) whether a positive
emotion promoting group counseling would facilitate train-
ing effects. A sample of 124 older adults with SMC were
randomly assigned into three groups. The first group (G1,
n=42) received 6-hour group counseling and then 4-week
memory training. The second group (G2, n=38) completed
6-hour reading followed by 4-week memory training. The
third group (G3, n=44) received 6-hour group counseling
and 4-week health lectures. All three groups completed cog-
nitive assessments at baseline, mid-test and post-intervention.
G1 and G3 had resting-state functional magnetic reso-
nance imaging scanning at mid-test and post-intervention.
Compared with G3, G1 demonstrated decreased memory
complaints and improved performance on both lab memory
tests and everyday memory tasks after training. When com-
pared with G2, group counseling enhanced positive emo-
tion in G1, and positive emotion boosted cognitive benefits
from training, leading to larger memory improvement in G1
(Cohens d= 1.17) than in G2 (Cohens d= 0.63). Moreover,
the boost effects of emotion on training gains were corre-
lated to amygdala-hippocampus connectivity. The results
suggest that memory training could enhance memory func-
tion in elderly with SMC, and positive emotion may facilitate
the effects of memory training.
DEVELOPING AHEALTH NUMERACY SCALE TO
ASSESS MEDICAL DECISION MAKING AMONG
OLDER ADULTS
J.Wang1,2, Y.Chen2, Y.Fu3, 1. Psychology, University of interviews. Controlling for the impacts of age and educa-
Wisconsin-Stevens Point, Stevens Point, Wisconsin, 2.
Bowling Green State University, Bowling Green, Ohio, 3.
Indiana University of Pennsylvania, Indiana, Pennsylvania
As physical health and cognitive capacities decline in late
adulthood, older adults need to be able to make sound deci-
sions regarding medical matters to maintain an acceptable
level of well-being. As health information is often presented
IAGG 2017 World Congress
153
numerically, the ability to work with such information (health
numeracy) is extremely important in these decision making
processes. Unfortunately, while general numeracy (i.e., basic
mathematics abilities) has gained attention from aging and
decision making researchers, the construct of health numer-
acy was rarely studied. This research aimed to develop a tool
for measuring health numeracy in older adults, and then
to investigate health numeracys effectiveness in predicting
medical decision making. In study one, a pool of 16 health
numeracy items was developed and tested through an online
older adult sample (N = 262). By using a Rasch analysis,
items with difficulty scores that were too high or too low
were excluded, and 6 items remained. The refined numeracy
scale was validated by comparing to general numeracy and
medical decision making. Both convergent validity and pre-
dictive validity were satisfied. In study two, the refined scale
(N=108). It was found that the health numeracy scale was
a better tool over the general numeracy scale used in predict-
ing medical decision making in older adults from the com-
munity sample. Overall, this study developed a practical way
of measuring health numeracy, and provided evidence in the
benefits of health numeracy over general numeracy in medi-
cal decision making research.
THE JOINT INFLUENCE OF STRESS AND HEALTH
ON COGNITIVE FUNCTIONS AMONG U.S. CHINESE
OLDER ADULTS
Y.Chen1, J.Wang1, R.Zhang1, X.Dong2, 1. Psychology,
Bowling Green State University, Perrysburg, Ohio, 2. Rush
University, Chicago, Illinois
The Stress Paradox suggests that stress could have
either facilitating or impairing influence on cognitive
functions, depending on context. Age is positively associ-
ated with stress and negatively associated with health and
cognitive functions, while education is positively associ-
ated with cognitive functions. The present study aimed to
examine: 1)the impacts of age and education on cognitive
functions; and 2)the joint influence of stress and health
on cognitive functions above and beyond the impacts
of age and education. The Population Study of Chinese
Elderly in Chicago (PINE) used culturally and linguisti-
cally appropriate methods to study cognitive functions
of Chinese older adults. Preliminary studies found that
U.S. Chinese older adults reported higher levels of stress
and lower levels of health than the general American
older adults. About 3,159 Chinese older adults partici-
pated in the present study (58.9% female, age range 60 to
105years old). They rated their current health status and
used the Chinese Perceived Stress Scale to rate their stress
levels over the past two weeks. In addition, their cognitive
functions (i.e., working memory, perceptual speed, and
episodic memory) were assessed during the face-to-face
tion, hierarchical regression analyses revealed significant
effects of stress and health on cognitive functions, respec-
tively. However, the individual effects of stress and health
were no longer significant after entering the interaction
terms of stress and health. Results are discussed in lights
of the joint influence of stress and health on cognitive
functions among U.S. Chinese older adults.
154
ASSOCIATION BETWEEN IMPAIRED SWALLOWING
AND COGNITION IN HEALTHY OLDER ADULTS
L.A.LaGorio2, R.Shah1, A.Buchman1, S.E.Leurgans1,
D.A.Bennett1, 1. Rush Alzheimers Disease Research Center,
Chicago, Illinois, 2. Rush University Medical Center,
Chicago, Illinois
Impaired swallowing, termed dysphagia, is a common
morbidity of neurologic and non-neurologic diseases, but
can also affect up to 63% of older adults without known
disease. Among patients with neurologic disease like
stroke or dementia, dysphagia co-occurs with impaired
cognition; but, in community-dwelling elderly without
disease, the relationship between dysphagia and cognition
is unknown. This cross-sectional study examined associa-
tions between dysphagia and cognition in community-
dwelling elderly.
Participants were community-dwelling older adults
enrolled in the Rush Memory and Aging Project (MAP),
a longitudinal study of aging and dementia. MAP par-
ticipants complete a comprehensive cognitive assessment
battery; scores from 19 tests are consolidated into a com-
posite Z-score. For this study, 88 MAP participants (mean
age=83.62
6.86 years) without any disease known to
result in dysphagia, underwent dysphagia screening using
the Modified-Mann Assessment of Swallowing Ability
(MMASA), a validated and objectively scored dysphagia
screening tool. Scores 93 indicate dysphagia. Univariate
and multivariate analyses (adjusted for age, sex, education)
explored associations between swallowing, dysphagia, and
cognition.
Mean MMASA score=95.43 (SD=3.76); mean cogni-
tive Z-score=0.31 (SD=0.53). Swallowing was positively
correlated with cognition (r=0.40, p<.0001). Adjusted for
demographics, lower swallowing scores remained associated
with lower cognitive scores (R2=0.30, R2=0.16, B=0.042,
SE=0.014, p<.0001). Dichotomizing MMASA scores into
dysphagia/no dysphagia revealed that participants
with dysphagia [n=21 (24%)] had lower cognitive scores
[F(1,83)=5.59, p=.020].
Dysphagia was associated with lower cognitive function
in community-dwelling older adults without disease known
to result in dysphagia. Age-related dysphagia and impaired
cognition may follow similar pathophysiologic processes or
share common neurologic substrates.
RECEIPT OF FINANCIAL SUPPORT FROM ADULT
CHILDREN AND COGNITIVE FUNCTION AMONG
CHINESE OLDER ADULTS
P.Xu, J.A.Burr, Gerontology, University of Massachusetts
Boston, Boston, Massachusetts
Changes in Chinas cultural, economic, and family sys-
tems require further study of support options available for
older Chinese adults. This study examined the relationship
between receipt of financial support from adult children
and older parents cognitive function. Rural and urban dif-
ferences were also investigated. Data were drawn from two
waves of the Chinese Longitudinal Healthy Longevity Survey
(20052008). The study sample was restricted to older par-
ents who were alive at both waves and were 65105years
old having at least one living adult child. Cognitive function
Innovation in Aging, 2017, Vol. 1, No. S1
was measured by a modified version of the Mini-Mental State
Examination, with scores equal to or less than 18 indicat-
ing cognitive impairment. Prevelance models results showed
receiving financial support from adult children was associ-
ated with a lower likelihood of cognitive impairment. Asimi-
lar result was found among rural older parents. Bivariate
analyses of incidence models showed a negative association
between receiving money from adult children and cognitive
function. However, the relationship became insignificant
when social demographic characteristics were controlled.
Among rural older adults, those who received financial sup-
port from adult children had lower risk of becoming cog-
nitively impaired than those who did not receive financial
support. Being younger, married, having higher education,
being economically independent, and having higher self-
rated health were also associated with a lower risk of cogni-
tively impairment. The findings indicated the examination of
prevalence and incidence models yields different conclusions
about the relationship between receiving support and cogni-
tive health, especially when taking into consideration rural-
urban contexts.
SOCIAL FRAILTY HAS NEGATIVE IMPACT ON
COGNITIVE FUNCTION AMONG OLDER PEOPLE
K.Tsutsumimoto1,2, T.Doi1, H.Makizako1, R.Hotta1,
S.Nakakubo1, K.Makino1, T.Suzuki4,3, H.Shimada1, 1.
Department of Preventive Gerontology, National Center
for Geriatrics and Gerontology, Obu, Aichi, Japan, 2. Japan
Society for the Promotion of Science, Chiyoda, Tokyo,
Japan, 3. J.F. Oberlin University Graduate School, Machida,
Tokyo, Japan, 4. National Center for Geriatrics and
Gerontology, Obu, Japan
Social frailty as well as physical frailty may increase risk
of disability in older people. However, it is not clear whether
social frailty is associated with cognitive function for older
people. This study determined relationships between social
frailty and cognitive functions using cross-sectional data. In
the present study, 4,425 community-dwelling older people
(mean age: 72, 49% male) were included. We operationalized
social frailty using the following components: living alone,
going out less frequently than last year, not visiting friends
sometimes, not feeling helpful to friends or family, and not
talking with someone daily. Participants who replied to none
of these questions were non-frail; those replying to one ques-
tion were pre-frail; those replying to two or more questions
were frail. We used the National Center for Geriatrics and
Gerontology-Functional Assessment Tool including tests of
word list memory, attention, executive function, and process-
ing speed. Participants with one or more scores at least 1.5
standard deviations below the age- and education-adjusted
reference thresholds were defined as declining in cognitive
function. The overall prevalence rates of social pre-frailty
and social frailty were 25% and 11%, respectively. We
found significant relationships between declines in cognitive
function and social pre-frailty (odds ratio [OR]) 1.28, 95%
confidence interval [95% CI]) 1.091.50) and social frailty
(OR 1.55, 95% CI 1.251.93). Socially frail individuals had
higher risks of cognitive decline than those without social
frailty.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE RELATIONSHIP BETWEEN COGNITIVE
FUNCTIONING AND HEARING ABILITY IN OLDER
ADULTS
J.Shen, P.Souza, Communication Sciences and Disorders,
Northwestern University, Niles, Illinois
Built on the recent epidemiologic evidence of the asso-
ciation between hearing loss and cognitive impairment, the
present study aimed to investigate the relationship between
cognitive functioning and hearing ability in a group of healthy
community-dwelling older adults with a wide range of ages
and hearing status. Montreal Cognitive Assessment (MoCA),
a cognitive screening test for detecting mild cognitive impair-
ment (Nasreddine etal., 2005), was used to assess cognitive
functioning. Hearing ability was measured by clinical audio-
metric and speech-in-noise testing. The study included eighty
older participants with an age range of 5689 years and
hearing status ranging from near-normal hearing to moder-
ate hearing loss. The results showed that older individuals
MoCA score was strongly associated with hearing ability.
Hearing (i.e., pure tone threshold) significantly predicted
individual performance on MoCA, particularly for those test
items that rely heavily on auditory input. Taken together,
these findings highlight the intimate relationship between
cognitive functioning and hearing ability, which should be
recognized by the medical professionals in order to better
serve the aging community (Work supported by NIH).
BMI, COGNITION, AND EXERCISE RELATIONSHIPS
IN THE SEATTLE LONGITUDINAL STUDY
E.Emerick1, J.A.Blaskewicz Boron2, S.L.Willis3, K.Schaie3,
1. Gerontology, Youngstown State University, Youngstown,
Ohio, 2. University of Nebraska Omaha, Omaha,
Nebraska, 3. University of Washington, Seattle, Washington
According to body mass index (BMI) statistics, current
data show that 34.9% of all adults in the U.S. are obese,
with levels increasing in adults across income and educa-
tion levels (Center for Disease Control; CDC, 2010). Prior
literature on the relationship between BMI and cognition
has revealed inconsistent findings, with some variation based
upon ability investigated. Using a subsample of 759 middle-
aged and older adult participants (mean age=60.91 years;
SD=12.18; Range=4093years; 54.4% female; mean educa-
tion level=15.80years) from the 1998 and 2005 waves of the
Seattle Longitudinal Study, BMI-cognition relationships were
examined for six cognitive abilities. Participants were catego-
rized by weight based on the CDCs BMI standards: normal
weight (n=305), overweight (n=261), and obese (n=193).
Participants were stratified by the amount of days exercised
in the past week: 03 days (n=455) or 47 days (n=274).
Repeated measures MANCOVAs were employed, controlling
for gender and education. Asignificant two-way interaction
of BMI and exercise groups (F(5, 3529)=2.44, p=.032) indi-
cated that both normal weight and obese adults bolstered
cognitive performance when exercising 47days rather than
03days; however, overweight adults performed worse when
exercising 47days compared to 03days. Current findings
indicate that past exercise amount may play a role in cogni-
tive performance. Discussion will consider possible reasons
for these cognitive differences between exercise and BMI
groups in the current sample.
IAGG 2017 World Congress
155
UNDERSTANDING COHORT DIFFERENCES IN
COGNITIVE FUNCTIONING: EVIDENCE FROM THE
MIDUS NATIONAL STUDY
S.Agrigoroaei1, M.Hughes2, M.E.Lachman2, 1. Universit
catholique de Louvain, Louvain-la-Neuve, Belgium, 2.
Brandeis University, Waltham, Massachusetts
There is evidence that more recent birth cohorts show bet-
ter cognitive performance than earlier ones. Our goal was
to use data from two representative samples in the MIDUS
national study in order to examine possible sources of cohort
differences for multiple cognitive tests on the BTACT (Brief
Test of Adult Cognition by Telephone). Two samples of the
same age range were tested, on average, 8years apart. The
first sample (N=3,929; age range: 32 to 76, M=54.38, SD
=11.02) was assessed between 2004 and 2006 (participants
born between 1928 and 1974). Participants from the sec-
ond sample (N=2,512, age range 32 to 76, M=54.48, SD
=12.71) were tested between 2010 and 2014 (born between
1934 and 1982). Consistent with past research, significant
cohort differences were obtained using a time-lag design
on the majority of the BTACT tests. In addition, our results
revealed stronger cohort effects in older age groups. Older
individuals from the more recent birth cohorts showed better
cognitive performance than those of the same age from the
earlier cohorts. On average, the more recent cohorts were
also characterized by higher levels of education, better func-
tional and self-rated health, and also by a greater frequency
of physical and cognitive activity. We will consider the role
of increases in health-promoting behaviors such as an active
and engaged lifestyle in addressing the mechanisms involved
in cohort shifts in cognitive performance.
LONG-TERM EFFECT OF SUBJECTIVE HEARING
ASSESSMENT ON SELF-RATED MEMORY
S.J.Cutler1, C.Brgaru2, 1. Sociology, University of
Vermont, Bridport, Vermont, 2. University of Bucharest,
Bucharest, Romania
Recent research demonstrates an association between
hearing ability and dementia. Despite these findings, mecha-
nisms underlying the relationship remain unclear. Here we
examine one such mechanism: the effect of subjective hear-
ing assessment on subjective memory functioning. Data for
the study come from the University of Michigans Health
and Retirement Study. Rs include persons 60 and older at
T1 (in 1992)who remained in the study at T11 (2012) (total
N=1,136). Using latent growth curve modeling, we examine
the effect of self-rated hearing on self-rated memory at base-
line and the effect of rate of change in self-rated hearing on
rate of change in self-rated memory controlling for age, gen-
der, education, marital status, and subjective health. Principal
findings include the following: (1) there are strong and sig-
nificant relationships (p<.001) between self-rated hearing
and self-rated memory and between their rates of change
net of the control variables; (2) the R2s indicate that 44% of
the variance in self-rated memory is explained by self-rated
hearing and the controls and that 33% of the variance in
the rate of change in self-reported memory is explained by
the rate of change in self-rated hearing and the controls;
and (3) goodness of fit tests (CFI and RMSEA) are satisfac-
tory. That there is a clear linkage between subjective dimen-
sions of hearing and memory and changes therein suggests
156
the value of pursuing this connection as one mechanism by
which hearing problems might lead to dementia. Practical
implications for areas such as providing informed consent
are also considered.
SLEEP EARLIER IN LIFE AND LATE LIFE COGNITION:
MULTICENTER POPULATION DATA FROM SWEDEN
AND FINLAND
I.P.Kreholt1,2, M.Kivipelto1, I.Skoog3, L.M.Johansson3, ings demonstrate that long-term CR may prevent age-related
J.Skoog3, L.Sjberg1, H.Wang1, S.Sindi1, 1. Aging learning impairments via suppressing apoptosis in mice.
Research Center (ARC), Stockholm, Sweden, 2. Institute
of Gerontology, Jnkping, Sweden, 3. Institute of
Neuroscience and Physiology, Center for Health and Ageing
AGECAP, Gothenburg, Sweden
Sleep disturbances are associated with mental wellbeing
and physical health. Few studies have examined the long-
term associations between sleep and cognition. In this study
we assess the associations between sleep disturbances and
cognition using population-based data.
Using four population-based studies (three Swedish, one
Finnish), we analyzed data on insomnia. The short-term fol-
low-up analyses (911 years follow-up time) used all four
studies (N=3058). Midlife mean ages in the four datasets
were 70, 70, 70 and 83years. The long follow-up analyses
used a Swedish dataset and the Finnish dataset with 21 and
22years follow-up respectively (N=2068). Mean age was 50
and 58years. Cognition was assessed using the Mini-Mental
State Examination (MMSE).
We performed ordinal logistic regressions for the associa-
tions between sleep and cognition. The following potential
baseline confounders were adjusted for: Data material, fol-
low-up time, baseline age, sex, years of education (linear),
alcohol consumption (linear), presently smoking, physically
active, cohabitation, cardiovascular conditions, hypnotics
(yes/no), and hopelessness (for short follow-up).
Short follow-up results using all four datasets showed
similar significant associations in all models; insomnia was
associated with poor cognition (fully adjusted model (all
above covariates), beta= -0.14, p=0.013). Long follow-up
results using the Finnish dataset showed significant associa-
tions controlling for follow-up time, age, sex, and education
(beta= -0.20, p=0.040; Fully adjusted, beta= -0.18, p=0.076).
No significant associations were found in the Swedish data-
sets (fully adjusted beta= -0.06, p=0.585).
In conclusion, insomnia in late adulthood is associated
with worse late-life cognition.
LONG-TERM CALORIC RESTRICTION PREVENTS
AGE-RELATED LEARNING IMPAIRMENT VIA
SUPPRESSION OF APOPTOSIS
L.Ma, R.Wang, Y.Li, Xuan Wu Hospital, Capital Medical
University, Beijing, China
Caloric restriction (CR) is the most reliable intervention
to extend lifespan and prevent age-related disorders in vari-
ous species from yeast to rodents. However, the underlying
mechanisms have not yet been clearly defined. Therefore, we
aimed to identify the underlying mechanisms of long-term CR
on age-related learning impairment in C57/BL mice. Thirty
six-week-old male C57/BL mice were randomly divided into
three groups: normal control group (NC group, n=10), high
energy group (HE group, n=10), and CR group (n=10). of current and future dementia prevalence and facilitates the
Innovation in Aging, 2017, Vol. 1, No. S1
After 10 months, the average escape latency was lower in
the CR group compared with the NC group, and the average
time taken to first cross the platform in the CR group was
significantly shorter than the HE group. Both Bcl-2 protein
and mRNA expression levels in the CR group were signifi-
cantly higher than those of the NC group and HE group. The
expression of Bax, Caspase-3 and PARP protein in the CR
group was significantly lower than the NC group. Our find-
SESSION 515 (POSTER)
COGNITIVE IMPAIRMENT, FRAILTY, AND END OF
LIFE
TRANSLATING EVIDENCE-BASED DEMENTIA
INTERVENTIONS TO THE COMMUNITY
E.Gould, S.Hughes, S.Shuman, B.Lyda-McDonald,
K.Maslow, J.M.Wiener, RTI International, Washington,
District of Columbia
Efforts to translate evidence-based dementia interven-
tions into community practice aid in determining effective
programs and services. Randomized clinical trials are impor-
tant to identify efficacy of a treatment or intervention, but
translation studies provide useful findings about its impact
in the community. Translation studies provide valuable infor-
mation about care practices that can be successfully delivered
in the community and help identify needs for adjustment of
the intervention to suit different groups of people. However,
even with evidence supporting the benefits, only a small por-
tion of published interventions developed become widely
disseminated, implemented, and sustained in either clinic
or community settings. Many factors should be considered
when deciding whether a program or intervention is appro-
priate for a community such as congruence with respect to
agency mission and organizational practices, staffing exper-
tise needed for implementation, capacity to maintain fidelity,
and a reliable source of funding to ensure sustainability. Most
of the translation studies of dementia interventions have
been funded by the Administration on Aging through the
congressionally mandated Alzheimers Disease Services and
Supports Program (ADSSP) followed by the U.S. Department
of Veterans Affairs (VA); and the Rosalynn Carter Institute
for Caregiving in partnership with Johnson and Johnson.
This presentation will provide a brief overview of barriers
and considerations for community translation and focus
primarily on the ADSSP grantee experience translating evi-
dence-based dementia interventions to the local community.
A NATIONAL DEMENTIA REGISTER FOR IRELAND:
THE RIGHT APPROACH TO MEETING OUR
DEMENTIA DATA NEEDS?
L.Hopper, S.Hughes, T.Burke, K.Irving, School of
Nursing and Human Sciences, Dublin City University,
Dublin 9, Ireland
With dementia prevalence set to increase as our population
ages, there is an urgent need to gather valid epidemiological
data in Ireland that provides accurate and reliable estimates
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
development of effective dementia health and social policy.
This study examined the feasibility of developing a national
dementia register for Ireland. Arapid review of national and
international patient registry literature was undertaken to
identify registry functions, underlying design and process
models, best-practice guidelines for their development, and
the legal, ethical, clinical, technology, and financial issues rel-
evant to the creation of an Irish dementia registry. Following
ethical approval, we also conducted two focus groups with
people with dementia and twenty-one expert stakeholder
interviews with clinicians, and representatives from research,
health, and social care organisations in Ireland and the UK,
existing Irish patient registries, and international dementia
registries. Discussions followed an agreed structure, were
audio-recorded, transcribed, and analysed using inductive
content analysis. Common themes that emerged from the
literature review and stakeholder discussions were: regis-
try function; registry data; benefits and risks; governance;
legislation; barriers and facilitators; lessons learned; best
practice; and complexities within the Irish system. Given the
government strategy of addressing research and information
systems as part of the 2014 National Dementia Strategy, it
is opportune to examine the best approach to improving
dementia data recording in Ireland. These results provide an
evidence-base on which to progress this debate.
WHAT CONSTITUTES STABILITY OF HOME-
BASED CARE ARRANGEMENTS FOR PEOPLE WITH
DEMENTIA? AMETA-STUDY
K.Khler1,2, M.von Kutzleben1, I.Hochgraeber1,2,
J.Dreyer1,2, B.Holle1,2, 1. German Center for
Neurodegenerative Diseases (DZNE) Site Witten, Witten,
Witten, Germany, 2. University of Witten/Herdecke, School
of Nursing Science, Witten, Germany
Worldwide, most people with dementia live at home. The
stability of home-based care arrangements is discussed as a
crucial factor in health care policy and dementia research.
For informal carers maintaining stability is an ever-chang-
ing challenge throughout the caring trajectory. We will be
presenting a currently conducted synthesis of quantitative
and qualitative studies with the primary research question:
What constitutes and influences stability of home-based care
arrangements for people living with dementia? The meth-
odology of meta-study will be used (synthesis of meta-data-
analysis, meta-method, meta-theory). For details see
PROSPERO registration number CRD42016041727. First
results show that the dynamic nature of stability as a contin-
uous process is a broadly overlooked phenomenon and there
is a lack of studies with a trajectory perspective. The majority
of quantitative studies focuses on risk factors for institution-
alization, but fails to comprehend the dynamics behind it.
Qualitative research aims at understanding informal caregiv-
ing as a social construction, but pays little attention to its
direct impact on whether a care arrangement can be main-
tained or not. From this synthesis a lot can be learned about
how the phenomenon of stability has been understood and
approached in dementia research within the last decades. The
final results will help to define research gaps that have been
overlooked in the past and to develop research questions and
study designs that will be able to meet the methodological
and theoretical requirements of this complex phenomenon.
IAGG 2017 World Congress
157
Finally, they will provide an empirical and theoretical basis
to develop stability promoting interventions.
DESIGN ARESTROOM SUITABLE FOR THE
SENIORSDEVELOP THE DESIGN SPECIFICATIONS
FOR TAIWANS RESTROOM
C.Chang, Architecture and Building Research Institute,
Ministry of the Interior, Taiwan, New Taipei City, Taiwan
The present paper, through the comparison of restroom
design specifications between the US and Japan as well as
the review of decrees, case investigations and expert inter-
views, explored how to target on the restroom in buildings
and home to conduct design in order to improve the seniors
living security and satisfaction after Taiwan enters an aging
society in the future. Research conclusions: 1. This study
found that Japan restroom specification include wheelchair
toiletsinner-toilet equipped with colostomy equipment and
multi-functional toilets, while the United States adopts acces-
sible toilet. Therefore, Taiwan shall be in response to the
building types and their usages to design restrooms of simple
type and multiple-function type, respectively. 2.In additional
to personal use, the elderly restroom may involve in issues
of the assistance provided by carer and the usage of men
and women as well as the conflicts with wheelchair users.
Therefore, it is suggested that the development of such design
specifications should be conducted from several dimensions
of gender equality, accessibility, safety and comfort etc.
and take into account of space planning and toilet room
design, including how to accommodate different needs for
toilet room, accessible facilities, toilet subsidiary accessory
contents, washbasin, guide signs, etc. In the future, Taiwan
should consider the economic factor and public acceptance
to adopt demonstration site for setting, and then incorporate
it into legislation in order to cope with the coming aging
society.
SOCIAL EXCLUSION, SOCIAL CAPITAL, AND
LIFE SATISFACTION OF OLDER ADULTS WITH
DISABILITY
I.Song, S.Won, Y.Song, Daegu Cyber University,
Gyeongsan, Korea (the Republic of)
This study aims to address social exclusion on life satis-
faction of older adults with disability. Also, it is to identify
moderating effects of social capital. Authors conducted a
secondary analysis using 4th waves of Korean Longitudinal
Study of Ageing (KLoSA). The sample in this study was 438
older adults with disability. Income, work, health, living
arrangement, and education were included as social exclu-
sion factors. The dependent variable, life satisfaction, was
measured through a question asking, how are you satisfied
with your life in general? (0100). Finally, interaction with
neighbors, attending religious meeting, and social gather-
ing with friends were included as moderators, social capital.
Gender, age, marital status, and place of living were included
as control variables. Multiple regression results showed that
health, housing, and education were statistically significant
to life satisfaction. Thus, those who reported health condi-
tion was poor, lived in a rented house, and had less than mid-
dle school degree were less satisfied with their life than their
counterparts. Among social capital factors, interaction with
neighbors and social gathering with friends were significant.
158
Testing moderating effects was significant only for housing
and attending religious meeting. When moderating effects
were included in the model, all the social exclusion factors
were not significant. Based on the findings, authors discussed
social work implications to enhance life satisfaction of older
adults with disability through reorganizing social services
programs and developing social policies.
THE ASSOCIATION BETWEEN PAST FALLS AND
SELF-RATED BALANCE ON THE SETTING OF GOALS
AMONG OLDER PEOPLE
J.S.Oliveira1,2, C.Sherrington1,2, A.Tiedemann1,2, 1. The
George Institute for Global Health, Sydney, New South
Wales, Australia, 2. The University of Sydney, Sydney, New
South Wales, Australia
Goal-setting may be used to facilitate health behaviour
change. Balance-challenging exercise can prevent falls. We
investigated the association between the types of physical
activity (PA) goals selected and the fall history and self-
rated balance of people aged 60+ years participating in a
randomised controlled trial aimed at increasing PA and pre-
venting falls. Participants nominated two PA goals at base-
line, which were summarised into categories (fitness; muscle
strength; balance; weight loss; or flexibility). Chi-square
analysis compared the proportion of participants with poor/
fair self-reported balance, and those with past falls who set
balance-related goals compared with other types of goals.
Participants were 130 people with mean age of 69years (SD=
6.4, 69% females). Forty-two participants (32%) rated their
balance as poor/fair and 36 (28%) had fallen in the past year.
Overall fitness was the most common PA goal (57%), fol-
lowed by weight loss (14%). Thirty-seven people (28%) set
balance-related goals which comprised a significantly higher
proportion of participants with poor/fair self-reported bal-
ance compared to the proportion with good balance (n=22,
52% versus n=15, 17% respectively, p<0.001). The propor-
tion of past fallers who nominated a balance-related goal
(n=12, 33%) was similar to the proportion of non-fallers
nominating a balance-related goal (n=25, 27%, p=0.45).
These results show that participants who had poor/fair self-
rated balance were more likely to nominate balance-related
PA goals, however participants who had fallen in the past
year were not more likely to set a balance-related PA goal
than non-fallers.
FRAILTY IN OLDER ADULTS: COMPETENCE CARE,
INNOVATIVE PERSPECTIVES IN ELDERLY CARE
T.Kardol, Vrije Universiteit Brussel, Brussels, Belgium
To access collectively funded institutional care the gov-
ernment has put the bar very high. For this reason residents
of care institutions have a great need for support in caring,
Because of their multiple disorders every day institutional
practice shows that the residents often only be seen as peo-
ple with disabilities and not as people with abilities, ambi-
tions and important social networks. This is a persistent evil
in institutional care in a lot of European countries. Ashort
moving film, called See me, will be shown to demonstrate
what this means for the frail older people who live in a care
facility. In order to ensure that frail elderly people are seen as
individuals with qualities and ambitions, or as ordinary peo-
ple, who are seen, it must change in care facilities. Emphasis
Innovation in Aging, 2017, Vol. 1, No. S1
should be placed on a dignified and meaningful life for frail
older people in care facilities. To realize that seven pillars for
competence care are developed, namely:
1.Strengthen the resilience
2.Pay attention to experiences of loss and focus on
resistance
3.Encourage reciprocity
4.Focus on talent development
5.Enjoy today and look forward to tomorrow
6.Pay attention to the role of relatives
7.Pay attention to a dignified end of life
After two years working with this new care concept in
two care facilities in The Netherlands living and working in
the care institution has been given a different look. Ashort
film will be shown to demonstrate how a care facility is
transformed into a meeting place and live studio.
AID IN DYING: QUESTIONS AND CONCERNS OF
PROVIDERS AND THE PUBLIC
C.L.Cain, S.McCleskey, University of California, Los
Angeles, Los Angeles, California
Aid in dying (AID) is a practice whereby a person at the
terminal stage of a serious illness may request a prescription
meant to hasten death. AID is now legal in five states across
the United States and many additional states will consider
similar laws over the next year. While interest in aid in dying
has grown, questions about how to best carry out the prac-
tice, how to support patients to make end-of-life decisions
that are best for them, and how to ameliorate disparities in
quality of life at end-of-life continue. This presentation will
briefly summarize what we know about the practice of aid in
dying, what laws in the U.S.entail, and concerns of providers
and the general public. Using a new survey of physicians, we
will show that providers are most concerned about carrying
out their obligations in an ethical and safe way. This includes
knowing the legal process, understanding options for pro-
viding end-of-life care, explaining medications used in aid in
dying, and having support through the process. Some con-
cerns vary by provider type. In addition, we use data from
focus groups with community members to show that the gen-
eral public is concerned about patients knowing all options,
possible coercion, how practices fit with religious beliefs, and
how aid in dying will affect their family members. We sum-
marize findings related to improving AID implementation as
well as enhancing end-of-life care generally.
ADHERENCE TO ADVANCE CARE PLAN IN AN END-
OF-LIFE PROGRAM FOR ELDERLY FROM NURSING
HOMES IN HONG KONG
K.D.Yuk1,2, H.Ming Ma1,2, K.Au1, M.Leung1, J.Ng1,
H.Cheng1, S.Yin Yung1, E.Hui1,2, 1. Community Geriatric
Assessment Team, Prince of Wales Hospital, Shatin, Hong
Kong, Hong Kong, 2. The Chinese University of Hong
Kong, Hong Kong, Hong Kong
Background: In Hong Kong, dying in nursing homes will
trigger a Coroners referral, and over 11,000 nursing home
residents were sent to acute hospitals to die every year. End-
of-life (EOL) care in Hong Kong developed rapidly in recent
years. An EOL Program for nursing home residents was
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
established, aiming to promote advance care plan (ACP) dis-
cussions and facilitate care in place.
Objective: To evaluate the adherence to patients ACP
preferences, and where and how their death occurred.
Design: Retrospective clinical audit of data from clinical
notes and electronic patient records for the period October
2015 to March 2016.
Results: 83 nursing home residents were enrolled into
the program during this period, with a mean age 92.4years
(median=93) and 87.8% of which had dementia. Advance
care plans were established in all residents, mostly with their
next-of-kins. All (100%) indicated their preference of do-
not-attempt CPR (DNACPR). 32.9% indicated their prefer-
ence against the use of both naso-gastric tube (NGT) feeding
and non-invasive positive pressure ventilators (NIPPV). 51
participants (61.4%) accepted using NGT as a mode of feed-
ing. During the patient journeys, adherence to ACP regarding
NGT and NIPPV use were both 98.8% respectively. There
were 35 (42.2%) deaths within this 6-month period, and
the average duration of care per death case was 120.7days
(median=125). 26 (74.3%) of these deaths occurred in an
extended care hospital, in particular 15 (42.9%) participants
died in designated EOL wards.
Conclusion: Participants of this EOL program had their
ACP preferences honored and deaths occurred in place.
PREVALENCE OF ADVANCE CARE PLANNING
AMONG ELDERLY HEART FAILURE
M.Shimonishi, M.Hisamune, M.Matsui, National Defense
Medical College, Tokorozawa, Saitama, Japan
Purpose: Elderly heart failure (HF) patients are increas-
ing, they have a significant symptom burden and palliative
care needs including advance care planning (ACP). End-of-
life discussion is needed to improve quality of life among
elderly HF patients, little is known about factors related to
promoting ACP and completion of advance directives (AD)
in HF patients. This study examined completion rates of AD
and predictors of ACP process in HF patients by conducting
a systematic review.
Methods: We searched PubMed and CINAHL from 1992
to 21 June 2016 using keywords congestive heart failure,
heart failure, advance care planning, advance direc-
tives, completion, factors, and predictors. Abstracts
of the search results were reviewed according to inclusion
criteria which refer to completion rates of AD and factors
related to ACP process.
Results: Fourteen articles were selected according to the
criteria. Participants were 6 inpatients, 3 outpatients, 1 com-
munity-dwelling persons, 1 family, and 4 physicians or pro-
viders. Completion rates of AD were from 12.7% to 49%.
Factors related to completion of AD were older age, gender,
race, marital status, education, perceived health, informed
about ADs, knowledge, discussed AD with family, and dis-
cussed AD with physician.
Conclusion: AD Completion rates were not high in HF
patients. Few patients were not ready to talk about ACP
in outpatients, therefore, patient and provider discussion
before is important to promote ACP and completion of AD
in elderly HF patients.
IAGG 2017 World Congress
159
IMPLEMENTING APROCESS OF RISK-STRATIFIED
CARE COORDINATION FOR OLDER ADULTS IN
PRIMARY CARE
J.Elliott1, P.T.Stolee1, G.Heckman1, V.Boscart2,
L.Giangregorio1, 1. University of Waterloo, Waterloo,
Ontario, Canada, 2. Conestoga College, Kitchener, Ontario,
Canada
Primary health care may be the best place within the
health system to coordinate care for older persons, but at
present is poorly equipped to do so. Recent reviews found
that an effective primary care model for complex patients
requires appropriate targeting, engagement of patients and
caregivers, and coordination with other services. This pro-
ject aimed to understand the perceptions and experiences of
providers, patients and caregivers with implementation of
processes to achieve these aims. The Chronic Care Model
and a multi-level framework for implementation of health
innovations guided this study. Data collection and analysis
followed a developmental evaluation approach. Data were
collected using observations, individual interviews, a risk-
stratification tool and tracking forms. Six patients, two fam-
ily caregivers, and 13 providers were purposefully sampled
from three primary care settings (rural and urban). Following
implementation of a risk screening tool and an online refer-
ral mechanism, 560 patients were screened for level of risk,
with care coordinated based on level of need. Although the
screening and referral process took additional time in a busy
practice context, health care providers, patients and caregiv-
ers identified many benefits. These included early identifica-
tion of service need, greater awareness of community services
available, and improved relationships between patients and
providers. A process of risk-stratified care coordination
offers potential benefits for older patients, caregivers and
providers. However, taking the time to have meaningful con-
versations with patients was a challenge, and organizational
structures and funding models may need to be modified to
support fuller implementation.
AWARENESS OF ORGANIZATIONAL CULTURE
AMONG STAFF OF ANEW DEMENTIA-CARE
SPECIALIZED HOSPITAL IN JAPAN
H.Kawamura1, M.p.Kanai2, S.Kobayashi1, Y.Matsushita1,
S.Furuya3, M.Kajiyama3, 1. Tokyo University of
Technology, Tokyo, Japan, 2. Kanto Gakuin University,
Yokohama, Japan, 3. Kawasaki Memorial Hospital,
Kawasaki, Japan
This study aims to identify differences in the awareness
of the organizational culture among nurses and care work-
ers at a newly established dementia-care specialized hospital.
Aself-rating questionnaire survey was administered to 150
nurses and care workers working at a dementia-care special-
ized hospital in August, 2014, three months after the opening
of the hospital. Ascale by Harrison & Stokes (1992) of 15
items was used to measure the organizational culture ori-
entation with four answer options for levels of power, role,
achievement, and support orientations. Of the 105 responses
(70%) 75 (50%) were valid (nurses, 53.3%; care staff,
46.7%). The mean age of respondents was 40.48.0years.
The existing organizational culture was ranked from achieve-
ment, support, role, to power orientations. The scores of the
organizational index were 10.4 for nurses and 6.0 for care
160
workers, showing significant differences. For the preferred
organizational culture, achievement orientation was highest
in both groups. A newly established dementia-care special-
ized hospital showed a strong achievement oriented organi-
zational culture with a common vision or purpose, suggesting
that staff engages in duties with a strong sense of responsibil-
ity. The achievement orientation of the preferred culture was
stronger than that of the existing culture. The results suggest
that staff would act from a common view of duties, suggest-
ing the importance to make organizational arrangement to
maintain the orientation. The awareness of the power ori-
entation among care workers was stronger than for nurses.
DIRECT AND INDIRECT EFFECTS OF SOCIAL
ENGAGEMENT ON COGNITIVE IMPAIRMENT
AMONG CHINESE OLDER ADULTS
Y.Fang1,2, F.Mao1,2, Z.Zhou1,2, 1. State Key Laboratory of
Molecular Vaccinology and Molecular Diagnostics, Xiamen,
China, 2. Key Laboratory of Health Technology Assessment
of Fujian Province University, Xiamen, China
Objective: To decompose the total effect of social engage-
ment on cognitive impairment through psychological well-
being and to explore gender differences.
Methods: A total of 6,998 older adults aged 65 and
over were obtained from the latest two waves of Chinese
Longitudinal Healthy Longevity Survey. Social engagement
was constructed by marital status, living situation, availabil-
ity of help, availability of confidant, and social participation.
Cognitive impairment was defined as 18 of the Mini-Mental
State Examination. Psychological well-being was measured
by seven items concerning mood-related and personality-
related concepts of affect. The total effect was decomposed
into direct and indirect effect by using logistic regression
based on the Karlson, Holm, and Breen (KHB) method.
Results: The prevalence of follow-up cognitive impairment
among the whole population was 15.69%, with 10.19% and
20.93% among male and female sub-sample respectively.
The majority of old men scored 4 in social engagement while
a majority of old women score 3.Old men had a better aver-
age score of psychological well-being than old women (19.52
vs. 18.44). The mediating effect was 15.38%, with 13.07%
and 21.43% in the whole sample, male and female sub-sam-
ple respectively. However, the mediation was only significant
in male sub-sample.
Conclusions: Social engagement was associated with an
increased risk of cognitive impairment in old men. Moreover,
part of the effect was significantly mediated by psychologi-
cal well-being among male older adults. It helps us to pour
more attention to old men when interventions are proposed
to improve their cognitive function and quality of life.
PROMOTING ADVANCE CARE PLANNING IN COPD
M.Hisamune, M.Shimonishi, M.Matsui, National Defense
Medical College, Tokorozawa, Saitama, Japan
Purpose: Chronic Obstructive Pulmonary Disease (COPD)
is one of the few causes of mortality and COPD patients
are increasing especially aged 75 years and older in Japan.
Advance care planning (ACP), which involves patients-pro-
vider communication about end-of-life care, is important for
COPD patients to promote end-of-life discussion. This study
Innovation in Aging, 2017, Vol. 1, No. S1
reviewed completion rates of advance directives (AD) and
related factors to ACP discussion in COPD patients.
Methods: A systematic review was conducted search-
ing of PubMed and CINAHL from 1992 to 30 June 2016.
Keywords such as Chronic Obstructive Pulmonary Disease
(COPD), advance care planning, advance directives,
completion, factors, and predictors were used to select
the articles. Abstracts of the search results were reviewed
according to inclusion criteria which described completion
rates of AD and factors related to ACP process.
Results: Ten articles were included for the review regard-
ing the study purpose. Qualitative research design was used
5 studies of 10. Completion rates of AD were from 17%
to 61%. A study of outpatient palliative care program for
COPD reported that documented advance care plan at the
initial appointment 0% changed 61% at follow-up. Amul-
ticenter, prospective, longitudinal study showed preferences
regarding CPR or MV changed in 38.3% of the patients dur-
ing the follow-up period, and related factors were generic
health status, mobility, symptoms of anxiety and depression.
Conclusion: AD Completion rates and factors related to
ACP process were well-not examined in COPD. Professional
support to COPD patients is important, therefore, respira-
tory practitioners must choose the right time to promote
ACP discussion.
SESSION 520 (POSTER)
DEMENTIA AND ALZHEIMERS DISEASE I
ETHNIC DIFFERENCES IN FORMAL AND SOCIAL
SUPPORT AND QUALITY OF CARE ON MOOD IN
PEOPLE WITH DEMENTIA
F.Ma, M.Gonzalez Catalan, S.Paulraj, L.M.Brown,
T.Tormala, R.G.Gomez, PhD Program in Clinical
Psychology, Palo Alto University, Palo Alto, California
Ethnic differences have been found in caregivers level and
type of formal and informal social support offered to people
with dementia. Both types of social support influence the emo-
tional wellbeing of people with dementia. This study exam-
ined the influence of ethnicity on the relationship between
the depression severity of people with dementia and the fac-
tors of social support and quality of care. As part of a larger
study, 101 Latino American, 214 African American, and 321
Caucasian older adults with dementia of the Alzheimer type
(DAT) were evaluated using the Mini Mental Status Exam.
Caregivers were administered the Center for Epidemiological
Studies Depression Scale, the Revised Memory and Problem
Behavior Checklist, the Quality of Care questionnaire, and
questions pertaining to the frequency of Formal Care and
Social Support. A multiple regression model revealed that
after controlling for patients mental status and caregiver
depression, a composite variable that combined quality of
care and social support significantly explained an additional
2% of the variance in this sample. When examining these
factors by ethnic group, caregiver depression remained an
important predictor of the persons depression severity.
However, only quality of care significantly predicted depres-
sion for Latino older adults with dementia, whereas, only
frequency of social support predicted depression in African
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
American older adults with dementia. For Caucasians, nei-
ther quality of care or social support significantly predicted
depression. These findings suggest that mental health profes-
sionals should consider ethnic differences when considering
the relationship of quality of care and social support on the
level of depression in people with dementia.
A LONGITUDINAL STUDY OF COGNITIVE DECLINE
AND ITS FACTORS AMONG OLDER KOREANS:
LATENT MIXTURE MODEL
J.Min, Social Work, San Diego State University, San Diego,
California
As Alzheimers disease continues to place enormous bur-
den on both the individuals and society, an identification of
the patterns of cognitive change over time receives growing
attention. This study identifies a mixture of heterogeneous
trajectories of cognitive changes in the population-based lon-
gitudinal panel survey. Data came from a four-wave panel
survey; Korean Longitudinal Study of Ageing (KLoSA) from
2006 to 2012. A sample of 2,445 is selected; 60 years of
age or older who did not show cognitive impairment (i.e.,
MMSE-K greater than 24)in 2006. Cognitive function was
assessed by MMSE-K. The latent growth mixture models
(LGMM) were estimated in Mplus 7 to identify heteroge-
neous groups with cognitive change over time. Two distinct
classes of patterns of change in cognitive functions show the
best model fit. Class 1 (Stable group) represents 91.5% of
the study sample, indicating relatively stable, yet somewhat
downward trend over six years as noted by mean scores
of MMSE-K (T1=26.9, T2=25.9, T3=24.9, T4=25.7).
On the other hand, Class 2 (Rapid decline group; 8.5%)
shows sharp decline from T1 to T3 (26.3, 20.2, 16.6) and
stay around 16.7 at T4. A post-hoc analysis indicates that
the rapid decline group were more likely to be female, have
lower educational level, have more IADLs, and have lower
participation with social activities. Disentangling two het-
erogeneous patters of cognitive changes over time among
older adults has significant implication for research, practice,
and policy for older individuals with Alzheimers disease and
their family.
POTENTIALITIES OF MEMORY CAFS IN
SUPPORTING PEOPLE WITH DEMENTIA AND THEIR
CARERS
L.Arajo1,2, M.J.Amante1, C.Alvarez3, I.Sousa3, 1. ESEV,
CI&DETS.IPV, Viseu, Portugal, 2. CINTESIS, UNIFAI.
ICBAS, Porto, Portugal, 3. Portuguese Alzheimer Portugal,
Lisboa, Portugal
Alzheimer/Memory Cafs recently emerged in several
European countries and in North America as an initiative
that involves people with dementia, their family/friend car-
ers, and all others interested in dementia, focused in sociali-
zation with an educational component. The sessions occur
monthly and include a presentation on a different topic
alternately with a stimulation/recreation activity, as well as
refreshments, in a very informal and caf-like atmosphere.
The present study gathers evidence from eleven Cafs
groups developed across Portugal in order to present the
impact of this type of intervention in supporting people with
dementia and their family members/carers. During the last
three years of program implementation, 177 persons with
IAGG 2017 World Congress
161
dementia and 737 family members/carers, as well as 142
persons with memory problems and 272 persons interested
on this topic have participated on the 226 Cafs sessions
that were developed. Qualitative data was collected with a
subgroup of family members (N= 50)regarding their opin-
ion on the main benefits of attending sessions to themselves
and their relatives with dementia. Main key themes from
the analysis, such as dementia-friendly environments, where
family can be together with their relatives, other caregivers
and persons with dementia socializing in the community,
and the potential of Cafs for reducing the stigma, obtain-
ing information and discussing the disease openly with
other persons (e.g., family, carers, professionals, volunteers)
are presented and discussed as important potentialities of
this type of support available to people with dementia and
their carers.
WHAT DO WE NEED TO KNOW? ACONTENT
ANALYSIS OF INTERNET-BASED DEMENTIA
RESOURCES
L.M.Schneider, K.Johanson, L.F.Feliciano, University of
Colorado, Colorado Springs, Colorado Springs, Colorado
With the rise and popularity of the Internet, information
about virtually any topic is readily accessible to anyone with
computer access and a basic understanding of navigating the
Internet. Approximately 80 percent of Internet users have
used the Internet to search for health-related information.
However, not every website on the Internet is monitored
or reviewed for accuracy, readability, or usability. While
research has investigated the qualities and elements of health
education websites, little research has focused specifically
on dementia websites. Exploration in this area is critical, as
millions of Americans are expected to experience dementia
within the coming decades and may seek information pre-
dominantly online. In this study, a content analysis was con-
ducted with dementia websites to investigate how the depth
of information provided in each website is associated with
website rank, reading level, navigability, website domain, and
types of dementias mentioned. Websites were coded by two
graduate students using a predetermined codebook; inter-
rater reliability was calculated. Correlational analyses and
a standard multiple regression analysis were conducted on
the variables. Results revealed that many dementia web-
sites present information at a reading level too difficult for
the average American to comprehend. Furthermore, results
demonstrated that websites that are clearly marked and well-
organized tend to provide information about multiple types
of dementia, which may allow consumers to glean deeper
information about dementia and enhance their online learn-
ing experience. Future research should strive to investigate
full websites rather than initial pages and the extent that
each website discusses each type of dementia.
SPATIAL, TEMPORAL, AND VARIABILITY NORMS
FROM THE GAITRITE SYSTEM PREDICT MILD
COGNITIVE IMPAIRMENT
T.V.Lukyn1, S.Hundza1, C.DeCarlo1, R.A.Dixon2,
S.W.MacDonald2, 1. University of Victoria, Victoria, British
Columbia, Canada, 2. University of Alberta, Edmonton,
British Columbia, Canada
162
Mounting evidence indicates associations among tempo-
ral, spatial, and variability metrics of gait and clinical out-
comes including fall risk, mild cognitive impairment (MCI),
and movement disorders.
Data from the Victoria Longitudinal Study (VLS) for select
cohorts and retest waves were employed as a cross-sectional
reference sample of older adults with intact cognitive perfor-
mance and no history of falls. Participants (n=213) were 70
to 85 years of age (M=77.00, SD=4.22), with 152 women
and 61 men. Regression-norming techniques were employed
in the PREVENT Study, a multifactorial investigation of
dementia, to identify participants with MCI. PREVENT par-
ticipants (Controls=23, MCI=11) were 72 to 83years of age
(M=77.45, SD=4.23) with 20 women and 14 men. Select gait
metrics were gathered from both samples using a 16-foot
GAITRite computerized walkway. Participants walked
across the mat at a self-determined normal pace a total of
8 times comprising 2 conditions: a walk-only condition (4
passes at a normal pace) and walking under cognitive load (4
passes counting backwards).
The combination of velocity (under both conditions), sin-
gle support time (walk-only) and Stride Time SD (walk-only)
yielded a 90.6% MCI-classification accuracy (81.8% sensi-
tivity; 95.2% specificity). Each SD increase in velocity under
cognitive load was associated with a 25-fold decreased risk
of MCI classification, while each SD increase in single sup-
port time was associated with a 17.75-fold increased risk.
Findings provide strong preliminary evidence that regression-
derived norms of specific GAITRite indicators can facilitate
identification of MCI risk within an independent sample.
DCRC_ABC RESOURCES TO SUPPORT THE
MANAGEMENT OF BEHAVIOURAL AND
PSYCHOLOGICAL SYMPTOMS OF DEMENTIA
K.Burns, R.Jayasinha, H.Brodaty, Dementia Collaborative
Research Centrre, University of New South Wales, Sydney,
New South Wales, Australia
In 2011 the Australian Government funded the Dementia
Collaborative Research CentreAssessment and Better Care
(DCRC-ABC) to develop Behaviour Management, AGuide to
Good Practice, Managing BPSD. We systematically reviewed
academic and grey literature to examine the evidence for
psychosocial, environmental and biological interventions
for managing BPSD. Intervention studies were critically
evaluated to determine the strength of the evidence. The
document provides guidance for the Australian Government
funded Dementia Behaviour Management Advisory Services
(DBMAS). Additional considerations for Aboriginal and
Torres Strait Islander peoples and those from Culturally and
Linguistically Diverse (CALD) backgrounds were incorpo-
rated. Training packages support the implementation of the
evidence and practice-based principles of the Guide.
DCRC-ABC subsequently developed summary versions;
AClinicians Field Guide to Good Practice, Managing BPSD
and AGuide for Family Carers, Dealing with Behaviours in
People with Dementia for family carers. Electronic resources
followed with the BPSD Guide App for clinicians and the
Care4Dementia App for family carers and frontline staff.
Evaluation of the BPSD Guide App demonstrates its capacity
to support clinicians.
Innovation in Aging, 2017, Vol. 1, No. S1
In collaboration with Northern Territory DBMAS, DCRC-
ABC developed BPSD posters to assist clinicians supporting
those living in remote Aboriginal communities. A national
knowledge translation (KT) project with the Australian
Government funded Dementia Training Study Centres sup-
ports the implementation and evaluation of DCRC resources
based on the Guide. A project to develop and evaluate an
eLearning resource highlighting additional considerations
for those managing BPSD in lesbian, gay, bisexual, transgen-
der and intersex (LGBTI) people is underway. (www.demen-
tiaresearch.org.au/bpsdguide.html) APPS - search BPSD
Care4Dementia
EFFECTIVENESS OF ACOLLABORATIVE
CONTINUUM OF CARE MODEL FOR PATIENTS AND
FAMILIES WITH DEMENTIA
J.L.Clark, R.Ghatak, T.McManis, A.C.Bilbrey,
D.Gallagher-Thompson, Aging Adult Services, Stanford
Health Care, Stanford, California
Patients, families, and providers struggle with the com-
plexities of Alzheimers disease and related dementias as fam-
ilies report poor understanding and poor support for care
planning. A quality improvement model was established at
Stanford Health Care in 2008 to follow patients and families
through the continuum. The model has since been strength-
ened with collaborations from Stanfords Center for Memory
Disorders and the Stanford NIH Alzheimers Disease
Research Center. This poster outlines the results of a survey
from caregivers receiving transitional care coordination and
home visits. Survey revealed effectiveness of the program.
The importance of integration (rather than fragmentation)
of services and providers was stressed, along with knowing
there was a number to call for support through the contin-
uum. Of the 50% of respondents who completed the surveys:
nearly 100% of respondents felt that consultations, family
meetings, referrals, guidance and support during transitions
of care were Very Helpful; that information on coping and
understanding complex behavior was Very Helpful; that
the information provided improved the quality of life for the
patient; that the caregiver understood the disease better; and
that the program helped their family avoid future problems.
Nearly 100% Strongly Agreed that they felt comfortable
requesting help from staff in the future and had an overall
satisfaction with being heard as new problems arise. At a
junction where a cure is still far away, all efforts to support
families and improve quality of life are strongly welcomed
by families, most of whom have little or no preparation for
a caregiving role.
THE KINTUN PROGRAM IN CHILE: EFFECTS IN
OLDER PERSONS WITH MILD TO MODERATE
DEMENTIA
J.M.Aravena3, J.Gajardo2, M.Budinich3, 2. University
of Chile, Santiago, Chile, 3. INTA University of Chile,
Santiago, Chile, 3. Kintun Center, Santiago, Chile
The Kintun Program is an innovating health intervention
project launched in Chile in 2013. It aims to enhance partici-
pation of persons with dementia (PwD) in everyday activi-
ties, respite for the caregivers and improve home-based care.
The program involves different components including day
care center, home visits, training for caregivers, counseling
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and community education. These actions are developed by
a multidisciplinary team. This program represents a novel
approach to dementia care in Chile as a country with policies
and dementia care strategies still under development. To ana-
lyze the effect of the Program Kintun on the PwD, a quasi-
experimental study was conducted during the implementation
of the program, with repeated measures at baseline (T.0.) and
after 1014 weeks of intervention (T1) during September
2013 and June 2014. Data were collected using: ADCS-ADL
(activities of daily living), MMSE (cognition), TUG (fall risk)
and NPI-Q (neuro-psychiatric behaviors and distress). Data
were analyzed with t-student considering p<0,05 and 95%
CI. Final sample included 35 PwD, mean age 77,38,14,
54,3% (19) women. Dementia severity 51,4%(18) mild,
42,9%(15) moderate, and 5,7%(3) moderate-severe.
Cognition, activities of daily living, and distress scores show
no difference (MMSE: T.0= 13.75.51 and T.1=13.95.64, with Posterior Cortical Atrophy (PCA) a rare dementia
dif=0.27, p=0.713; ADCS-ADL: T.0= 46.716.34 and T.1=
48.717,46, dif=2.0, p=0.293; NPI-Dis: T.0=14.710.40 visual impairment in contrast to relatively spared memory
and T.1=12,9 11,49, dif=1.85, p=0.267). Fall risk and
neuro-psychiatric behaviors scores show improvement
(TUG: T.0=16.77.18 and T.1=12.683.18, dif=4.05, of 23 people with typical AD completed (i) a battery of cog-
p<0.001; NPI-Q: T.0=23.411.92 and T.1=18.511.51, nitive tests assessing memory, language and visual function,
dif=3.92, p<0.45). The Kintun Program shows positive
effects on neuro-psychiatric behaviors, fall risk and maintain
cognition and activities of daily living.
PROACTIVE DEMENTIA CARE: EARLY
INTERVENTIONS WITH PERSONS WITH DEMENTIA
AND THEIR CAREGIVERS
T.C.Andersen, M.K.Luptak, Social Work, University of
Utah, Salt Lake City, Utah
Background: Psychosocial interventions addressing car-
egiver burden in moderate-to-severe neurocognitive disorders
have been extensively studied and use an array of validated
outcome measures. Technological advances in imaging and
biomarker technology allow for earlier diagnosis; however,
psychosocial interventions and related outcomes measures
have not kept pace. Current knowledge gaps include research
on psychosocial interventions for: 1)early stages of the dis-
ease; and 2)caregiver-care recipient dyads. This presentation
reports findings from a pilot study addressing these gaps.
Methods: This study examined the effects of Proactive
Dementia Care (PDC), an intervention for individuals with
early-stage neurocognitive disorders, and their caregivers,
conducted over a 3-year period at a University Cognitive
Disorders Clinic in a metropolitan area in the Intermountain
West. Eighty dyads (an individual diagnosed with a progres-
sive dementia and a designated caregiver) were enrolled.
Study subjects were randomized into either the PDC treat-
ment arm or the Standard Dementia Specialist Care (SDSC)
treatment-as-usual arm. The PDC intervention allowed clini-
cians to partner with care dyads at the time of diagnosis to
develop a comprehensive set of planning steps and to sup-
port families in proactively completing these steps.
Results: Data from multiple outcome measures was
collected at 4 time-points for this study: baseline (n=80),
4months (n=58), 12months (n=54), and 18months (n=54).
Analyses were run to identify differences between the inter-
vention and the treatment as usual group. This presentation
IAGG 2017 World Congress
163
will describe multiple outcome measures, report key findings,
discuss lessons learned, and summarize next steps.
SEEING WHAT THEY SEE: COMPENSATING FOR
CORTICAL VISUAL DYSFUNCTION IN ALZHEIMERS
DISEASE
M.Sullivan1,3, E.Harding1, K.Yong1, A.Carton1,
R.Woodbridge2, S.Crutch1, K.J.Gilhooly2, M.L.Gilhooly2,
1. University College London (UCL), London, United
Kingdom, 2. Brunel University London, London, London,
United Kingdom, 3. Nipissing University, North Bay,
Ontario, Canada
This poster reports on a study of brainsight in Alzheimers
disease (AD), integrating findings from three preparatory
studies lead by neuropsychologists, engineers and social sci-
entists. The work relies on unique insights offered by those
usually caused by AD, but characterised by early, progressive
and language function.
A total of 27 people with PCA and a comparative sample
(ii) tasks involving navigation and object finding within a
simulated environment (PAMELA) and (iii) in-depth indi-
vidual and dyadic interviews in the home.
Neuropsychological and PAMELA studies identified peo-
ple with PCA had particular difficulty in recognising and
locating objects presented among visual clutter. PAMELA
studies provided suggestions on the optimal environmental
conditions for people to navigate and locate objects.
The interviews concurred that perceptual problems in AD
result in numerous physical challenges in daily life (e.g. dress-
ing, reading) but the management of these difficulties was
mediated by complexities within the social environment (e.g.
identity maintenance).
We conclude that widely varying profiles of cortical visual
dysfunction in AD can result in a range of challenges for indi-
viduals and families, and that the physical environment can
be moderated in ways which support performance of every-
day activities. This project highlights the need for interven-
tions to bolster existing capital within the family system and
acknowledge the changing nature of AD-related difficulties
over time.
EQUINE GUIDED SUPPORT PROJECT:WORKSHOPS
FOR PEOPLE LIVING WITH EARLY STAGE
DEMENTIA AND CARE PARTNERS
N.Askari1, A.C.Bilbrey1, M.Blair Humber2, P.Hertel3,
N.A.Schier-Anzelmo3, J.Hartman1, D.Gallagher-
Thompson1, 1. Stanford University, Palo Alto, California,
2. Palo Alto University, Palo Alto, California, 3. Connected
Horse, Rocklin, California
There are 35 million people living with dementia world-
wide. This number is expected to triple by 2050. Family car-
egiving remains the most common form of care, although
researchers from around the world find that stress signifi-
cantly typifies this experience. Additionally, persons are diag-
nosed earlier in the process, so that living with early-stage
dementia is becoming more of a global reality. Yet few specific
services exist to meet the needs of this population and their
164
family caregivers. This project is an innovative approach that
offers considerable promise for application beyond the San
Francisco Bay area where it was conducted.
A guided tour of the equine facility, followed by two
5-hour workshops, focused on activities with horses, discus-
sion groups and mindfulness practices led by trained staff.
Activities with horses included observing herd behavior,
grooming, leading them, and connecting with them over the
fence - all were intended to teach non-verbal communica-
tion skills to both care partners and the person living with
dementia (PWD). Reflection on these experiences was the
discussion groups goal.
Pre/post-test design used standardized measures of stress,
burden, mood, and social support for both care partners and
PWD. Eighteen completed assessment (n=26): 9 dyads of
care partners and PWD. Quantitative and qualitative findings
indicated significantly increased positive perception of social
support; greater reciprocity, awareness, upliftedness and
appreciation of one another in dyads. Trends for improved
mood in both members of the dyad were also noted. Future
plans include partnering with other sites, expanding pro-
grams positive outcomes on a larger scale.
ARE NEIGHBORHOODS ASSOCIATED WITH THE
LIKELIHOOD OF DEMENTIA? ASTUDY IN THE
TOKYO METROPOLITAN AREA
H.Murayama1,2, M.Sugiyama2, H.Inagaki2, C.Ura2,
F.Miyamae2, A.Edahiro2, T.Okamura2, S.Awata2, 1.
Institute of Gerontology, The University of Tokyo, Tokyo,
Japan, 2. Tokyo Metropolitan Institute of Gerontology,
Tokyo, Japan
Background: Although several risk factors associated
with dementia have been investigated on individual lev-
els, little is known regarding whether neighborhood fac-
tors affect dementia. This study explored the relationship
between neighborhood-level variables and dementia among
elderly people.
Methods: A cross-sectional questionnaire survey was
conducted in 2015. The participants were all residents aged
65+, living in a ward in the Tokyo metropolitan area, which
comprises 262 neighborhood areas (n=132,005). We meas-
ured demographics, socioeconomic status, health status, and
social capital (SC), in addition to providing a self-admin-
istered dementia checklist. The checklist consisted of 10
items, and its validity and reliability have been confirmed.
The cut-off point was 17/18, and a score of 18+ indicated
being demented (Clinical Dementia Rating of 1+). SC com-
prised three indicators: social cohesion, social network, and
social participation. Neighborhood-level variables included
the aging rate and educational level (proportion of people
graduating from junior high school; higher proportions indi-
cated lower neighborhood educational level). Neighborhood
SC was an aggregate of the individual scores of each SC
indicator.
Results: The analysis included 75,358 questionnaires.
A multilevel logistic regression analysis stratified by sex
showed that higher neighborhood educational level was
associated with less likelihood of dementia occurring in
both sexes, after controlling for individual-level and other
neighborhood-level covariates. Moreover, women living in
Innovation in Aging, 2017, Vol. 1, No. S1
neighborhoods with larger social networks were less likely
to be demented.
Conclusions: Higher educational levels and denser social
networks at the neighborhood-level were associated with
less likelihood of dementia in older Japanese. Our findings
provide valuable evidence regarding contextual factors of
dementia.
BEHAVIORAL IMPACT OF TAKING AN ONLINE
DEMENTIA RISK ASSESSMENT
C.C.Merz, M.Wynn, B.D.Carpenter, Psychological &
Brain Sciences, Washington University in St. Louis, St.
Louis, Missouri
Preventive strategies for dementia may be most effective
if started early, though their implementation is a challenge.
This longitudinal study examined behavioral intentions and
behavior change in 118 older adults (M age=69 yrs) who
used an online dementia risk assessment tool. Participants
provided health information on the website and received a
personalized report that described their risk of developing
dementia and recommended actions. Before and immediately
after using the tool, participants indicated their intention to
make health promotion changes. Then, 30 days later, they
indicated which actions they had taken. At baseline, 50%
of participants intended to take at least one action, which
rose to 62% after reviewing their personalized report.
Significantly more people intended to change their alco-
hol intake, diet, exercise, speak with family about risk, see
their primary care physician, and obtain information about
dementia after reviewing their report. One month later, 64%
of participants reported they had taken at least one action,
though not always the people who intended to. Participants
who received more urgent risk information were more likely
to endorse behavioral intentions (r=.25, p < .01) and report
having made changes (r=.26, p < .01). However, one month
after using the tool, 37% of the sample had taken no actions.
Results from this study suggest that using an online dementia
risk assessment tool has an inconsistent impact on behavior
change that might reduce the risk of dementia.
HOW THE MINDFULNESS CONCEPT COULD
BENEFIT THE CAREGIVING OF OLDER ADULTS
I.Tournier, D.Ferring, University of Luxembourg,
Luxembourg, Luxembourg
Publications about mindfulness are growing exponen-
tially since 2000 and are dominated by two major theoreti-
cal frameworks. The first one, related to meditative practices,
defines mindfulness as paying attention in a purposeful and
non-judgmental manner to the present moment. The second,
more related to information processing, defines mindfulness
as the processes of actively making new distinctions about a
situation and its environment by avoiding to rely on auto-
matic categorizations. With respect to the interaction between
the caregiver and the person receiving the care, mindfulness
might exert both direct and indirect benefits on the psycho-
social well-being of both. We introduce in our presentation
an information-processing approach that elaborates and
identifies the mechanisms of how mindfulness can directly
improve the interaction quality between the cared-for person
and the caregiver. The notions of the present moment and as
well as non-judgmental attention are the essential factors in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
this process. As factors that lead to such an attitude we pro-
pose an integrative heuristic model that takes into account
characteristics of both the caregiver and cared-for person.
PAIN INTERFERENCE IN PERSONS WITH
DEMENTIA: ABEGINNING EXPLORATION OF ITS
ASSESSMENT
P.Block1,2, L.Snow8,7, A.Amspoker3,4, B.N.Renn5,
S.Pickens6, N.L.Wilson3,4, M.Stanley3,4, M.Kunik3,4,
1. The University of Alabama, Tuscaloosa, Alabama, 2.
Tuscaloosa VA Medical Center, Tuscaloosa, Alabama,
3. Michael E.DeBakery VA Medical Center, Houston,
Texas, 4. Baylor College of Medicine, Houston, Texas,
5. University of Washington School of Medicine, Seattle,
Washington, 6. University of Texas Health Science Center
at Houston, Houston, Texas, 7. Alabama Research Institute
on Aging, The University of Alabama, Tuscaloosa, Alabama,
8. Department of Psychology, The University of Alabama,
Tuscaloosa, Alabama
There is strong evidence that pain is highly prevalent in
persons with dementia (PWD), yet under detected and poorly
treated. Pain interference, the degree to which pain inter-
feres with a persons ability to function, is a key pain treat-
ment outcome, yet little is known about how to assess pain
interference in PWD. Accurate assessment of pain in PWD
is challenging because dementia makes PWD progressively
less able to accurately self-report; caregiver proxy reports are
thus an important part of pain assessment for PWD. The pre-
sent study examined discordance between PWD and proxy
reports of pain interference in a sample of 203 community-
dwelling veterans with pain and dementia and their caregiv-
ers. Results indicated only a moderate association between
PWD and proxy report for pain interference, r=.37, p<.0001.
In comparison, the PWD/proxy report association for pain
intensity was somewhat higher, r=.46, p<.0001. Next, pre-
dictors of PWD/proxy discordance were explored using two
multivariate regression models with (1) pain interference dis-
cordance as the dependent variable and (2) pain intensity dis-
cordance as the dependent variable. Burden, mutuality, and
cognitive impairment were simultaneously entered as predic-
tors in both models. There were no significant predictors of
pain interference discordance, and mutuality emerged as the
only unique significant predictor of pain intensity discord-
ance (=-.20, p=.0092). In summary, pain interference PWD/
proxy discordance is considerable and not well character-
ized. Because the effects of pain treatment efforts cannot be
fully understood without valid assessments of pain interfer-
ence, it will be important for investigators to conduct addi-
tional research in this area.
INFORMATION AND COMMUNICATIONS
TECHNOLOGY IN DEMENTIA CARE: ACCEPTANCE
AMONG PROFESSIONAL CAREGIVERS
J.OSullivan1, J.Nordheim1, L.Jordan1, B.Hesse2, ended questions, we interviewed 22 staff that completed the
S.Mller2, J.Antons2, 1. Charit-Universittsmedizin GPA education. Staff responses were thematically analysed.
Berlin, Institute of Medical Sociology, Berlin, Germany, 2.
Technische Universitt Berlin, Quality and Usability Lab,
Berlin, Germany
When it comes to dealing with symptoms associated with
dementia, a number of studies have established the effec-
tiveness of psychosocial interventions. However, in view of
IAGG 2017 World Congress
165
limited financial and human resources, implementing effec-
tive interventions in daily practice can be a major challenge
for care providers. Recently, there has been a growing interest
in the use of Information and Communication Technologies
(ICTs) for supporting psychosocial interventions in nursing
home settings. ICTs are cost-effective and widely available,
and using them could potentially ease the burden of demen-
tia care delivery. Therefore, in order to assess acceptance
and attitudes of professional caregivers regarding ICTs in
dementia care, a sample of N=205 professional caregivers
(M=38,81 yrs; 70% female) from 10 residential care facili-
ties located in Berlin completed a standardized question-
naire (TA-EG) on factors associated with technology use and
acceptance. Additionally, 11 semi-structured interviews were
conducted. Results showed that older and female caregivers,
respectively, reported less Competence (z=-4.21, p < .01 and
z=-4.44, p < .01, resp.) and Enthusiasm (z=-2.38, p < .05
and z=-4.01, p < .01, resp.) regarding the use of technology
in their work environment. Furthermore, qualitative content
analysis of the interview transcripts revealed both factors
promoting the use of ICTs in residential dementia care, and
potential barriers. Important recommendations for the devel-
opment of ICT-based interventions in dementia care will be
reported and general implications for their design and suc-
cessful adoption will be discussed.
GENTLE PERSUASIVE APPROACHES IN DEMENTIA
CARE: BUILDING STAFF CONFIDENCE AND
EFFICACY
J.Tabamo1, L.Hung2, D.Bohl1, N.Hillier3, J.Martin3, 1.
Medicine Program, Vancouver Coastal Health Authority,
Vancouver, British Columbia, Canada, 2. University of
British Columbia, Vancouver, British Columbia, Canada,
3. Langara College School of Nursing, Vancouver, British
Columbia, Canada
Literature suggests that patients living with dementia in
the hospital are complex to care for, and staff are under-
prepared to meet their unique needs. This proportion is
expected to significantly increase, creating an urgent call to
action. The Gentle Persuasive Approach (GPA) in Dementia
Care: Supporting Persons with Responsive Behaviours is
an evidence-based Canadian curriculum that is designed to
help provide person-centered care for patients living with
dementia in residential care, and offers a potential solution
for other areas of practice. This poster highlights the benefits
and limitations of introducing GPA in acute medicine and
mental health units at Vancouver General Hospital.
We used mixed methods to evaluate a GPA education pro-
gram delivered through a 7.5-hour workshop for staff mem-
bers from acute medicine and mental health units. After the
GPA workshop, 112 staff completed the standardized GPA
program evaluation survey. Using semi-structured open-
Eighty five percent of staff that attended the GPA work-
shops had no previous formal dementia care education. All
staff agreed that the GPA course would improve how they
cared for people with dementia in the hospital. Results of the
interviews revealed useful information for future facilitation
of GPA implementation in the hospital setting.
166
Supporting the facilitators and addressing limitations
around GPA implementation can further improve the confi-
dence, efficacy and capacity for staff to successfully care for
patients living with dementia in the hospital.
CAREGIVING ACTIVITIES OF FAMILY CARERS AFTER
TRANSITION TO NURSING HOME: FINDINGS OF
ASURVEY
L.Hartmann1, A.Stephan1, A.Renom Guiteras2, G.Meyer1,
1. Institute for Health and Nursing Science, Martin Luther
University Halle-Wittenberg, Halle (Saale), Germany, 2.
Witten/Herdecke University, Witten, Germany
The period after nursing home admission is particularly
challenging. Family carers of people with dementia have to
cope with their changed role in the new setting. To support
them in maintaining their caring role, their contribution in
the nursing home must be better understood.
This secondary analysis used German data from a pro-
spective cohort study which was part of the European pro-
ject RightTimePlaceCare (20102013). Personal interviews
were performed using a standardized questionnaire focusing
on frequency and lengths of visits during the past 14days,
and the frequency of 15 predetermined care activities during
the past 30days. Baseline interviews took place 13months
after admission (T0), and follow-up 3 months later (T1).
Descriptive data analysis was conducted.
The answers of n=119 family carers, mainly children,
were analyzed. On average, they visited their relative 67
times a fortnight, usually between 12 hours. Siting and talk-
ing (T0=77%/T1=69%) and taking the person with demen-
tia for a walk (T0=62%/T1=59%) were mainly reported.
Support in ADL was provided constantly by around 20% of
the relatives. Activities like crafts and sports were mentioned
only rarely (T0=0%/T1=3%). No significant change in the
behavior of family caregivers was noted over the observation
period. However, most activities were reported less often at
T1. Afew activities slightly increased, such as supporting the
person with dementia in crafts, sports and music. The results
provide a detailed picture of family carers activities, indicat-
ing that involvement in more active everyday activities in the
nursing home could be increased.
RICE-FARMING CARE FOR PEOPLE WITH
DEMENTIA; ANOVEL WAY OF SOCIAL
PARTICIPATION FOR THE ELDERLY
C.Ura1, T.Okamura1,2, S.Yamazaki3, T.Ishiguro4,
M.Miyazaki4, M.Ibe4, A.Kubota4, Y.Kawamuro4, 1.
Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan, 2. University of Tokyo, Tokyo, Japan, 3. Bunkyo
Gakuin University, Saitama, Japan, 4. Kawamuro Memorial
Hospital, Niigata, Japan
Background: Although the collaboration between care
and agriculture has been seen in the European context, lit-
tle has been reported about the effect of care farm for the
people with dementia. Rice-farming has been embedded in
Japanese cultural traditions. We propose the novel method
of social participation for dementia which uses rice-farming
in its program.
Aim: To conduct a pilot study that assesses the effect of
rice-farming care on the QOL and social participation of the
people living with dementia.
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: Eight elderly persons (7 men, 1 woman)
have been included in the study. Their mean age was
68.36.2 years. Their diagnoses were MCI (n=2) and
Alzheimers disease (n=3), and the others (n=3). Their
mean of MMSE score was 224.8 points (range 1427).
They participated in the rice-farming program with the
experienced facilitators every week, followed by the prob-
lem-solving group work. We observed and evaluated their
degree of independence and their interaction each other
during the program. Questionnaire about QOL, social par-
ticipation, and physical health was collected prior to the
study.
Results: All of them are continuing the program at now,
and attendance rate of 10 weeks was 92.5%. There was no
unexpected events including injures or rejection. All of them
enjoyed the rice-farming subjectively and objectively, but
those with less impaired ADL showed more participation to
the program.
Discussion: Our study revealed that people living with
dementia can enjoy rice-farming safely. Compared with tra-
ditional day-care services, they could participate in the pro-
gram more spontaneously.
CONCERNS OF ALZHEIMERS DISEASE IN OLDER
CHINESE AMERICANS: THE ROLE OF ALZHEIMERS
LITERACY
F.Sun1, X.Gao2, Q.An3, 1. Michigan State University, East
Lansing, Michigan, 2. Huazhong University of Science and
Technology, Wuhan, Hubei, China, 3. East China Normal
University, Shanghai, Shanghai, China
Purpose: This study aims to understand the concerns of
Alzheimers disease (AD) in a sample of Chinese American
elders aged 55 or older living in senior housing facilities.
Focus of this study is the role of Alzheimers literacy (encom-
passing actual knowledge of AD and cultural beliefs of AD)
in influencing elders concerns of AD.
Methods: Survey was delivered to 207 Chinese American
elders (Mage=75.3, SD=7.5) through face-to-face interviews.
Participants were recruited from four subsidized senior
housing facilities in Phoenix metropolitan areas. About two
thirds were female, and 38.1% had less than high school
education.
Results: Participants had moderate levels of concerns
about AD; the younger age group (55 to 64)was more con-
cerned about AD than the older age group (age 80 or above).
Participants who had more actual knowledge of AD had
higher levels of concerns of AD; and those who embraced
more traditional Chinese beliefs of AD (e.g., AD determined
by ones fate) reported higher levels of concerns of AD. Other
significant risk factors included individuals depressive symp-
toms and lack of inter-generational support.
Conclusion: Efforts should be made to address worries of
Alzheimers in Chinese American elders in subsidized hous-
ing facilities. Emphasis should not be limited to enhancing
individuals knowledge of AD. Special attention needs to be
paid to reducing culturally biased perceptions of AD and
addressing emotional disturbance that could arise in this
group after they acquire information of AD, such as that AD
is not curable at this point of time.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 525 (POSTER)
DEMENTIA I
ANTIPSYCHOTIC USE PATTERNS AMONG PATIENTS
WITH DEMENTIA DURING TRANSITIONS FROM
HOSPITALS TO SNFS
A.Gilmore-Bykovskyi1, K.Kennelty2, 1. University
of Wisconsin-Madison, School of Nursing, Madison,
Wisconsin, 2. University of Iowa, College of Pharmacy,
Iowa City, Iowa
Transitions from a hospitals-to-skilled nursing facili-
ties (SNF) for patients with dementia (PwD) are fraught
with challenges for patients, caregivers, and their provid-
ers. Research suggests that these transitions are further
complicated by antipsychotic medications commonly used
to manage dementia-related behavioral symptoms. Some
SNF providers report being unwilling/unable to accept PwD
requiring antipsychotics to manage behavioral symptoms
and describe routinely receiving inaccurate/incomplete medi-
cation histories regarding antipsychotic utilization during
hospitalization highlighting abrupt withdrawal of antipsy-
chotics prior to discharge as a common problem. No research
has examined patterns of antipsychotic usage among PwD
during hospital-to-SNF transitions. This retrospective cohort
study identified changes in antipsychotic medication admin-
istration during the last 48 hours of hospitalization as com-
pared to antipsychotics ordered upon discharge. Patients
with dementia and primary discharge diagnosis of stroke/hip
fracture who were discharged from one of two hospitals to
a SNF (N=343) between 20032008 were included in the
analyses. Overall 21% of patients received an antipsychotic
within the last 48 hours of discharge. Twenty-five percent
of patients who received an antipsychotic within the last 48
hours of hospitalization had potentially abrupt discontinu-
ation of antipsychotics on discharge. These rates varied by
medication, with Haldol and Seroquel having the highest
rates of potential abrupt discontinuation at 65% and 27%
respectively. Future research should examine inter-setting
communication regarding these medication histories as lim-
ited information about the level of medication interventions
required to manage complex symptoms and related thera-
peutic benefit or adverse events may hinder the timely devel-
opment of individualized care plans in the SNF setting.
KNOWLEDGE, BELIEFS, AND WILLINGNESS:
INGREDIENTS TO PREVENT ALZHEIMERS DISEASE
S.Kim1, R.Isaacson2, 1. Australian National University,
Canberra, Australian Capital Territory, Australia, 2. Weill
Cornell Medical College, New York, New York
Modifiable risk factors for Alzheimers disease (AD) have
been actively sought and identified in recent years. Despite
this, it remains a challenge to encourage risk-reducing life-
style and health behaviors in individuals at risk. The aim of
this study was to investigate whether AD knowledge, beliefs,
and willingness to reduce risk would be the key determinants
of AD preventive behaviors.These data were drawn from
Alzheimers Universe (www.AlzU.org), an online course and
educational program developed in the USA. One hundred and
forty four people (mean age=61.1; SD=9.1) who completed
IAGG 2017 World Congress
167
both baseline and follow-up (3months after completion of
the program) questionnaires were included in these analyses.
Eighty three percent of participants were female, the major-
ity (96.5%) were Caucasian and sixty eight percent had ter-
tiary education. Linear regression suggested that changes in
willingness (=.539, p<.01), changes in perceived suscepti-
bility (=-.565, p<.05), baseline knowledge (=.030, p<.05)
and baseline perceived susceptibility ( =1.159, p<.001) were
significantly related to an increase in AD preventive behav-
iors. These factors were adjusted for age, gender, education,
ethnicity and smoking status. Further analysis demonstrated
that change in knowledge was a significant moderator
(p<.05) of the relationship between wiliness at baseline and
behavioral changes. This study suggests that an increase in
knowledge and willingness is linked to increased AD preven-
tive behaviors. Promoting effectiveness-proven educational
programs such as Alzheimers Universe may encourage addi-
tional AD preventive behaviors and therefore reduce the risk
of developing AD.
WORK IS LIKE ACONVEYOR BELT: FINDINGS
FROM AN ETHNOGRAPHIC STUDY OF ACUTE
TRAUMA WARDS
A.Varley1, B.Penhale2, T.Backhouse1, N.Lambert2,
F.Poland2, J.Cross2, S.P.Hammond1, C.Fox1, 1. Norwich
Medical School, University of East Anglia, Norwich, United
Kingdom, 2. School of Health Sciences, University of East
Anglia, Norwich, Norwich, United Kingdom
Older people and their families consistently place high
value on hospital care which promotes personalised rela-
tionships between staff and patients; often termed Person-
Centred Care (PCC). PCC features in care guidelines from
across Europe, North America and the Asia-Pacific region,
evidencing the value placed on approach emphasising per-
sonhood enacted via PCC approaches.
PCC practices can often become displaced in hospital care
settings, relying upon highly routinized and task driven care
orientations which prioritise physical rather than psycho-
logical health needs. This paper reports on an ethnographic
study undertake as part of an international research pro-
gramme exploring ways to better deliver care to people liv-
ing with dementia who are admitted to secondary care with
hip fracture.
Observations were undertaken by five academic and
three trained lay researchers in Emergency Departments
and Trauma wards in three hospitals from across the United
Kingdom, generating a data corpus of 144 hours of observa-
tions (48 observations, 3 hours per observation). Applying
a thematic lens to fieldnotes collected from the differing
spaces, practices that were socially malign featured regu-
larly alongside positive person work (Kitwood, 1997). The
paper will present examples and provide recommendations
for the amplification of PCC opportunities that can to buffer
the task driven emphasis of acute care environments. We
concluding that, being task orientated and providing PPC are
not mutually exclusive phenomena.
IM STILL HERE: THE EXPERIENCE OF LIVING WITH
EARLY ONSET DEMENTIA
M.Sakamoto1,2, S.L.Moore2, S.Johnson2,3, 1. Nursing,
University of British Columbia, Vancouver, Manitoba,
168
Canada, 2. Athabasca University, Vancouver, British
Columbia, Canada, 3. University of Alberta, Edmonton,
Alberta, Canada
Dementia is a growing social and health care concern in
todays world. Although dementia is most often associated
with the aging process, younger people can also be diagnosed
with the disease. Early onset dementia (EOD) is dementia
onset before the age of 65. Dementias degenerative nature
is particularly challenging for younger people, as the dis-
ease tends to occur during a phase of life occupied with and
characterized by middle-age tasks. In effect, younger people
with dementia are forced to navigate and live a health expe-
rience normally encountered later in life. This presentation
will summarize a Masters of Nursing research study that
examined the EOD experience from the point of view of four
adults under the age of 65 living with dementia, in particular
examining how these individuals perceived their own per-
sonhood. Using Interpretative Phenomenological Analysis
(IPA) as the research method, as well as integrating an arts-
based approach, this qualitative study revealed that the EOD
experience can be incorporated into six themes: A Personal
Journey, Navigating the System, The Stigma of Dementia,
Connecting to the World, A Story Worth Telling and Im
Still Here. The participants stories as presented via these six
thematic threads show that despite the challenges of living
with dementia, people with EOD can have a strong sense of
personhood. Implications for practice and policy making, as
well as recommendations for future dementia research will
be discussed.
INCREASED CARDIOVASCULAR CAPACITY IS
ASSOCIATED WITH CORTICAL THICKNESS IN
OLDER ADULTS WITH VCI
L.ten Brinke, C.Hsu, T.Liu-Ambrose, Physical Therapy,
University of British Columbia, Vancouver, British
Columbia, Canada
Vascular Cognitive Impairment (VCI), also known
as vascular dementia, is after Alzheimers Disease (AD)
the most common type of dementia worldwide. A com-
mon biomarker of AD is a decrease of cortical thickness.
Hypertension and diabetes are common risk factors for
cerebral small vessel disease, which contribute to the devel-
opment of cognitive vascular impairment. Exercise is a
promising strategy for altering the trajectory of dementia by
altering brain structure and function. The aim of this study
was to investigate the association between general cardio-
vascular capacity (Six-Minute Walk Test) and changes in
cortical thickness in older adults with VCI. Seventy-one
older adults aged 5696 years with VCI were randomly
assigned to either a 6-month trice-weekly aerobic training
program, or a 6-month nutrition program (i.e., control).
Participants performed a 3T MRI scan at baseline and trial
completion to determine cortical thickness. Results showed
that improved general cardiovascular capacity in the aero-
bic training group, measured by an increase in performance
on the Six-Minute Walk Test, was correlated with a higher
cortical thickness at six months (r= 0.56, p=0.045). Thus,
a 6-month aerobic training program might be a good strat-
egy to prevent cortical thinning in older adults diagnosed
with VCI.
Innovation in Aging, 2017, Vol. 1, No. S1
MULTIVARIATE TRAJECTORIES OF COGNITIVE
DECLINE IN OLD AGE: CLUSTERS AND RISK
FACTORS
H.Amano, A.Kitamura, M.Nishi, Y.Taniguchi, S.Seino,
Y.Yokoyama, Y.Fujiwara, S.Shinkai, Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan
This exploratory study aimed to identify clusters of dec-
lination trajectories in terms of longitudinal multi-domain
measurements of cognitive function, which would be related
to common or specific risk factors. We conducted annual
health check-ups for aged residents in Kusatsu, Japan,
in 20022014, which included the Mini-Mental State
Examination (MMSE). This analysis utilized a part of the
data composed of up to 10 observations for 887 participants
who scored 25 or higher on the baseline MMSE. We applied
the group-based multi-trajectory model to the repeated
measurements of six sub scores of the MMSE to identify four
typical trajectories, which were characterized by (1) intact
cognitive function, (2) lower attention, (3) lower attention,
early decline in recall and declining orientation, or (4) lower
attention and declining recall, orientation, language and con-
struction. The trajectories were taken by 49%, 39%, 7%,
and 4% of the subjects, respectively. The logistic regression
analyses revealed that membership in each of the latter three
trajectory groups was associated with (2) older age, lower
education, diabetes mellitus, hypertension, and high white
blood cell counts; (3) older age, low ankle-brachial blood
pressure index, diabetes mellitus, and low hemoglobin levels;
or (4) lower education, history of stroke, low hemoglobin
levels, high white blood cell counts, tooth loss, and hyper-
tension. There appeared two different trajectories of steep
cognitive decline, one of which was related to diabetes mel-
litus and atherosclerosis; the other, to hypertension, inflam-
mation, and stroke. In addition, tooth loss may be relevant to
the latter, and anemia, to both.
E-INTERACTION WITH CONSENSUS-BASED
RESOURCES FOR DETECTION AND MANAGEMENT
OF DEMENTIA IN PRIMARY CARE
N.Loskutova1, E.M.Bullard1, W.R.Venable1, C.Smail1,
E.Vidoni2, 1. National Research Network, American
Academy of Family Physicians, Leawood, Kansas, 2.
University of Kansas Medical Center, Kansas City, Kansas
Recognition of dementia in primary care remains chal-
lenging even as national attention to the issue has risen.
Despite the clear ethical, safety, health, and financial plan-
ning benefits of addressing cognitive health early, identi-
fication of dementia in at risk patients mostly happens at
a time of crisis, hospitalization, or late in the disease. The
goal of this project was to bring together high performers
in Primary Care and Gerontology to streamline the pro-
fuse dementia care resources into a coherent framework
for stimulating best practices in recognition and manage-
ment of cognitive impairment in primary care. Participants
were identified using the DARTNet Practice Performance
Registry to rank high performers in diagnosis of dementia
(prevalence of ICD-9/10 codes). Ten practicing primary care
physicians were recruited from geographically diverse loca-
tions across the United States. A mixed methods approach
was applied to resource evaluation and focus group domain-
based moderated discussion. The work of the panel produced
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
an adaptable algorithm and identified resources included in
a web-based interactive toolkit readily accessible and dis-
seminated to primary care clinicians through the American
Academy of Family Physicians website and other conference
and meeting venues, free of charge. Evaluation and reach
of the toolkit is measured by ongoing web-analytics (visits,
repeat visits, pages viewed, time in toolkit, etc.) and user sur-
veys. Analysis is underway to fully characterize the user value
of the toolkit. Development and availability of the toolkit is
creating a greater awareness and ability to detect cognitive
impairment at an earlier stage in disease progression among
primary care physicians.
EFFECTS OF AMYLOID ON CHANGES IN COGNITIVE
AND PHYSICAL FUNCTION IN VASCULAR
COGNITIVE IMPAIRMENT
E.Dao1, J.Best1, R.G.Hsiung1, V.Sossi1, C.Jacova2,
R.Tam1, T.Liu-Ambrose1, 1. University of British
Columbia, Vancouver, British Columbia, Canada, 2. Pacific
University, Forest Grove, Oregon
Alzheimers disease (AD) and subcortical ischemic vascu-
lar cognitive impairment (SIVCI) are the two most common
causes of cognitive impairment and often patients present
with mixed AD-SIVCI pathology. Currently, much of our
knowledge on the effects of co-existing amyloid pathology in
SIVCI are based on cross-sectional studies and little is known
about their effects on changes in cognitive and physical func-
tion over time. Thus, the objective of this study was to assess
the impact of amyloid pathology on global cognitive, execu-
tive functions, and physical function over a 12-month period
in people with SIVCI. This was a planned secondary analysis
of data acquired from a proof-of-concept randomized con-
trolled trial of aerobic activity in people with SIVCI. Ahier-
archical multiple linear regression analysis was conducted to
determine the unique contribution of amyloid pathology on
cognitive/physical function after controlling for age, experi-
mental group assignment, and baseline cognitive/physical
performance. We found that amyloid pathology significantly
predicted decreased performance in: 1) Attention (Stroop
Test adjusted R-square change of 32.0%, p < 0.05); 2)Set
shifting (Trail Making Test adjusted R-square change
of 34.7%, p < 0.05); 3) Processing speed (Digit Symbol
Substitution Test adjusted R-square change of 35.0%, p <
0.05) and; 4) Falls risk (Physiological Profile Assessment
adjusted R-square change of 9.0%, p < 0.05). However, amy-
loid did not predict changes in global cognition or working
memory (p > 0.05). Our study suggests that amyloid plaques
might be a marker for future decline in cognitive and physi-
cal performance among older adults with a primary diagno-
sis of SIVCI.
HOSPITAL ADMISSIONS OF PERSONS WITH
DEMENTIA: RESULTS OF THE EUROPEAN
RIGHTTIMEPLACECARE PROJECT
G.Meyer1, R.Schmitz1, A.Renom2, A.Stephan1, 1. Institute
of Health and Nursing Sciences, Martin-Luther-University
Halle-Wittenberg, Medical Faculty, Halle (Saale), Saxony-
Anhalt, Germany, 2. Witten University, Witten, Germany
Persons with dementia are at high risk of hospital admis-
sion. Although often unavoidable, the referral to an emer-
gency department (ED) or admission to an acute hospital
IAGG 2017 World Congress
169
represents an unfavorable discontinuity of care with threats
to persons with dementia, e.g. nosocomial complications and
deterioration of mobility and cognition. There may be differ-
ent patterns of hospital admission in persons with dementia
across Europe because of different health care services. We
conducted a secondary analysis of data assessed through the
Resource Utilization in Dementia within the European pro-
ject RightTimePlaceCare (countries: DE, EE, ES, FI, FR, NL,
SE, UK). The study population comprised 2014 persons with
dementia living at home and being at risk of institutionaliza-
tion (n=1223) or admitted to a nursing home during preced-
ing 3 months (n=791). Mean age was 82.96.5 years and
mean MMSE 13.26.8; 67% were women.
Out of 1719 persons with dementia assessed at three
months follow-up, n=194 (11.4%) had experienced at least
one admission to ED and/or hospital; 70% were living at
home. Most often reasons of admission were medical diag-
noses, pulmonary infections, and fractures. Differences
between countries in terms of admission frequency, reasons
and wards referred to were only small. Few characteristics
were associated with an increased risk of hospital admission
(setting home care, weight loss, decreased Katz Index).
Our results contribute to the body of knowledge about
the frequency and reasons of hospital admission of people
with dementia in different countries and settings and there-
fore to the foundation of intervention development aimed to
decrease avoidable hospital admissions.
SAFETY AND EFFICIENCY OF ANTI-PARKINSON
DRUGS FOR DLB/PDD PATIENTS
H.Kowa, F.Kanda, T.Toda, Neurology, Kobe University,
Kobe, Hyogo, Japan
One of the characteristic features of DLB (Dementia with
Lewy Body) is high sensitivity to medicine, including not
only neuroleptic drugs but also anti-parkinson drugs. Once
hallucinations or systematized delusions were induced, it is
too difficult to control psychiatric disorders as well as par-
kinsonism. The aim of this study is to decide the best anti-
parkinson drug(s) for the treatment of parkinsonism with
DLB and PDD (Parkinsons disease with Dementia) patients.
28 patients diagnosed with DLB and 20 diagnosed with
PDD were examined. Their histories of prescription medi-
cation and those of side effects were obtained retrospec-
tively from medical records. [Results] Among 48 patients,
9 cases were not prescribed any anti-parkison drugs at all.
Another 21 cases had some side effects, such as temporary
hallucinations, delusions or nausea. Antiparkison medica-
tions causing frequent side effects included trihexyphenidyl
(100%), amantazine (67%), istradefylline (63%), selegiline
(50%) and dopamine agonists (33%). On the other hand,
entacapone (10%), zonisamide (11%) and levodopa with
carbidopa or benserazide (13%) seemed to be relatively safer
for DLB/PDD patients. As to dopamine agonist, rotigotine
(25%) showed lower rate of side effects than pramipexole
(45%) and ropinirole (40%).
In conclusion, for the treatment of parkinsonism in cases
of DLB/PDD, levodopa/carbidopa or benserazide is the first
choice, however, if more anti-parkinson therapy is necessary,
the second candidate is zonisamide and/or entacapone from
the viewpoint of safety.
170
PSYCHO-EDUCATION FOR INFORMAL DEMENTIA
CARE-GIVERS: IS REFRAMING THE MOST
IMPORTANT STRATEGY?
S.Pihet, S.Kipfer, P.Vaucher, School of Health Sciences
Fribourg, Fribourg, Switzerland
Persons with dementia are often reliant on care given to
them by close relatives or friends. These informal care-givers
play a key role in helping their loved ones remain living at
home but they can experience a heavy burden, putting them
at high risk for exhaustion and health challenges which often
leads to early institutionalization of the person with demen-
tia. Psycho-educative interventions are effective in improving
quality of life for care-givers, they typically teach a range of
coping techniques but we know little about how these strate-
gies are implemented in daily life. Our aim was to evaluate a
validated psycho-educative program for informal care-givers
for persons with dementia (15 sessions focused on three cop-
ing strategies: reframing, problem-solving and support-seek-
ing). We did a pre-post analysis using mixed-methods design.
Eighteen of 24 care-givers completed the program (drop-
out 21%). Results showed a reduction in burden (t=2.13,
p=.025, d=0.41) and psychological distress (t=1.94, p=.035,
d=0.54) and an increase in self-efficacy (t=-2.33, p=.016,
d=0.47). We used interactive software to record implementa-
tion strategies used by the care-givers over 15 weeks. They
improved their identification of unhelpful thoughts (=0.10,
p=.045), tried more often to reframe them (=0.24, p=.005),
and became more successful at doing so (=0.24, p=.018).
In contrast, problem-solving and support-seeking remained
stable. In post-intervention interviews care-givers consist-
ently mentioned that reframing was a helpful strategy which
may, in part, explain the quantitative findings. In conclusion,
having informal care-givers conceive the challenges they face
differently seemed to be a promising core component of an
efficient psycho-educative program.
RESULTS OF AMODERATE-INTENSITY EXERCISE
PROGRAM FOR IWDS: IMPLICATIONS AND FUTURE
DIRECTIONS
N.Dawson1, K.S.Judge2, M.Gregory1, 1. University of
Central Florida, Orlando, Florida, 2. Cleveland State
University, Cleveland, Ohio
Individuals with dementia (IWDs) experience difficulties
across cognitive and functional domains resulting in disabil-
ity. Non-pharmacological interventions aimed at reducing
disability are greatly needed. Exercise is a low-cost and eas-
ily implemented approach for addressing disability but has
not received extensive investigation. The aim of the current
study was to develop and evaluate a novel and innovative
moderate-intensity functional strength and balance pro-
gram for IWDs using a randomized-controlled intervention
trial. The sample consisted of 23 IWDs with an average age
of 76.63 years demonstrating mild to moderate cognitive
impairment (MMSE: x=20.83). Data indicated a high level
of acceptability and feasibility of the current intervention
with 99.04% treatment adherence suggesting that IWDs
can participate in a moderate-intensity exercise program.
Efficacy was examined using multiple linear regression.
Group assignment significantly predicted performance in key
outcome measures. IWDs in the intervention group demon-
strated improvements in lower-extremity strength (B=5.92,
Innovation in Aging, 2017, Vol. 1, No. S1
t=3.26, p=.004), balance (B=4.04, t=4.13, p=.001), and fast
gait speed (B=.32, t=2.61, p=.02). These findings highlight
the role exercise can be used to address IWDs disability.
Clinical implications and future research directions will be
discussed including: 1) translating findings to clinical prac-
tice; 2)extending the protocol to include modifications that
would potentially impact cognitive domains and psychologi-
cal well-being; and 3) inclusion of physiological biomark-
ers to understand the underlying mechanisms of exercise on
IWDs.
OPEN LABEL TRIAL OF MAGNESIUM L-THREONATE
IN PATIENTS WITH DEMENTIA
T.E.Wroolie1, K.Watson1, K.Chen2, D.Balzafiore1,
E.Reiman2, N.Rasgon1, 1. Department of Psychiatry
& Behavioral Sciences, Stanford University School of
Medicine, Stanford, California, 2. Banner Alzheimers
Institute, Phoeniz, Arizona
In the United States, there are an estimated 5.2 mil-
lion cases of Alzheimers Disease (AD), with AD and other
dementias affecting nearly 1 in 3 senior adults. With the
mounting financial and emotional burden of patient
care, finding safe and efficacious treatments is essential.
Emerging research on the cognitive effects of Magnesium
L-Threonate (MGT) suggests that supplementation may be
benefit individuals with AD. Although limited, existing ani-
mal and human clinical trial data regarding the neural and
cognitive outcomes after MGT supplementation, a mecha-
nistic explanation of MGT effects is beginning to emerge,
including upregulation of NMDAR signaling pathways. The
current open label trial explored the effects of MGT use in
patients with mild to moderate dementia. Fifteen patients
underwent 18F-FDG-PET imaging, cognitive testing, and
blood draws at baseline and at 12 weeks of treatment in
order to assess the acute effect of MGT supplementation
on hippocampal and prefrontal cortex mediated cognitive
abilities including executive function, attention, processing
speed, verbal fluency and memory. Cognitive testing and
blood draws were also performed after 8 weeks of MGT
discontinuation. Findings showed a significant improve-
ment in regional cerebral metabolism along with improve-
ment in a global index of cognitive functioning in the total
sample after 12 weeks of MGT treatment. Increased red
blood cell magnesium levels were associated with improve-
ments in overall cognition and executive functioning in
some but not all patients. Larger placebo controlled clinical
trials are warranted to evaluate MGT as an effective, easily
accessible, and affordable treatment supplement for indi-
viduals with AD.
SCIENTIFIC EVIDENCE FOR POSITIVE EFFECTS OF
FAIRY TALE TELLING FOR PEOPLE WITH DEMENTIA
I.Kollak1, C.Luderer2, D.Dierking4, 1. Health and Nursing
Management, Alice Salomon University Berlin, Berlin,
Germany, 2. Martin-Luther-Universitt Halle-Wittenberg,
Halle (Saale), Germany, 4. Katharinenhof am Dorfanger in
Fredersdorf, Brandenburg, Germany
The Tales+Dementia+Study accompanied the project
Once upon a time FAIRY TALES AND DEMENTIA,
initiated and conducted by the German Center for Fairy
Tale Culture. The project, financed by the German Federal
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Ministry of Family Affaires, offered regular events of fairy
tale narrations twice a week in five nursing homes located
across Germany in Berlin, Frankfurt/Main and near
Hamburg. 62 nursing home residents with dementia took
part in the project.
The major aim was to analyze and better understand the
effects of fairy tale narrations on people with dementia and
challenging behavior living in nursing homes. The leading
questions was: Do fairy tale narrations as psychosocial inter-
vention improve the participants well-being?
Data were collected through video recordings of the
participants and storytellers, short memos of the events,
free observations of the participants in everyday situations,
guideline interviews with health professionals and storytell-
ers as well as through documentation analysis. The data was
analyzed via video interaction and content analysis always
organized as group sessions.
The analysis of 20 hrs. of videos and 21 interviews
proved that activity and social interaction were encouraged
by fairy tale narrations and competences were (re)activated.
Challenging behavior, especially agitation, fear and apathy,
were significantly reduced. Awell-being became apparent.
The study provides scientific evidence that structured
and free fairy tale narrating addresses the needs of people
with dementia, reduces their challenging behavior, activates
resources and should be offered regularly to enhance the
well-being.
MAIN REASONS FOR EMERGENCY DEPARTMENT
AND HOSPITAL ADMISSION IN PATIENTS WITH
COGNITIVE IMPAIRMENT
I.Fort, M.Ciudad Mas, B.Bodegas, S.J.Santaeugnia, to arise from the stage of their FAST6e, and a slow curve
Badalona Serveis Assistencials, Badalona, Barcelona, Spain
Patients with cognitive impairment are frequent users of
Emergency Department (ED) and acute hospital units.
The main objective of this study was to analyze main rea-
sons that lead patients with cognitive impairment or demen-
tia to an ED or acute hospital admission. Asecond objective
was to determine whether there were differences in the fre-
quency of visits depending on age and the existence and
severity of cognitive impairment.
The cohort of the study included 459 people attended by
the Diagnosis and Treatment of Cognitive Disorders Unit
(DTDU) of Badalona Serveis Assistencials for the first time
(from 2004 to 2008)and followed during 5years.
There were 154 men and 305 women, with a mean age of
75.9years. Initial diagnosis were Mild Cognitive Impairment
(MCI) (35.1%), Alzheimers Disease (22.4%), Vascular
Dementia (13.7%), Non cognitive impairment (13.5%),
Mixed Dementia (Vascular Dementia and Alzheimer Disease)
(10.2%) and Other dementias (5.1%).
380 people were attended at ED (1742 total visits) with
a mean of 4.6 visits per patient. Main reasons for visits were
falls, injuries and joint pain (29.6%), respiratory disor-
ders (10.5%), digestive disorders (9.4%), urinary infection
(3.5%), dizziness (3.3%), behavioural symptoms (2.9%),
and other reasons (40.8%). 248 people were admitted at
least 1 time in the acute hospital with a mean of 1.2 admis-
sions per patient. Main causes were surgical conditions
(28%), respiratory diseases (17.6%), heart diseases (9,1%),
injuries (7.1%) and other medical reasons (38.2%).
IAGG 2017 World Congress
171
We found that age was related to higher frequency of ED
admission. MCI was found associated with both ED and
hospital admission.
EATING DYSFUNCTION ACCOMPANYING
DETERIORATION OF AD ON THE BASIS OF
FUNCTIONAL ASSESSMENT STAGING
A.Edahiro1, H.Hirano1, Y.Watanabe1, Y.Ohara2,
K.Motokawa1, M.Shirobe1, J.Yasuda1, S.Awata1, 1.
Tokyo Metropolitan Geriatric Hospital and Institute of
Gerontology, Itabashiku, Tokyo, Japan, 2. Department of
Oral Health Education, Graduate School of Medical and
Dental Science, Tokyo Medical and Dental University,
Tokyo, Japan
Background: The eating dysfunction is caused by deterio-
ration of dementia. It causes malnutrition, and raises a risk
of frailty and mortality rate. However, its details are unrec-
ognized. We examined the eating dysfunction and nutrition
states in elderly people with Alzheimers disease (AD) on the
basis of Functional Assessment Staging (FAST).
Methods: Subjects included 146 elderly AD females
(mean age: 86.76.2 years) requiring care in Japan. They
underwent vital function tests (Barthel index and self-feeding
assessment), severity of AD (e.g., FAST), nutritional status
(e.g., MNA-SF) and a basic information survey. All data
were classified by FAST and used to draw approximate
curves. The protocol in the present study was designed
according to the Declaration of Helsinki.
Results: Barthel index showed S-shaped curve
(y=0.0729x3 - 2.0573x2 + 10.333x + 65.523, R2=0.7505).
Self-feeding assessment showed the eating difficulty came
(y=0.0032x3 - 0.0176x2 + 0.1781x + 19.308, R2=0.6051).
On the other hands, MNA-SF showed very slow drop line
(y=0.0016x3 - 0.0568x2 + 0.1909x + 11.329, R2=0.4327).
Conclusions: An aspect of each functional decline became
clear by putting each approximate curve on top of one
another. Eating dysfunction became much more pronounced
severity of AD on the basis of FAST. It is necessary to offer
predictive support for elderly patients with AD, after com-
prehending consideration of functional decline over time and
the differences in the cause of dementia.
CLINICAL VIDEO TELEHEALTH (CVT) FOR
DEMENTIA: RURAL PROVIDER AND VETERAN
RECOMMENDATIONS
M.I.Rossi1,2, M.Homer1, C.Dolbee1, S.Shaffer1, L.Jost1,
N.Kovell1, P.Bulgarelli1, W.Musser1, 1. VA Pittsburgh
Healthcare System, Pittsburgh, Pennsylvania, 2. University
of Pittsburgh, Pittsburgh, Pennsylvania
Introduction: In rural areas, older patients with cognitive
decline, have little access to geriatric providers to provide
diagnosis, treatment and support as the disease progresses.
The TeleDementia clinic, an interdisciplinary Clinical Video
Telehealth (CVT) clinic addresses this need.
Methods: Types of recommendations made via CVT by
the team of a geriatrician, geriatric psychiatrist, psychologist,
and social worker were analyzed and compared to recom-
mendations made to similar patients seen in-person.
Results: From 5/20139/2015, 341 patients with cogni-
tive decline attended 724 TeleDementia clinic encounters and
172 Innovation in Aging, 2017, Vol. 1, No. S1

referring rural providers received 1098 recommendations (Asian, Black/African American, American Indian/Alaska
regarding specialized dementia care. Native/Native Hawaiian/Pacific Islander, Hispanic/Latino).
Common themes of recommendations included: refer- Speakers knowledge/expertise and interactive sessions were
ral to VA services n=650(59.2%), evaluation of sensory highly rated; post-conference evaluation respondents (n=118)
deficits n=69 (6.3%), treatment/ monitoring of orthostatic intend to use information to improve: communication with
hypotension n=61 (5.6%), improving diabetic manage- LGBT/straight care-recipients, LGBT caregivers and/or pro-
ment n=73 (6.6%), recommendations related to reversible viders (61%); management of care-recipients (59%); and
causes of symptoms n=144 (13.1%), Geri Psychiatry refer- educate LGBT caregivers and LGBT elder care-recipients
ral n=73(6.6%), gun safety, hunting, and driving n=71(6.6 (48%). Examples of attendees information needs were: car-
%). . The majority of Veterans received recommendations egiver stress, coping with discrimination, end-of-life, cultural
related to adjusting medications. Fifty-one (15%) of Veteran competency, transgender health, etc. This interactive commu-
also had documented polypharmacy. Themes of recommen- nity awareness model can be adapted for LGBT elders, care-
dations were related to specialists seen. Recommendations providers and healthcare professionals in global communities.
were similar to those in a face-to-face dementia clinic.
Implementation of recommendations was initially low but SESSION 530 (POSTER)
improved when the geriatric team initiated consults, services,
and follow-ups.
DEPRESSION, ANXIETY, AND PERSONALITY I
Conclusion: Recommendations made in TeleDEMENTIA
clinic are common to clinical recommendations made by ger-
SOCIAL SUPPORT RESOURCES AND DEPRESSIVE
iatric professionals when Veterans are seen face to face. What
SYMPTOMS IN COMMUNITY-DWELLING KOREAN
makes these recommendations notable is these Veterans may
OLDER ADULTS
never have received any recommendations without access to
S.Lee, Department of Nursing, University of Ulsan, Ulsan,
dementia care by telehealth. Implementation of recommen-
Korea (the Republic of)
dations improved when the team initiated services.
Objective: Evidence has shown that social support may
have beneficial effects on mental health in elderly population.
AGING AND DIVERSE LGBT COMMUNITIES:
The present study examined the association between social
BUILDING AWARENESS FOR COGNITIVE DECLINE
support resources measured by the Resource Generator and
AND CAREGIVING NEEDS
depressive symptoms among community-dwelling Korean
M.R.McBride1, L.Eskenazi2,8, M.C.Alcedo3, M.Tzuang1,4,
older adults.
D.Tan1,5, E.Yau6, M.Adelman3,7, D.Gallagher-
Method: A cross-sectional survey of 1000 randomly
Thompson1, 1. Stanford University, Stanford, California,
selected older people in Chuncheon city (a rural town in
2. Family Caregiver Alliance, San Francisco, California,
South Korea) was conducted in 2015. Self-reported measures
3. Openhouse-SF, San Francisco, California, 4. Johns
included sociodemographic characteristics, health character-
Hopkins University, Baltimore, Maryland, 5. San Francisco
istics, social support resources, and depressive symptoms.
Department of Public Health, San Francisco, California, 6.
Multiple linear models were applied for the analysis.
Alzheimers Association, Northern CA and Northern NV
Results: After controlling for the effects of potential
Chapter, San Jose, California, 7. San Francisco Department
covariates, multiple linear models indicated that the higher
of Aging and Adults Services, San Francisco, California, 8.
level of social support resources from family was associated
National Center on Caregiving, San Francisco, California
with fewer depressive symptoms, whereas the higher level of
Health disparities exist in LGBT older adult communi-
social support resources from friends or neighbors was sig-
ties, a high risk population for chronic health conditions.
nificantly associated with greater depressive symptoms. The
Cognitive decline from Alzheimers disease and related dis-
easy availability of medical and social facilities was associ-
orders (ADRD) is an increasing concern in LGBT communi-
ated with fewer depressive symptoms
ties due to natural aging. A2010 report estimated an increase
Conclusion: Although we cannot exclude the possibility
from 3 million to 7 million LGBT elders by 2030. Access to
of reverse causation due to the cross-sectional design, this
care challenges for LGBT elders, caregivers and service pro-
study adds to previous work on the potential utility of the
viders include lack of knowledge, discriminatory services,
Resource Generator for evaluating the relationship between
stigma, socioeconomic barriers, etc. To build ADRD aware-
social support resources and depressive symptoms. Service
ness, a partnership of seven community and academic organi-
providers can develop strategies for decreasing depression by
zations held a one-day, highly-interactive conference on
increasing social support resource from family members and
priority topics from results of a pre-event community survey.
promoting an easy availability of medical/social facilities.
Sessions included: diagnosis/treatment/side-effects; LGBT
affirming assessment and resources; substance use/effects on
LGBT elders; health equity; diverse communities needs; car- WIDOWHOOD AND DEPRESSION TRAJECTORIES OF
egiving and mental health. About half of 227 attendees were OLDER ADULTS IN THE HEALTH AND RETIREMENT
service providers (nurses, social workers, public health work- STUDY
ers, therapists, psychologists, etc.); the remainder were from F.Zhao, G.Hong, D.Russell, Iowa State University, Ames,
the LGBT community (caregivers, care-recipients, care-part- Iowa
ners, families). Half of attendees were white and the remain- This study examined the heterogeneity of depression tra-
der reflected the diversity of greater San Francisco region jectories before and after widowhood in later life and the

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
effects of socio-demographic variables on these depression
trajectories. Respondents were 1664 widowed older adults
aged over 50 from waves 1 to 11 of Health and Retirement
Study (HRS). Depression of the respondents was meas-
ured by an abbreviated 8-item version of the Center for
Epidemiological StudiesDepression Scale (HRS CES-D).
The HRS CES-D score was used for selected respondents
at four consecutive waves: pre-widowhood wave, widow-
hood wave, and two post-widowhood waves. Using latent
class growth analysis, four groups were identified as the
depression trajectories before and after widowhood. Low
Depression group (68.0%) consists of respondents whose
depression score remained low all the time, Increasing
Depression group (14.5%) whose depression score was
low at pre-widowhood wave but increased after widow-
hood, Decreasing Depression group (11.5%) whose high
depression score at pre-widowhood wave decreased over
time, and High Depression group (5.9%) whose depression
score was chronically high. Multinomial logistic regression
analysis was conducted and age, gender, race, education
level, as well as household income at pre-widowhood wave
were found significant in differentiating different trajecto-
ries. The study highlights the importance of focusing on
trajectories of depression over time among widowed older
adults and identifying factors that predict both the devel-
opment of depression and decreases in depression over
time.
EMOTION REGULATION AND DEPRESSION IN
SENIORS: THE ROLE OF EXECUTIVE FUNCTIONS
AND PERCEIVED STRESS
V.Huang, A.J.Fiocco, Psychology, Ryerson University,
Toronto, Ontario, Canada
Depression is a mental health disorder that significantly
impacts quality of life in older adults. Chronic perceived
stress and emotion regulation (ER) are both associated with
onset and maintenance of depression. Maladaptive ER has
been linked to greater perceived stress levels and prolonged
experience of depressed mood. It is suggested that the use of
adaptive ER strategies requires different domains of execu-
tive functions (EF), which commonly decline with chronic
stress and increase in age. Given that some ER strategies
require greater cognitive resources, it is plausible that both
perceived stress and EF may modify the relationship between
ER and depression. The present study examined the role
of EF and perceived stress in the relationship between ER
and depression among community-dwelling older adults.
Participants (N=70) aged 60+ completed the Trail-Making
Task B, the Cognitive Emotion Regulation Questionnaire,
the Beck Depression Inventory-II, and Perceived Stress Scale-
10 as part of a larger study. Controlling for age, sex, edu-
cation, and perceived socioeconomic status, a significant
indirect effect of maladaptive ER on depression through per-
ceived stress was found (0.47, 95% CI [0.21, 0.84]). This
mediation was moderated by levels of EF (Maladaptive ER
x EF: =.01, t=2.20, p=.03). This study is the first to elu-
cidate the interrelationship between underlying mechanisms
of depression and may help support the development of per-
sonalized programs that help maintain emotional well-being
among older adults.
IAGG 2017 World Congress
173
RELATIONS OF SEXUAL FUNCTIONING AND
SATISFACTION ON DEPRESSION IN OLDER LESBIAN
WOMEN AND GAY MEN
S.Spies-Upton, C.Escher, S.Paulraj, C.Cummings,
L.M.Brown, T.Tormala, R.G.Gomez, PhD Program
in Clinical Psychology, Palo Alto University, Palo Alto,
California
Depression as well as dissatisfaction with sexual wellbe-
ing is common in older lesbian women and gay men. This
study explored the relationship of sexual functioning and
satisfaction with depression severity in lesbians and gay men
who were ages 55years and older. As part of a larger study,
32 lesbian women and 44 gay men were given the Center
for Epidemiological Studies Depression Scale, Changes in
Sexual Functioning Questionnaire, and questions regarding
sexual satisfaction and frequency of current sexual activity.
In gay men, depression severity was significantly correlated
with sexual functioning (r=-.448, p=.015) but not with gen-
eral sexual satisfaction (r=-.212, p=.287). When examining
specific items of sexual satisfaction, enjoyment, frequency,
desire, and thoughts and pleasure of thoughts of sexual activ-
ity were significantly negatively correlated with depression
severity. As for sexual functioning, only ability and frequency
of ejaculation and pleasure in orgasm was negatively corre-
lated with depression severity in gay men. In lesbian women,
depression was not significantly correlated with sexual func-
tioning or satisfaction or to specific items of sexual satisfac-
tion and functioning. Results suggest that depression severity
was negatively correlated with sexual satisfaction but less so
with functioning in gay men. However, no significant rela-
tionships were found between sexual functioning and sat-
isfaction with depression in lesbian women. These findings
suggest that sexual satisfaction and functioning may play an
important role in the emotional wellbeing of older gay men,
but not in older lesbian women.
THE IMPACT OF CATARACT SURGERY ON
DEPRESSION AMONG OLDER ADULTS:
APROPENSITY SCORE ANALYSIS
R.Wong, Brown School of Social Work, Washington
University in St. Louis, Saint Louis, Missouri
Cataracts is an eye disorder that is the leading cause of
vision loss in the United States. Although individuals with
cataracts typically undergo cataract surgery, the impact of this
treatment on depression remains inconclusive. The purpose
of this study was to examine the impact of cataract surgery
on depression among older adults through a propensity score
analysis. Data was retrieved from the Health and Retirement
Study (HRS), which surveys a nationally representative sam-
ple of older adults over age 50. The sample was restricted
to individuals with cataracts, but have not previously
undergone cataract surgery (n=182) in 2010. Depression
was measured by the seven-item Composite International
Diagnostic Interview-Short Form (CIDI-SF) scale in 2012.
Greedy matching and propensity score weighting were both
conducted as a sensitivity analysis to estimate the effect of
cataract surgery on depression. Through Poisson regression,
both approaches were consistent in suggesting a statistically
significant increase in depression scores following cataract
surgery. Greedy matching indicated individuals who received
cataract surgery were expected to have an incidence rate for
174
depression scores 4.81 times that of individuals without sur-
gery (p<.05). Propensity score weighting indicated an aver-
age treatment effect (ATE) incidence rate ratio (IRR) of 2.65
(p<.05) and an average treatment effect for the treated (ATT)
IRR of 3.00 (p<.05) for individuals with cataract surgery.
Our findings support previous studies in suggesting cataract
surgery may exacerbate depressive symptoms in older adults.
Therefore, further research is needed to understand factors
contributing to increased depression following cataract sur-
gery and how this can be prevented.
THE RELATIONSHIP OF NEUROTICISM AND
DEPRESSION AMONG OLDEST-OLD ADULTS
G.D.da Rosa1, P.Martin2, L.W.Poon3, 1. Gerontology variance in cognitive performance, R2=0.12, F(4, 242)= 8.70,
Institute, Georgia State University, Suwanee, Georgia, 2.
Iowa State University, Ames, Iowa, 3. University of Georgia,
Athens, Georgia
The purpose of this study was to assess the association of
six personality facets (Anxiety, Anger, Hostility, Depression,
Self-Consciousness, Impulsiveness, and Vulnerability) of
Neuroticism from the NEO PI-R with subscales of the
Cornell Scale for Depression in Dementia (depression,
mood, behavioral disturbance, ideation, physical signs, and
cyclic functions). Participants included 234 centenarians
and 72 octogenarians from the Georgia Centenarian Study.
Several blocked hierarchical multiple regression analyses
were computed separately with proxy reports of partici-
pants Neuroticism levels as predictors of the Cornell scales.
The results suggest that participants with higher scores on
the Anxiety personality facet had higher scores on overall
depression, mood related signs, and ideation disturbance.
Higher score on angry hostility were associated with higher
levels of mood-related signs and cyclic functions. Higher
levels of the depression facet of Neuroticism were related
to higher scores on overall depression, mood related signs,
behavioral disturbance, physical signs of depression, cyclic
functions, and ideation disturbance. Participants with higher
scores on self-conscientiousness had lower scores on depres-
sion. Participants higher in vulnerability had higher score on
mood-related signs of depression. Covariate results suggest
that older participants had lower scores on mood related
signs, and ideation disturbance. Women had higher scores on
physical signs of depression compared to men. Participants
who lived independently were more likely to report higher
scores on depression, and lower scores on cyclic functions.
High cognitive functioning participants had lower scores on
depression, mood-related signs, and higher scores on idea-
tion disturbance.
IS DEPRESSIVE SYMPTOMATOLOGY ASSOCIATED
WITH POORER COGNITIVE PERFORMANCE
AMONG OLDER ADULTS?
K.Condeelis, M.R.Crowther, K.Murry, D.Dragan, The from a mean of 3.7 (SD 1.34) after the first session to about
University of Alabama, Tuscaloosa, Alabama
Previous literature has focused on both depressive symp-
tomatology and cognitive performance among older adults
in inpatient settings. However, there is a paucity of research
examining the association between depressive symptomatol-
ogy and cognitive performance among community-dwelling
older adults. Therefore, the study objective was to examine
depressive symptomatology and cognitive performance in
Innovation in Aging, 2017, Vol. 1, No. S1
a nationally representative sample of community-dwelling
older adults.
An archival data analysis was conducted using data from
the Midlife in the United States-II Study, Projects 3 and 4.The
sample consisted of 256 older adults (M=71.84, SD=5.40,
Range=6584). Depressive symptoms were assessed using
the Center for Epidemiologic Studies Depression Scale.
Cognitive performance was measured using the Brief Test of
Adult Cognition by Telephone.
Multiple hierarchical regression was used to test the
hypothesized model. The presence of depressive symptoma-
tology significantly predicted poorer cognitive performance,
b=-.02, p<.001 and explained a significant proportion of
p<.001. Findings suggest that depressive symptomatology is
significantly associated with poorer cognitive performance in
this sample of older adults.
For community dwelling older adults, the presence of
depressive symptomatology may serve as a contributing fac-
tor of poorer cognitive performance. These findings suggest
that depressive symptomatology is an important factor to
consider within the context of cognitive performance among
older adults. Future research should focus on providing
intervention strategies for older adults with depressive symp-
tomatology as a means to moderate its effects on cognitive
performance among this segment of the population.
IMPLEMENTING EVIDENCE-BASED DEPRESSION
CARE IN NURSING HOMES: ATREATMENT
FIDELITY STUDY
S.Meeks1, K.Shryock1, K.Van Haitsma2, 1. University
of Louisville, Louisville, Kentucky, 2. Pennsylvania State
University, State College, Pennsylvania
There is a gap between what we know about evidence-
based depression care and what is available in nursing
homes. Closing the gap will require understanding context-
specific implementation issues specific to nursing homes.
We present implementation fidelity data from the treatment
arm of a randomized control trial of BE-ACTIV, a 10-week
depression treatment designed for implementation in nurs-
ing homes. 40 patients in 15 nursing homes were treated by
graduate student therapists. Audio-recorded sessions were
rated by the therapists and their Ph.D.supervisor for adher-
ence to treatment protocol and session quality. There was
moderate agreement on adherence and quality that exceeded
chance (mean ICC for adherence =.81 and session quality
=.53). Average adherence to core program features ranged
from 8094%; mean quality was 5.6 (SD 0.61) out of 6
points. Patients completed an average of 7.05 sessions (SD
3.67) and 26 completed 10 sessions. The theoretical basis of
BE-ACTIV is behavioral activation; the therapist and client
increasingly planned new pleasant events across sessions 15,
6 activities a week across sessions 69, with a similar pro-
gression in percent activities completed, ending with about
80% completed. Number of sessions and number and per-
cent of activities completed were significantly related to the
likelihood of remission at post-treatment, and of maintaining
improvement at 3-month follow-up. Results demonstrate the
feasibility and fidelity of BE-ACTIV in diverse nursing homes
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
with diverse patients, and support the theoretical premise of
the intervention.
THE EFFECTS OF RTMS ON PSYCHOMOTOR
RETARDATION IN ELDERLY DEPRESSION
V.Thomas-Ollivier1, E.Foyer1,2, S.Bulteau2, A.Sauvaget2,
T.Deschamps1, 1. Laboratory Movement, Interactions,
Performance (E.A. 4334), University of Nantes, France,
Nantes, France, 2. Department of Addictology &
Consultation-Liaison psychiatry, Nantes University
Hospital, Nantes, France, Nantes, France
Depression-related psychomotor retardation (PMR) is
often misinterpreted as the age-related slowing, playing down
the importance of depression in aging population. Thus we
tested the PMR-related cognitive flexibility by assessing the
verbal fluency performance in healthy older controls (n=18;
mean age: 61.79.23 years) and in age-matched patients
with major depressive disorder (MDD) (n = 29; mean age:
57.112.4 years). We also examined the antidepressant
effects of repetitive transcranial magnetic stimulation (rTMS)
in eligible MDD patients (n=17), evidenced by an expected
verbal fluency improvement. Three scores were assessed for
semantic and phonemic fluency tests: (1) total number of
words generated excluding preservative and intrusive errors;
(2) number of switches; and (3) mean cluster size. The results
clearly showed that PMR in geriatric depression differed
from the age related slowing. Significant differences between
groups in cluster size (p < 0.05) and percent of preservative
errors (p < 0.04) were found for the phonemic fluency perfor-
mance. In addition to significant improvement of the depres-
sion level (p < 0.001) and the PMR score (p < 0.001) after the
rTMS treatment, the results showed a nonsignificant trend
toward an increasing verbal fluency performance. Overall,
the present study confirms the negative influence of depres-
sion on verbal episodic memory performance, regardless of
age. But the depression-related deficits in cognitive flexibility
seem not to be associated with the PMR scores before and
after the rTMS treatment, challenging the possible validation
of verbal fluency performance as one of relevant hallmark
of PMR.
THE ASSOCIATION BETWEEN PHYSICAL ACTIVITY
AND DEPRESSION IN OLDER ADULTS WITH
PARKINSONS DISEASE
M.Ventura1, J.K.Johnson1, D.E.Barnes1,2, 1. University of
California, San Francisco, San Francisco, California, 2. San
Francisco VA Medical Center, San Francisco, California
It is important to understand the associations between
physical activity (PA) and mood in the early stages of
Parkinsons disease (PD) progression. The purpose of this
study was to explore the relationship between PA and depres-
sion in newly diagnosed, untreated individuals with PD. We
analyzed data from the Parkinson Progression Markers
Initiative and examined depression (Geriatric Depression
Scale; GDS) in 260 de novo individuals with PD. Participants
with a GDS score 5 were considered not depressed and
those with a GDS score >5 were considered depressed. We
also examined scores on the Montreal Cognitive Assessment
and self-reported levels of PA (Physical Activity Scale for the
Elderly). Physical activity including light, moderate and stren-
uous PA, were tallied to create summary scores for frequency
IAGG 2017 World Congress
175
(days/week) and duration (hours/day). Thirty-four percent
of study participants reported being depressed at baseline.
Those who were depressed had fewer years of education
(15 vs. 16years, p=0.02) but did not differ significantly by
age, sex or cognitive function compared to those with no
depression. Study participants engaged in PA for an aver-
age of 1.30.4days/week for 2.20.4 hours. There were no
significant differences in PA levels between those who were
depressed or not depressed. Depressive symptoms were high
in this cohort of patients with newly diagnosed, untreated
Parkinsons disease. However, we did not observe an asso-
ciation between physical activity and depressive symptoms
cross-sectionally. Future studies should examine the longi-
tudinal association between physical activity and depressive
symptoms in this cohort.
THE INTERPLAY OF LIFE EVENTS, RELIGIOUS
EXPRESSION, AND SOCIAL SUPPORT WITH
DEPRESSION
A.M.Ogletree, R.Blieszner, L.P.Sands, Human
Development, Virginia Tech, Blacksburg, Virginia
Based on Pearlins stress process model, we examined
relationships among religious expression/participation,
social support, and depressive symptoms in adults who expe-
rienced significant life events (SLEs) within the past year.
Data came from the ORANJ BOWL study and included
5,468 randomly-dialed New Jersey residents aged 5074 in
2008. We explored which events were the strongest indica-
tors of the SLE construct and most associated with higher
CES-D scores. We hypothesized more depressive symptoms
among individuals with more stressful events, less social sup-
port, and lower religious expression. Religiosity was meas-
ured using 6 items from the Multidimensional Measurement
of Religiousness/Spirituality. The 10-item CES-D indexed
depressive symptoms; life events were recorded on a 14-item
Cochrane-Robertson Life Event Inventory; perceived social
support was measured using 4 items. Structural equation
modeling assessed construct factor loadings and hypoth-
esized associations; fit indices revealed good model fit to
the data (x2=3637.32, p=0.000, df=221; RMSEA=0.053,
NNFI=0.911, CFI=0.922, SRMR=0.047). The strongest indi-
cators of SLE were three items reflecting relational family
events. Maximum likelihood estimates partially supported
the hypotheses: individuals with more stressful events, lower
public religious expression, and less perceived social support
reported significantly more depressive symptoms. However,
individuals with more private religious expression also had
more depressive symptoms. These findings reveal that private
versus public religious expression may have different roles in
coping with significant life events.
RELIGIOSITY AND DEPRESSIVE SYMPTOMS IN
OLDER ADULTS COMPARED TO YOUNGER ADULTS:
MODERATION BY AGE
M.A.Stearns, E.D.Lantz, D.K.Nadorff, Mississippi State
University, Starkville, Mississippi
Overall, religious individuals are more likely to have a
positive life view, and are less likely to suffer from depressive
symptoms. Given the high prevalence of depressive symp-
toms among older adults, it is important to identify possi-
ble protective factors. Thus, the current study examines the
176
effect of age on the relation between religiosity and depres-
sive symptoms.
The sample (N = 316) was recruited using MTURK.
Measures included age, the Center for Epidemiological
Studies Depression Scale (CESD), and the Stearns-
McKinney Assessment of Religious Traits (SMART).
Alarge variance of ages was sought and ranged from 19 to
67. As expected, we found that the older adults aged 50 and
older (M=230.35, SD=106.97) were more religious than
younger adults aged 1830 (M = 230.35, SD = 106.97, t examine the individual contributions of personality traits
(1,437) = -6.07, p < .001). Additionally, younger adults
(M=18.40, SD=13.72) reported more depressive symp-
toms than the older adults (M = 9.43, SD = 10.45, t (1,
67.975)=3.16, p=.002).
Moderation analyses were conducted using SPSS Process
macro on the entire data set. The interaction between religi-
osity and age just missed significance in predicting depres-
sive symptoms, t (1, 315)=-1.74, p=.08. There was not a
significant relation of religiosity on depressive symptoms for
those one or more standard deviations below the mean age
(t=0.26, p=.80), whereas there was a significant relation
for those one standard deviation above the mean (t=-2.40,
p=.02). Implications, future directions, and limitations are
discussed.
PERSONALITY, BOREDOM, AND COMPENSATORY
USE OF TV IN THE HEALTH AND RETIREMENT
STUDY
P.A.Fox1, S.T.Mejia2, K.A.Hooker3, 1. DePaul University,
Chicago, Illinois, 2. University of Michigan, Ann Arbor,
Michigan, 3. Oregon State University, Corvallis, Oregon
In addition to being a sedentary activity with health and
well-being correlates, TV watching is also one of the most
commonly reported daily activities among older adults.
Despite especially high variability in time spent watching
TV in this age group, personality has not been well inte-
grated into explanations of that variation, or the study
of conditions under which TV watching may serve as a
compensation strategy when other activities are not avail-
able (Van der Goot, 2015; Baltes & Baltes, 1990). We used
2012 Health and Retirement Study data (N = 4,655) to
examine conscientiousness, neuroticism, perceived bore-
dom yesterday, and hours spent watching TV yesterday to
examine how personality shapes time spent on this activity
and the importance of perception that one does not have
other things to do. As expected, lower conscientiousness
and higher neuroticism were associated with watching TV
longer as well as lower experienced well-being during TV
watching (Net positive affect while watching TV; BC=.54,
BN=-.42, both p<.001; Smith etal., 2014, p.63). However,
high conscientiousness individuals watched less TV only if
the day was low in boredom. For neuroticism but not con-
scientiousness, there was a significant indirect effect via
boredom, and unexpectedly, the remaining association of
neuroticism to TV time was negative (B = -.17, p<.05).
This suggests that beyond the boredom-TV pathway, neu-
roticism may be associated with less TV watching. Results
partially supported the connection of conscientiousness to
selective TV watching, and neuroticism to compensatory
use of TV.
Innovation in Aging, 2017, Vol. 1, No. S1
MALADAPTIVE PERSONALITY AND SOCIAL ROLE
IMPAIRMENT IN DEPRESSED OLDER ADULTS IN
PRIMARY CARE
A.Romirowsky1, R.A.Zweig1,2, L.Glick1, J.Sirey3, 1.
Yeshiva University, Bronx, New York, 2. Albert Einstein
College of Medicine, Bronx, New York, 3. Weill Cornell
Medicine, White Plains, New York
Personality pathology is associated with impaired social
functioning in adults, though further evidence is needed to
and processes to social functioning in depressed older adults.
This study is a secondary analysis examining the relationship
between maladaptive personality traits and processes and
social role impairment in depressed older adults in primary
care (N=56). Participants were 77% female and ranged in age
between 5589 (M=66.82, SD=8.75). Personality pathol-
ogy was measured both by maladaptive traits (NEO-FFI)
and processes (Inventory of Interpersonal Problems; IIP-15).
Individual variable as well as combined predictive models of
social role impairment were examined. Higher neuroticism
( = 0.30, p <.05), lower agreeableness ( = -0.35 p<.001)
and higher IIP-15 ( = 0.28, p<.01) scores predicted greater
impairment in social role functioning. Categorical analyses
of these variables found significant differences in social role
functioning between individuals with high and low levels of
agreeableness (p=.05) and IIP-15 scores (p <.01). All moder-
ation analyses were non-significant, but a combined predic-
tive model of neuroticism and IIP-15 scores predicted unique
variance in social role impairment (R2= .71). These find-
ings highlight the importance of accounting for personality
pathology, as measured by both traits and processes, in the
assessment and treatment of older adults with depression. In
addition, these findings lend support for continued research
into both linear and non-linear relationships between per-
sonality pathology and domains of functional impairment in
older adults.
PERSONALITY AND ALL-CAUSE MORTALITY:
COMBINED ANALYSIS BETWEEN NEUROTICISM
AND EXTRAVERSION
H.Iwasa1, Y.Masui2, Y.Gondo3, H.Inagaki2, Y.Yoshida2,
1. Fukushima Medical University, Fukushima-shi, Japan, 2.
Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan,
3. Osaka University, Osaka, Japan
Purpose: Although recent studies have confirmed a rela-
tionship solely between personality traits and mortality,
combinations of personality have been not fully investigated.
This study explored whether a combination of personality
traits was related to all-cause mortality among the middle-
aged and elderly.
Methods: Atotal sample of 1050 men and 1424 women
aged 52 to 77 years were examined at the baseline. The
Eysenck Personality Inventory was administered to assess
neuroticism and extraversion. We created three categories
approximating the three tertiles of each personality trait
score. We also combined the two scores and created four
groups: Gloomy (N+E-), Passionate (N+E+), Low-keyed
(N-E-), and Resilient (N-E+).
Results: During the 7-year follow-up period, 187 persons
(7.6%, 119 men and 68 women) died, and 261 people (10.5%,
112 men and 149 women) moved away from the target region.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Cox proportional hazards model, adjusted for gender, age, edu-
cation, presence of psychiatric problems, and chronic diseases,
showed that neuroticism (hazard ratio [HR]:1.48,95% confi-
dence interval [CI]: 1.052.08, for the highest tertile) and extra-
version (HR: 0.64, 95% CI: 0.440.93, for the highest tertile)
were independently associated with mortality. The combined
analysis showed that Gloomy (HR: 2.01, 95% CI: 1.302.29)
and Passionate (HR: 1.57, 95% CI: 1.062.32) demonstrated
a higher mortality risk and that Low-keyed did not have a sig-
nificant mortality risk, compared to Resilient.
Conclusions: Our results suggest that individuals with
high neuroticism and low extraversion are prone to shorter
lives and that mortality risk is elevated when combining the
two traits.
DYADIC ASSOCIATIONS OF CONSCIENTIOUSNESS
FACETS AND HEALTH, HEALTH BEHAVIOR, AND
WELLBEING OVER TIME
J.Lee, W.Chopik, Michigan State University, East Lansing,
Michigan
Objectives: Previous research suggests that the personali-
ties of an individual and her/his spouse can have large impli-
cations for health and well-being. However, much of this
research has been cross-sectional and has focused on broad,
global personality traits. Less is known about how the com-
ponents of personality traits (i.e., facets) affect changes in
health and well-being over time in older couples. The cur-
rent study applied actor-partner interdependence models to
examine how conscientiousness and its facets moderated
changes in health, health behavior, and well-being in older
couples over a four-year period.
Method: 3,271 older heterosexual couples (N=6,542
individuals; Mage=67.34, SD=8.59) from the Health and
Retirement Study filled out a personality questionnaire at
baseline. Measures of health (self-rated health, chronic ill-
nesses), health behavior (light, moderate, and vigorous exer-
cise), and well-being (depression) were assessed three times
over a four-year period. Actor-partner interdependence
models accounted for the non-independence of spouses and
tested how partner conscientiousness affected health, health
behavior, and well-being over time.
Results: Actor conscientiousness, orderliness, and indus-
triousness most reliably predicted better health, health
behavior, and well-being. Partner conscientiousness pre-
dicted better self-rated health; partner orderliness and indus-
triousness predicted better health and more positive health
behavior. Many of these relationships persisted over the four-
year study window.
Discussion: The current study is the only of its kind to
examine the dyadic effects of personality facets on health
and well-being longitudinally. Results from the current study
highlight the benefits of modeling dyadic processes within
older couples and how these processes affect health and well-
being over time.
SUBJECTIVE WELL-BEING INDICIATORS AS
DEPRESSIVE SYMPTOMATOLOGY PROTECTORS ON
OLDER MEXICANS
S.Covarrubias-Castillo, E.Arias-Merino, B.Corona-
Figueroa, B.Ochoa-Sanchez, Universidad de Guadalajara,
Guadalajara, Mexico
IAGG 2017 World Congress
177
INTRODUCTION. Subjective well-being incorporates
the psychological dimension of aging. It is positively asso-
ciated to: being married, perceived good health, autonomy,
physical activity, social support, emotional and visual health,
as well as cognitive functioning; subjective well-being has
been negatively associated to depression.
OBJECTIVE. To determine a possible association between
subjective well-being indicators and depressive symptoma-
tology in Mexican older adults.
METHODOLOGY. Analytical and transversal study, with
2400 older adults data from Health, Well-being and Aging
Poll (Encuesta de Salud, Bienestar y Envejecimiento - SABE)
in the Mexican states of Colima and Jalisco. The depend-
ent variable was depression, and subjective well-being indi-
cators were: cohabitation satisfaction and religion, as well
as health, memory, sight, hearing, nutrition and monetary
income self-report. For the association tests, chi2 tests at 0.05
were used. Multivariate analysis was used, with adjusted OR
(CI=95%) and p<0.05. Disease and gender were included as
control variables.
RESULTS. Age range was from 60 to 98 years, with
a mean age of 70.91 +- 7.61 years. 62% (n: 1,489) were
women. Absolute prevalence of depressive symptomatology
was 23.8%. All analyzed subjective well-being indicators
obtained significant results; on multivariate analysis adjusted
for disease and gender, cohabitation satisfaction, good / regu-
lar memory, good /regular health, good hearing, good / regu-
lar income and female gender resulted as protective factors of
subjective well-being against depressive symptoms.
CONCLUSSIONS. Indicators of subjective well-being, in
general, protect older adults from depressive symptomatol-
ogy, some of them, even with a previously diagnosed disease.
UNDERSTANDING PATHWAYS AMONG SOCIAL
CAPITAL, DEPRESSION, AND SUICIDAL IDEATION
FOR KOREAN ELDERLY
J.Kim, S.Choi, Y.Song, S.Kweon, H.Bae, Pusan National
University, Busan, Korea (the Republic of)
Unfortunately the suicide rate of older adults in South
Korea has been ranked first among OECD countries for long
periods of time. Previous studies have identified older peo-
ples socioeconomic status, physical health, mental health,
and lack of social support are significantly associated with
suicidal ideation. However, little research has been con-
ducted to examine how older adults social capital including
social relationship can mitigate suicidal ideation mediated
by depression. For data analysis, 3524 older adults from
the Korean welfare panel study data were utilized. We used
structural equation modeling to examine direct and indirect
effects among social capital, depression, and suicidal idea-
tion. Results showed that higher levels of social trust and sat-
isfaction from family relations significantly predicted lower
levels of suicidal ideation. In addition, indirect paths from
social capital variables including social trust, reciprocity, and
relationships to suicidal ideation were all significantly medi-
ated by levels of depressive symptoms. The findings indi-
cate that enhancing older peoples social capital can reduce
their suicidal ideation as well as depressive symptoms. Thus,
we need to consider how to develop social capital through
strengthening social trust, reciprocity, and supportive net-
works among older adults.
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DEPRESSION AMONG OLDER PEOPLE IN SRI LANKA:
WITH SPECIAL REFERENCE TO ETHNICITY
A.Khaltar1, N.G.W.Priyadarshani2, N.Y.Delpitiya2,
C.Jayasinghe2, A.Jayasinghe2, A.Arai1, Y.Obayashi1,
H.Tamashiro1, 1. Hokkaido University Graduate School
of Medicine, Sapporo, Hokkaido, Japan, 2. University of
Peradeniya, Kandy, Sri Lanka
Sri Lanka, a multi-ethnic country, has been confronting
with an ageing population. There is a gap in health among
different ethnicities especially in older population. This study
was to ascertain if the factors associated with depression
differ among ethnic groups in community-dwelling older
people in Kandy, Sri Lanka. A cross-sectional survey was
conducted in people aged 60years or over living in selected
communities. The participants were asked about ethnicity
(Sinhalese, Tamils, and Muslims), sociodemographic char-
acteristics, and depression status by face-to-face interviews
with a structured questionnaire. Depression was measured
by 15-item Geriatric Depression Scale and the total score of 6
and above was considered as depression. The chi-square test
and multivariate logistic regression with two-way interaction
terms between ethnicity and other factors were performed.
Participants (n=778) consisted of 56.0% of Sinhalese,
21.9% Tamil, and 21.2% Muslim. Of the participants, the
prevalence of depression was 31.8%. The proportions of
depression were 27.3% in Sinhalese, 42.1% in Tamils, and
32.9% in Muslims. Multivariate logistic regression analysis
showed that low economic status, low perceived social sup-
port and having more than two self-reported diseases were
significantly associated with depression. These associations
and thus the factors did not differ among ethnic groups. The
findings from this study would help practitioners uncover the
older people with high risk and intervene its development or
exacerbation among them.
SESSION 535 (POSTER)
DISABILITIES I
DEPRESSIVE SYMPTOMS AS APREDICTOR OF
DISABILITY AFTER NEW MEDICAL DIAGNOSES IN
OLDER ADULTS
C.Wu, E.Skidmore, J.Rodakowski, University of
Pittsburgh, Pittsburgh, Pennsylvania
Study: Older adults face negative life adversities, such as
the onset of new medical diagnoses, which leads to disability
and increased mortality risk. In this study, we aim to inves-
tigate whether depressive symptoms and cognitive function
predict disability after controlling demographic and health-
related factors in older adults with new medical diagnoses.
Methods: We conducted a cross-sectional secondary data
analysis of Survey of the Health and Retirement Study. Sample
included 3100 older adults who self-reported for having new
medical diagnoses within last two years. The hierarchical
logistic regression analysis was used to examine the model fit
of two blocks of variables: 1)demographic (age, gender, part-
nership, education level, race, ethnicity) and health-related
(comorbidity, recent hospitalization) and 2) cognitive func-
tion and depressive symptoms. Results: Older adults have
an average of 69.9year-old (SD=10.4) with 58.8% female.
Innovation in Aging, 2017, Vol. 1, No. S1
Older adults with disability were more likely to be female
(OR=1.86, p<.001), with lower education level (OR=1.28,
p=.018), having comorbidity (OR=2.43, p<.001), and hav-
ing recent hospitalization (OR=1.70, p<.001). After control-
ling for demographic and health-related variables, depressive
symptoms (OR=7.31, p<.001) and low cognitive function
(OR=1.03, p=.001) were significant predictors of disability.
Conclusion: Findings demonstrate that depressive symptoms
and cognitive function are significantly associated with disa-
bility in older adults with new medical diagnosis. Depressive
symptoms showed clinical meaningfulness by the high mag-
nitude of effect size. Significance: Results will inform future
investigations focused on interventions for older adults who
are vulnerable to long-term disability to prevent by focusing
on depressive symptoms.
PREDICTIVE VALUE OF DISABILITY FOR ALL-CAUSE
MORTALITY IN THE ELDERLY
T.Peng, L.Wu, W.Chen, T.Kao, Division of Geriatric
Medicine, Department of Family and Community
Medicine,Tri-Service General Hospital, National Defense
Medical Center, Taipei, Taiwan
Disability is regarded as an serious issue in elderly indi-
viduals that affects quality of life. This study aims to explore
the relationship between disability and all-cause mortality
in the National Health and Nutrition Examination Survey
(NHANES 19992002). A total of 1,834 participants in
the age range of 6084 years were included. Five major
domains of disability, including activities of daily living
(ADL), general physical activities (GPA), instrumental
activities of daily living (IADL), lower extremity mobility
(LEM), and leisure and social activities (LSA) were acquired
by self-reporting. We applied an extended-model approach
with Cox (proportional hazards) regression analysis to
investigate the relationship between different features of
disability and all-cause mortality risk in the study popu-
lation. During a mean follow-up of 5.7 years, 77 deaths
occurred. An increased risk of all-cause mortality was
identified in elderly individuals with disability after adjust-
ing for potential confounders (hazard ratio [HR]: 2.23;
95% confidence interval [CI]: 1.29 to 3.85; P = 0.004).
Participants with more than one domain of disability were
associated with a higher risk of mortality (Ptrend=0.047).
Adjusted HRs and 95% CIs for each domain of disability
were as follows: 2.53 (1.49 to 4.31), 1.99 (0.93 to 4.29),
1.74 (0.72 to 4.16), 1.57 (0.76 to 3.27), and 1.52 (0.93 to
2.48) for LEM, LSA, ADL, IADL, and GPA, respectively.
This study supports an increased association between dis-
ability and all-cause mortality in the US elderly population.
Disability in LEM might be good predictor of high risk of
all-cause mortality in the elderly subjects.
BODY MASS, COGNITIVE STATUS, AND
FUNCTIONAL OUTCOMES IN OLDER MEN AND
WOMEN
C.M.Germain1, E.Vasquez2, J.A.Batsis3, 1. Psychiatry
and Behavioral Sciences, Duke University, Durham, North
Carolina, 2. University at Albany, Albany, New York, 3.
Giesel School of Medicine at Dartmouth, Hanover, New
Hampshire
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Innovation in Aging, 2017, Vol. 1, No. S1
Background: Body mass and cognitive status are indepen-
dently associated with physical and functional outcomes in
older adults. However, accumulating evidence suggests that
higher body mass may be protective during late life, in late
life. Yet little is known regarding the impact of cognitive
impairment at various levels of body mass in older adults.
Methods: We examined prevalence and odds of physical
and IADL limitations by cognitive status (normal/impaired)
and body mass category (normal, overweight, obese) in
4,033 older men and 5,563 women aged 60+ from 2006/
2008 waves of Health and Retirement Study. Models were
adjusted for age, race, education, physical activity level,
comorbidity and smoking status. Individuals with TICS score
7 were classified as cognitively intact/normal (REF); TICS
scores <7 were classified as cognitively impaired. Physical
limitation (PL) was determined using the HRS summary
score; IADL limitation was defined as difficulty/inability
with meals, chores, managing money. Models were adjusted
for age, race, education, physical activity level, comorbidity
and smoking status and weighted.
Results: Prevalence of PL in adults with cognitive impair-
ment in men were 50.7%, 52.3% and 67.3% for normal,
overweight and obese categories; for women, rates of PL
were 61.8%, 71.9%, 81.8%. Among men, cognitive impair-
ment was significantly associated with higher rates of physi-
cal impairment in normal OR 2.11 (1.074.21), overweight
OR 2.17 (1.174.03) and obese OR 1.09 (0.592.01weight
categories. Among women, adults who were cognitive
impairment was associated with physical limitations in nor-
mal OR 2.11 (1.074.21) and overweight categories OR 1.71
(1.02.91) but not obese OR 1.09 (0.592.01). Association
between obesity and cognition on IADL limitations are also
discussed.
Conclusion: Older adults with poor cognition are at
increase odds of physical limitations independent of body
mass. The impact of cognitive impairment in combination
with obesity varies between men and women and merits fur-
ther investigation.
METABOLIC SYNDROME AND DISABILITY IN
CHINESE NONAGENARIANS AND CENTENARIANS
M.Yang, B.Dong, Q.Hao, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Metabolic syndrome (MetS) increases with aging. Little is
known about the relationship between MetS and disability in
the elderly population, especially in the oldest old. We there-
fore conducted this study to investigate the possible associa-
tion between MetS and disability in a population of Chinese
nonagenarians and centenarians. Data were obtained from
a face-to-face survey conducted in 870 Chinese adults
aged 90 years or older. MetS was diagnosed according to
the International Diabetes Federation criteria. Activities of
daily living (ADL) and instrumental activities of daily liv-
ing (IADL) disabilities were evaluated using the physical
self-maintenance scale and the Lawton-Brody IADL scale,
respectively. The subjects included in the current analyses
were 500 women and 225 men (mean age: 93.83.1years). predictors of service needs were community ambulation,
MetS was present 13.0% in women and 9.8% in men. In
women, the prevalence of ADL and IADL disabilities was
significantly higher in the MetS group compared with the
non-MetS group (ADL:43.1% vs. 30.6%, p=0.044; IADL:
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179
73.8% vs. 59.8%, p=0.030). After adjusting for relevant
confounders, the MetS group showed significantly increased
odds ratios (ORs) for either ADL (1.8, 95% confidence inter-
val [CI] 1.23.4) or IADL disability (2.1, 95% CI 1.34.7)
compared with the non-MetS group. In men, similar results
were found with respect to the prevalence of ADL or IADL
disability and adjusted ORs between MetS and non-MetS
groups, but these results were not statistically significant. In
conclusion, in our study population, MetS appeared to be
associated with an increased risk of either ADL or IADL dis-
ability, especially in women.
PLANNING HEALTH SERVICES FOR SENIORS: CAN
WE USE PATIENTS OWN PERCEPTION?
S.Figueiredo1,2, A.Rosenzveig2, J.A.Morais3,4,
N.E.Mayo5,1,4, 1. School of Physical and Occupational
Therapy, McGill University, Montreal, Quebec, Canada, 2.
Center for Outcomes Research and Evaluation, Research
Institute, McGill University Health Centre, Montreal,
Quebec, Canada, 3. Faculty of Medicine, McGill University,
Montreal, Quebec, Canada, 4. Department of Geriatrics,
McGill University Health Centre, Montreal, Quebec,
Canada, 5. Division of Clinical Epidemiology, McGill
University, Montreal, Quebec, Canada
Across Canada, people over 75 years of age represent
16% of all hospital admissions. The admission rate per
100,000 seniors is 5 times higher for acute care and 22
times higher for complex continuing care than the rates
for younger adults. After a hospital discharge, dealing with
new disabilities can be difficult and even overwhelming.
Understanding patients needs in a timely manner may allow
services to be allocated to those at highest risk for deteriora-
tion, thus, improving care while optimizing health care cost.
Could patients perceptions of how they are feeling be used
as a marker of potential need for post-discharge services?
The aim of the study was to estimate whether self-
reported health can be used as an indicator of service needs
among seniors.
In this cross-sectional survey, age and sex-adjusted logis-
tic regression was used to estimate the link between func-
tional status indicators and fair or poor self-reported health.
Results were reported as Odds Ratio (OR) and its 95% con-
fidence interval (95%CI). Backward stepwise logistic regres-
sion was performed to identify the best predictive model of
service needs. Positive predictive value (PPV), sensitivity and
specificity were calculated to identify whether health percep-
tion could be used to identify people in need of physical reha-
bilitation services.
142 seniors agreed to answer the survey yielding a
response rate of 73%. Among the respondents (mean age
797; 60% women), 40% rated their health as fair or poor.
Seniors perceiving their health as fair or poor had higher odds
of reporting impairments, activity limitations, and participa-
tion restricitions (OR ranging from 2.37; 95%CI 1.03-5-45
to OR 12.22; 95%CI 2.6855.78) in comparison to those
perceiving their health as good or better. The most significant
household tasks, fatigue, and pain with 92% sensitivity and a
maximum adjusted R-squared of 0.65. Self-rated health used
as single-item showed a positive predictive value (PPV) of 1,
sensitivity of 52%, and specificity of 100%.
180
In conclusion, our results indicate that all seniors report-
ing fair or poor health have indicators of need for further
rehabilitation services. This question may be an alternate way
of querying about need as many older persons are afraid to
report disability because of fear of further institutionalization.
INVESTIGATION ABOUT ASSOCIATED ILLNESS
WITH DISABILITY IN COMMUNITY DWELLING
OLDER POPULATION
E.Kiyoshige1, M.Kabayama1, K.Sugimoto1, Y.Arai2,
T.Ishizaki3, Y.Gondo4, H.Rakugi1, K.Kamide1, 1. Division
of Health Sciences, Osaka University Graduate School
of Medicine, Suita City, Japan, 2. Keio University, Tokyo,
Japan, 3. Tokyo Metropolitan Institute of Gerontology,
Itabashi-ku, Tokyo, Japan, Tokyo, Japan, 4. Osaka
University Graduate School of Human Sciences, Osaka,
Japan
Background: Few studies have investigated associ-
ated illness with disability including life style related dis-
eases in community-dwelling older population. Aim of this
study is to clarify associated illness with disability among
80 years participants in the Japanese epidemiological
cohort study focused on community dwelling older popula-
tions (Septuagenarians, Octogenarians and Nonagenarians
Investigation with Centenarians:SONIC).
Methods: Study subjects were general population at
age 80 (1) years (n=965) in SONIC study. Disability was
defined as having the certification in Japanese long-term care
insurance system (LTCI). This certification was evaluated
considering cognitive and physical functions based on medi-
cal doctors evaluation in addition situation of subjects daily
life and support system for subject.
Results: 77 out of participants (7.9%, male:female=25:52)
were certified as disability in LTCI. Stroke (OR:8.38 for male,
8.11 for female) in both male and female and cardiovascular
disease (4.03) only in male, osteoporosis and osteoarthritis
(2.16, 2.45, respectively) and metabolic syndrome (2.43)
only in female were significantly associated with disability
in this study subjects. In addition, normal blood pressure
(<150/90mmHg) was also associated with disability only in
male (OR:4.41).
Conclusions: Obtained results in present study is similar
to Japanese national survey about associated illness in LTCI
among age 80 in Japanese community dwelling popula-
tion. Interestingly, there are significant positive associations
between disability and metabolic syndrome only in female
and normal blood pressure only in male in present study.
Afterwards, these associations should be carefully investi-
gated and clarified underlying mechanisms by analysis using
longitudinal data in SONIC study.
AUTISM SPECTRUM DISORDERS AND THE
HEALTHCARE EXPERIENCES OF AGING ADULTS
K.Kent1,2, 1. Health Services Administration, Xavier
University, Cincinnati, Ohio, 2. Miami University of Ohio,
Oxford, Ohio
The purpose of this qualitative, descriptive study is to
illuminate the experiences of adults diagnosed with Autism
Spectrum Disorders (ASD) and their challenges and successes
in receiving quality primary healthcare services. Through
Innovation in Aging, 2017, Vol. 1, No. S1
semi-structured interviews with eleven adults diagnosed with
ASD and/or their caregivers, this study explored their per-
spectives and impressions of their healthcare experiences.
Specifically, this study evaluated the population of adults
with ASD (age 30+) who are also diagnosed with intellec-
tual disabilities (ID). This population is challenged by a triple
jeopardy of age, intellectual disability and autism sympto-
mology (social/behavioral/communication challenges). In
addition to their ASD diagnosis, more than half of these
adults have major physical and mental health co-morbidities
that require regular medical attention. As a result, this popu-
lation often experiences negative health outcomes and sub-
optimal relationships with healthcare providers due to their
communication deficits, behavioral impairments and other
factors. Many of these medical and mental health condi-
tions could be better managed, and perhaps even prevented,
through more effective screening and prevention services
provided by primary healthcare providers. Payment sources
for health services also has a significant impact in access to
care. Many healthcare providers are well prepared to serve
this population, while some are not. Hence, sharing health-
care experiences is critical for preparing primary healthcare
providers to best serve ASD adults. By understanding the cur-
rent gaps in care and eliminating barriers, this will inform
the design for future improvements in the healthcare delivery
system for physicians, nurses, allied health professionals and
healthcare administrators.
IS VISUAL IMPAIRMENT JUST ANOTHER COMORBID
CONDITION?
B.Swenor, B.Munoz, S.West, Ophthalmology, Johns
Hopkins University, Baltimore, Maryland
Baseline data from the Salisbury Eye Evaluation study, a
population-based sample of 2,520 adults 65years or older
was used. Visual impairment was defined by visual acuity
and visual field measures. Time to complete three mobility
tasks was measured: walking up 7 steps, walking down 7
steps, and walking 4 meters. Mobility disability was clas-
sified as 1 standard deviation below the population mean
for each task. The total number of comorbid conditions was
determined using data on 16 conditions that affect mobil-
ity and categorized as 1, 2, 3, or 4+ conditions. Odds ratios
(OR) and 95% confidence intervals (CI) were determined
for each comorbidity strata adjusting for age, sex, and race.
Among older adults with 1 condition, the visually impaired
were more likely to be disabled on all three tasks than the
non-visually impaired (ORwalking up steps = 3.6; 95% CI:1.3
10.4; ORwalking down steps = 6.2, 95% CI:2.217.6; ORwalking 4
meters
=4.3, 95% CI:1.413.2). The association between visual
impairment status and disability walking up and down stairs
was attenuated and no longer significant when comparing
those with 2 conditions, but visually impaired were 3 times
more likely to have disability walking 4 meters than the non-
visually impaired (OR= 3.0, 95% CI:1.37.0). For those with
3 or 4+ comorbid conditions, the associations between vision
status and mobility disability declined and was not statis-
tically significant for any of the tasks. Results suggest that
while visual impairment is an important factor contributing
to mobility disability, as comorbid conditions accumulate
this effect is diluted.
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Innovation in Aging, 2017, Vol. 1, No. S1
THE ENRGISE PILOT STUDY: SCREENING AND
RECRUITMENT PRELIMINARY RESULTS
J.A.Cauley1, T.M.Manini4, R.A.Fielding5,
S.B.Kritchevsky2, M.M.McDermott3, A.Newman1,
W.T.Ambrosius2, M.Pahor4, 1. University of Pittsburgh,
Graduate School of Public Health, Pittsburgh, Pennsylvania,
2. Wake Forest School of Medicine, Winton-Salem, North
Carolina, 3. Northwestern University, Chicago, Illinois,
4. University of Florida, Gainesville, Florida, 5. Tufts
University, Boston, Massachusetts
Growing evidence shows that low-grade chronic inflam-
mation is an independent risk factor of disability and
impaired mobility. However, it is unknown whether inter-
ventions that reduce inflammation improve mobility. The
ENabling Reduction of low-Grade Inflammation in Seniors
(ENRGISE) Pilot Study is a multicenter randomized clinical
trial to test whether omega-3 fish oil (-3) or the angiotensin
receptor blocker losartan (LO) alone or in combination can
ameliorate walking speed and lower inflammation. A total
of 300 men and women age 70 years with elevated IL-6
and mobility impairment, as measured by slow gait speed
and self-reported mobility difficulty are being recruited at 5
academic clinical centers. Recruitment began April 2016 and
is expected to last 12months. Of the 1416 telephone screens
completed, 308 (25%) subjects had no self-report difficulty
walking or climbing stairs; 152 (21%) were ineligible for
both the LO and -3 study arms. Overall, 889 (63%) were
ineligible for the screening visit 1(SV1). We have completed
305 SV1s. To be eligible, subjects have to have a 4m walk
speed <1m/sec and >0.44 m/sec; 82% have met this criteria
and their blood was sent for IL-6 measurements. Of these,
82 (61%) had an elevated IL-6 (>2.3 and <10pg/ml) at SV1;
78 (87%) had an elevated IL-6 at SV2. To date, we have ran-
domized 32 individuals; mean (SD) IL-6=3.49 (1.53) pg/ml.
We will present the final results of the screening and recruit-
ment in ENRGISE. These results will inform the design of the
main larger trial to prevent major mobility disability.
FEAR OF FALLING AND ASSOCIATED FACTORS IN
COMMUNITY ELDERLY WITH CATARACTS
R.L.Menezes1,2, L.P.Paz1, L.de Andrade Cascalho1, 1.
University of Brasilia, Braslia, Federal District, Brazil, 2.
Brazilian Society of Geriatrics and Gerontology, Rio de
Janeiro, Brazil
Objectives: To investigate prevalence of the fear of fall-
ing of elderly with cataracts living in the community and,
the associated factors with high concern with falling occur-
rences. Methods: A cross-sectional, analytical and observa-
tional study. It was composed by 86 elderly diagnosed with
bilateral cataracts. To quantify the fear of falling among
elderly, the scale Falls Efficacy Scale-International-Brasil
(FES-I-BRASIL) was used. Other variables were obtained
through application of a structured questionnaire. Results:
Between participants, 41.9% reported low concern of falling,
while 58.1% reported high concern. From those last ones,
52% fell at least once on the past 12months and, 30% of
them are recurrent fallers. The activities to walk in slippery
surfaces, to walk in irregular surfaces and, to walk up balance tests in older adults at high risk for falls (N=24).
and down the stairs represented higher concern for elderly.
Conclusion: Cataracts or any other visual issue predispose
falls due to difficulty in overcoming obstacles present in the
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181
environment. Fear of falling is especially associated with fac-
tors acquired after the first fall episode.
ASSOCIATION BETWEEN HISTORY OF FALLS AND
SARCOPENIA IN ELDERLY FROM CURITIBA
PARANA, BRAZIL
N.B.Moreira1,2, A.S.Vojciechowski1, J.Melo Filho1,
A.R.Gomes1, M.C.Silveira1, A.L.Rodacki1, P.C.Bento1, 1.
Federal University of Paran, Brazil, Parana, Brazil, 2. Dom
Bosco College, Curitiba, Parana, Brazil
Sarcopenia and falls has been denoted as a consistent indi-
cator of frailty and mortality among the elderly. This study
verified the association between history of falls and sarco-
penia of elderly users of Public Health Units from Curitiba
Paran, Brazil. This observational cross-sectional study
assessed 815 elderly subjects (157 men; 70.97.6 years-
old and 658 women; 70.87.0 years-old). Sarcopenia was
diagnosed and classified according to the European Working
Group on Sarcopenia in Older People (EWGSOP) recommen-
dations: calf circumference (<31cm), 8m gait speed (<0.8m/s)
and strength handgrip (<20kg and <30kg for women and
men, respectively). The stages of sarcopenia were classified in
pre-sarcopenia, sarcopenia and severe sarcopenia. The history
of falls was obtained by questioning subjects the number of
falls experienced in the last 12months. The Ordinal Logistic
Regression and Odds Ratio (OR) were used to determine the
association between variables. The prevalence of sarcopenia
was 3.1% (0.4%, n=3 for men and 2.7%, n=22 for women).
Thirty-seven percent (n=304) reported at least one fall in
the last 12months, from which 20.9% experienced a single
fall episode (n=171). There was an association between the
number of falls and severe sarcopenia (OR=2.45, p=0.001,
95%CI=0.993.90), whereas the remaining stages showed
no significant association between sarcopenia and history
or number of falls (p>0.05). Elderly suffering from severe
sarcopenia presented two and a half times more chances to
fall. This association reveals the importance of intervention
program to prevent sarcopenia in an attempt to reduce the
number of falls among the elderly.
IMPACT OF AN ONLINE COGNITIVE TRAINING
PROGRAM IN OLDER ADULTS AT RISK FOR FALLS
H.J.Thompson1,2, G.Demiris1, E.McGough1, T.Eagen1,
1. University of Washington, Seattle, Washington, 2.
Harborview Injury Prevention and Research Center, Seattle,
Washington
The primary cause of traumatic injuries in older adults is
falls. For persons with cognitive impairment, fall risk is sub-
stantively higher primarily related to changes in executive
function. There is a growing interest among older adults
with regards to cognitive training (CT) for maintenance or
improvement of cognitive function. It has been speculated
that performing CT might reduce risk of fall in older adults
as higher-level cognitive functions have been implicated as
required to safely navigate ones environment.The purpose
of the current quasi-experimental study was to explore the
effectiveness of an online CT intervention on gait speed and
Subjects meeting criteria were enrolled in the study for
12 weeks and following baseline assessment, received 8
weeks (3 sessions/week) of an online CT program. The
182 Innovation in Aging, 2017, Vol. 1, No. S1

intervention targeted specific tasks such as processing PREVALENCE OF FUNCTIONAL DISABILITY

speed, divided attention, and task shifting. Mean age of AND ASSOCIATED FACTORS IN OLD AGE:
participants was 83.6 (SD 8.4). 62.5% of participants were APOPULATION-BASED STUDY
at least moderately comfortable with computers at base- J.S.Nascimento3,4, V.G.Moreira3,5, M.Pegorari2,
line. There was a statistically significant improvement from M.Mapelli2, D.Tavares2, R.A.Loureno3,5, 2. Tringulo
baseline on the 90 second balance test, which was retained Mineiro Federal University, Uberaba, Brazil, 3. State
4 weeks post-intervention (p<0.05). Gait speed on the 10M University of Rio de Janeiro, Rio de Janeiro, Rio de
walk remained unchanged from baseline during or 4 weeks Janeiro, Brazil, 4. Federal University of Rio de Janeiro, Rio
following the intervention. This intervention is a promising de Janeiro, Rio de Janeiro, Brazil, 5. Pontifical Catholic
strategy to improve balance and reduce risk of fall in older University of Rio de Janeiro, Rio de Janeiro, Brazil
adults at high risk. Further study in a larger randomized, The aim of the present study was to estimate the prevalence
controlled trial is warranted. and associated factors of disability in older people. It was a
cross-sectional, observational study, that assessed demographic
ASSOCIATION OF TELOMERE LENGTH WITH characteristics, health habits, functional capacity, occurrence of
FUNCTIONAL IMPAIRMENTS: DATA FROM NHANES falls and gait speed test in a sample composed by 482 commu-
19992002 nity-dwelling individuals, 80years old and older, living in the
J.A.Batsis1, R.T.Emeny1, T.A.Mackenzie1, E.Vasquez2, cities of Uberaba and Rio de Janeiro, Brazil. Basic (ADL) and
C.M.Germain3, P.Rippberger4, S.Bartels1, 1. Medicine, Instrumental (IADL) Activities of Daily Living were the depend-
Geisel School of Medicine at Dartmouth, Lebanon, New ent variables in two multivariate logistic regression model. The
Hampshire, 2. SUNY Albany, Albany, New York, 3. Duke prevalence of disability for ADL and IADL were 31.5% and
University, Durham, North Carolina, 4. University of New 78.2%, respectively; 70.7% were female, 61.4% were widow-
England College of Osteopathic Medicine, Biddeford, ers, and the average age was 85.36 (SD5.05). Negative health
Maine self-perception (OR=2.09; CI 1.28 3.41); higher number of
Background: Telomere shortening is associated with self-reported morbidities (OR=1:43; CI 1.23 1.66); use of
chronic diseases yet its relationship with everyday functional five or more drugs (OR=1.62, CI 1.02 2.59); living accom-
impairments has not been well characterized. We sought to panied (OR=2.12; CI 1.18 3.79) and no individual income
characterize the association of telomere length with physical (OR=2.41; CI 1.08 5.40) were associated with disability for
limitations (PL) as well as basic and instrumental activities ADL. For the IADL, negative health self-perception (OR=2.68;
of daily living (ADL) in a non-institutionalized population CI 1.53 4.69); use of five or more drugs (OR=2.01, CI 1.17
of older adults. 3.46); dissatisfaction with their economic status (OR=3.21; CI
Methods: The sample consisted of 2672 adults 1.79 5.76); lack of education (OR=5.06; CI 1.14 22.46)
aged60years from the 19992002 National Health and and the occurrence of falls in the past year (OR = 1.88; CI
Nutrition Examination Surveys. Data on physical limitations 1.09 3.22). The identification of risk factors in the elderly
(PL), instrumental activities of daily living (ADL)s and basic must be considered in the evaluation and development of care
ADLs were abstracted. Telomere length relative to standard for maintaining and restoration of functional capacity.
reference DNA (T/S ratio) was assessed using quantitative
PCR. We created separate multivariate regression models STEPPING PERFORMANCE IN OLDER ADULTS:
to examine the association between telomere length and ASSOCIATION WITH THE ACE GENE INSERTION/
the presence/absence of limitations (PL, basic/instrumental DELETION POLYMORPHISM
ADL), adjusting for age, race, education, gender, smoking, K.Shuler, J.F.Sucic, S.A.Talley, A.Goldberg, University of
co-morbidity, and physical activity. Michigan-Flint, Flint, Michigan
Results: The majority of the sample was female(55.5 Many factors are associated with stepping performance
%). Mean age was 70.90.28 years. Prevalence of PL, in older adults, including strength, balance and neuromuscu-
basic ADLs and instrumental ADLs were 54.0, 43.3 and lar coordination. The association between genetic factors and
27.5%. Mean telomere length (SE) in those with as com- stepping performance has not been well studied. Although the
pared to those without limitations was: PL 0.900.02 angiotensin-converting enzyme (ACE) gene insertion/deletion
vs. 0.93 0.02, p=0.03; basic ADL 0.90 0.02 vs. (I/D) polymorphism is associated with physical performance in
0.910.02, p=0.29; and instrumental ADL 0.920.02 older adults, the relationship between ACE genotypes and step-
vs. 0.890.02, p=0.02. Multivariable modeling adjust- ping performance is unclear. The purpose of this study was to
ing for all covariates demonstrated that the presence of examine the association of stepping performance with the ACE
impairments were not associated with telomere length gene polymorphism in older adults. Forty community-dwelling
(standard error);for PL =-0.0130.01, p=0.29, for adults (mean age 71.6 yrs) performed the 30-Rapid Step test
basic ADL =0.010.01, p=0.37, and for instrumental and the Maximum Step Length test. DNA was extracted from
ADLs =-0.010.01, p=0.31. saliva using commercially-available kits. The ACE I/D poly-
Conclusions: Older individuals with PL and instru- morphism was genotyped by 2 PCRs followed by visualiza-
mental ADL had shorter TL but a significant association tion of PCR products on agarose gels. To avoid misidentifying
was not observed after adjustment for confounding fac- I/D genotypes, an insertion-specific PCR was conducted on all
tors. Our results suggest having such a deficit abrogates DD samples. Differences in stepping among the genotypes was
the benefits of longer telomere length in individuals with evaluated using Kruskal-Wallis ANOVA followed by Mann-
these impairments. Whitney U test. Statistical significance was set at p<0.05. There
were statistically significant differences in the 30-Rapid Step

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
test and the Maximum Step Length test among individuals
with the 3 ACE genotypes. I/D genotype individuals stepped
faster than I/I individuals, and farther than D/D individu-
als (P<0.05). The ACE gene insertion/deletion polymorphism
appears to be associated with deficits in stepping performance
in older adults. As poor stepping performance increases risk for
falls in older adults, specific ACE genotypes may be associated
with increased risk for falls. Knowledge of an individuals ACE
genotype may provide added information in evaluating risk for
falls in older adults.
PROMOTING ADL INDEPENDENCE IN VULNERABLE
ELDERLY: SIX-MONTH FOLLOW-UP OF APILOT
COMPARATIVE TRIAL
C.Liu1,3, D.Clark2,3,4, H.Xu2,3,6, N.R.Keith2,3,5, 1.
Indiana University School of Health and Rehabilitation
Sciences, Indianapolis, Indiana, 2. Regenstrief Institute,
Inc., Indianapolis, Indiana, 3. Indiana University Center
for Aging Research, Indianapolis, Indiana, 4. Indiana
University School of Medicine, Indianapolis, Indiana,
5. Indiana University School of Physical Education and
Tourism Management, Indianapolis, Indiana, 6. Indiana
University School of Public Health, Indianapolis, Indiana
Muscle strength is essential but insufficient to reduce ADL
disability in older adults. Aparallel-group randomized con-
trolled trial was conducted to compare whether adding func-
tional and task-oriented training to resistance exercise would
generate a greater improvement on ADL performance rela-
tive to resistance exercise alone. Fifty-two older adults who
showed muscle weakness, lived a sedentary life style, and had
ADL difficulty were recruited from local subsidized housing
properties. They received 10 weeks of resistance exercise
or the 3-Step Workout for Life, which included practicing
functional movements and ADL tasks at home in addition to
resistance exercise. The Box and Blocks test, Timed Up and
Go, and Assessment of Motor and Process Skills were used
to measure physical function and ADL performance. At six-
month follow-up, all three outcomes in the 3-Step Workout
for Life group were not different from the baseline while the
resistance exercise only group showed a significant decline
(mean change in the Box and Blocks=-4.05, p=0.02; mean
change in the Timed Up and Go = 1.84, p = 0.01; mean
change in the Assessment of Motor and Process Skills=-0.25,
p = 0.01). More importantly, the 3-Step Workout for Life
group showed a greater improvement in ADL performance
when compared to the resistance exercise only group (group
mean difference=0.37, p<0.01). Adding functional, task-
oriented training to resistance exercise may help retain physi-
cal function and delay the decline of ADL performance after
six months of detraining in vulnerable older adults.
SESSION 540 (POSTER)
ECONOMICS OF AGING, RETIREMENT, PENSIONS,
AND FINANCIAL HEALTH
EXPERIENCES OF RETIREMENT LIFE AMONG
RETIREES UNDER PENSION SCHEMES COVERAGE IN
KENYA
S.M.Mwangi, L.Maina, Sociology, Kenyatta University,
Nairobi, Nairobi, Kenya
IAGG 2017 World Congress
183
In Kenya, the number of retirees exiting the laborforce
with terminal retirement benefits has been on the rise.
Retirement benefits are paid in four different modes, as
total lumpsum, or partial lumpsum, or monthly pension, or
annuities. Although studies have been conducted to exam-
ine the income security related to these modes of payment,
the experiences of the retirees receiving particularly total
lumpsum benefits have not been systematically documented.
Thus, the objectives of the study were: to explain the pri-
mary characteristics of the Kenyan retirees; document the
experiences of retirees receiving total lumpsum benefits; and
recommend ways of dealing with these experiences and chal-
lenges. A sample comprising of 978 persons aged 55 years
and older were recruited from 9 regions of Kenya. Data was
collected using a survey questionnaire and focus group dis-
cussions. Majority of them were males, rural residents and
married and received pension benefits from among the four
types of schemes in Kenya: National Social Security Fund,
civil service pension, occupational schemes and voluntary
pension schemes. Findings indicate that negative experiences
(e.g., mismanaging pensions, business failure, and unplanned
lending) outweighed positive experiences (e.g., starting and
running successful business, building a house). The study rec-
ommends that: retirees be encouraged to annuitize their pen-
sion savings in case other sources of retirement income may
fail; raise the minimum pension amount to dissuade pension-
ers from investing their retirement savings; conducting busi-
ness skills training for those exiting the workforce prior to
retirement; and encourage prior retirement planning to avoid
income pitfalls in retirement.
HOMEOWNERSHIP, SOCIAL INSURANCE, AND
OLD-AGE SECURITY IN THE UNITED STATES AND
EUROPE
S.Mudrazija, B.A.Butrica, Urban Institute, Washington,
District of Columbia
Government policies often encourage homeownership
as an effective way of building assets and a de facto self-
insurance mechanism for old-age security. In the wake of
the Great Recession, however, the homeownership rate in
the United States has been declining. It may not rebound to
its pre-recession peak in the foreseeable future, and it could
decline even further. This project compares the United States
and 10 European countries to understand the role of home-
ownership in retirement security, vis--vis public and private
pensions, and savings. Using panel data from the Health
and Retirement Study and the Survey of Health, Ageing,
and Retirement in Europe, it explores trends in homeowner-
ship among older adults in different countries, both before
and following the Great Recession, and examines how the
link between homeownership and old-age financial security
differs across these countries. The results show that home-
ownership rate in the United States (64%) is lower than in
Southern European countries, and similar or higher com-
pared to Northern and continental European countries.
However, older persons in Southern Europe are much less
likely than older Americans to tap into housing equity to sup-
port their standard of living in retirement. Unlike the United
States, European countries have generally not experienced a
substantial change in homeownership rates during and fol-
lowing the recent recession, regardless of the difference in
184
the severity of the economic crisis across countries. Anotable
exception is population of lower socioeconomic status. The
study concludes with a critical comparison of homeowner-
ship-related policies in the United States and Europe.
WOMENS BASIC FIRST PILLAR PENSIONS IN
EUROPE: WHAT FACTORS IMPACT THE AMOUNT?
S.Bould1,2, C.Krekula3, C.Gavray4, I.Crespi5, R.Eleta-De
Filippis6, N.Nikolaev7, 1. Gerontology Institute, University
of Massachusetts Boston, Somerville, Massachusetts, 2.
University of Delaware, Newark, Delaware, 3. Karlstad
University, Karlstads, Sweden, 4. University of Liege,
Liege, Belgium, 5. University of Macerata, Macerata, Italy,
6. University of Le Havre, Le Havre, France, 7. alivia
Technology, Woburn, Massachusetts
In all 5 of the countries studied, Germany, Sweden,
Belgium, France and Italy, women live longer than men and
risk having a lower amount of basic pension. This research
examines the variables of age, work experience, marital sta-
tus, educational level, and number of children as predictors
of pension amount for women. Unlike men, marital status
has a significant impact on pensions; widows have a higher
basic pension amount than married women; never mar-
ried and divorced women do better than married women in
Germany, France and Belgium.
This research uses the SHARE data from Wave 5 to estab-
lish the basic pension amount. This pension consists of the
state managed retirement pension plus old age pensions.
These sources provide the principal income for the majority
of retirees in these countries as the wage and salary related
private occupational pension has limited impact on post
retirement income for this cohort. The sample consists of all
women over 65 who do not receive any work related income
and report a pension amount for the last year of more than
1000 euro.
Initial results indicate that level of education is a signifi-
cant predictor of pension amount in all countries studied.
The womens education is a factor independent of her work
experience and probably reflects her marriage prospects.
Years of work experience is a significant predictor of pension
amount for all countries except Belgium while the number
of children is significant only in Germany. Final results will
compare equations for women with those for men.
GENDER IN NEO-LIBERAL RETIREMENT INCOME
SYSTEMS: COMPARING THE U.S., UK, AND
SINGAPORE
D.A.Street1, D.Price2,3, 1. Department of Sociology,
SUNY at Buffalo, Buffalo, New York, 2. The University of
Manchester, Manchester, United Kingdom, 3. Manchester
Institute for Collaborative Research on Ageing, Manchester,
United Kingdom
A substantial literature highlights how reliance on private
sector sources for later life finances systematically disadvan-
tages women. Critics of the neo-liberal policy turn argue that
this is because public responsibilities have increasingly been
privatized. We critically assess this claim in respect of pen-
sions using a comparative analytic approach to document
retirement income systems in the US, UK and Singapore,
three liberal countries often regarded as among the vanguard
for private arrangements for income. Our conclusions are
Innovation in Aging, 2017, Vol. 1, No. S1
derived from critical analysis of national policies and sec-
ondary analysis of official statistics. We find that, contrary to
prevailing assumptions, Singapore (often referred to as the
worlds most marketized country) has multiple inbuilt state
protections that minimize both risks and gender gaps in later
life provision for citizens, and has many of the characteris-
tics of protective state systems. However, in Singapore, the
most disadvantaged workers, often migrant women, are nei-
ther included in national accounts nor considered as poten-
tial recipients of income in later life, thus heavily skewing
the results. Such low-paid workers are included in data for
the other two countries. The US seems to occupy the mid-
dle ground among the three countries. Both US and UK rely
heavily on a mixed economy of retirement income; however,
the greater state support for public pensions in the US Social
Security system leads to categorizing the UK as the country
where older women, and older people in general, seem most
at risk of poor outcomes in old age.
FINANCIAL LITERACY AND THE ECONOMIC
EXPERIENCES OF OLDER ABORIGINAL ADULTS IN
CANADA
L.McDonald, E.Relyea, R.M.Mirza, J.Hsieh, K.Mercer,
B.MacDonald, C.Aliman, J.Fujioka, Institute for Life
Course and Aging, University of Toronto, Toronto, Ontario,
Canada
Lifelong socio-economic development disparity between
Indigenous Peoples and the general population across
Australia, New Zealand, the United States, and Canada is
a significant risk factor for marginalization in later years
(Brascoup, Weatherdon, & Tremblay, 2013). A scoping
review on international financial literacy programs con-
ducted prior to this study indicated the need to address finan-
cial knowledge gaps in Indigenous populations, specifically
focusing on financial literacy across the lifespan. The findings
of this review informed this mixed methods research study,
drawing on results from a consensus meeting (n=15), survey
(n= 50), and focus group data (n=25) to better understand
the financial realities of Canadian elderly Aboriginals who
live on and off reserves. The results of the study indicate that
the financial capabilities of older Aboriginals are not well
understood and that tailored money management initia-
tives must consider the needs of Aboriginal older adults with
lower income. Strategies to improve financial literacy are also
complicated by the implications of status, tax-exemptions,
gendered income disparities, and band laws. The knowledge
gained from this study led to the development of financial
literacy resources that address the following issues: navigat-
ing financial resources and benefits, saving and education
for grandchildren, legal and tax issues, and band issues. The
findings from this study are applicable beyond a Canadian
context to demonstrate the complexity of financial issues
faced by the growing elderly Indigenous communities, and
the need for diverse international financial literacy programs
to include cultural elements of knowledge translation, cul-
tural relevancy and cultural safety.
GOAL-SETTING TYPOLOGIES EVIDENT AMONG
COMMUNITY-DWELLING AUSTRALIAN RETIREES
D.Dudley, K.OLoughlin, V.Loh, The University of Sydney,
Lidcombe, New South Wales, Australia
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
While in many developed nations the transition to retire-
ment is becoming more complex, retirement remains a key
milestone in many peoples lives. As the time spent in retire-
ment increases, the quality of life of retirees is of growing
importance for researchers and policy makers across multi-
ple disciplines. Prior studies into the nature of personal goals
in retirement focus on the types of goals retirees have and
how these goals shape wellbeing. However, few studies have
examined how retirees view goal-setting in a broader life-
style context, the motivations underlying goal-setting, and
how these might change across retirement and with age. This
paper will examine these less well understood dynamics of
goal-setting.
Data from a series of paired and individual in-depth qual-
itative interviews with 60 semi- and fully-retired community-
dwelling Australians aged between 55 and 90years, indicate
that the process of setting goals and the kinds of goals that
are important to retirees appear to shift over time and at
different retirement stages. Three typologies are observed
in terms of the motivations for goal setting and the endeav-
ours pursued. The first group characterised by those in early
retirement or semi-retirement described goals set to create
structure, explore new experiences and develop skills. Mid-
retirement is characterised by a typology centred on goals
which maintain connection with friends, family, and engage-
ment with the broader community often through volunteer
work. Athird profile, more typical of those in late retirement,
is focussed on more practical and modest goals designed to
deliver independence and survival.
RETIREMENT ADJUSTMENT-THE EARLY YEARS: A3
COUNTRY QUALITATIVE COMPARISON
D.Smeaton, Policy studies Institute, London,
United Kingdom
In a review of psychological perspectives on the chang-
ing experience of retirement, Schultz and Wang note (2011:
8)retirees actively shape their experiences in retirement. As
active selves, retirees reflect on and evaluate their experiences
[and] are able to modify their environment to shape their
retirement experiences. Such perspectives emphasise the
salience of self-efficacy, agency and proactive behaviour in
shaping retired life, but can produce an under socialised con-
ception of the individual agent. In theorising retirement tran-
sitions and outcomes it is important to account also for the
extent to which retired lifestyles and choices are constrained
or facilitated by broader opportunities, cultural context and
social structure. Social position, labour markets, welfare and
pension systems set the context in which retirement path-
ways unfold. Opportunities may also be more locally deter-
mined, with community hubs, associational activity and local
facilities playing an important role in the promotion of social
integration.
In order to explore the influence of social context and
opportunity structures on the experience of retirement this
paper examines a sample of 135 older people aged 55+ inter-
viewed over 3years as they made the transition from work
to retirement in Italy, USA and England each characterised
by distinct cultural orientations and welfare regimes. Using
qualitative methods, the paper introduces the voices of these
retirees to gain insights into: their retirement journeys; pleas-
ures and disappointments; social roles and activities; and the
IAGG 2017 World Congress
185
opportunities and obstacles encountered in pursuing aspira-
tions. Implications of findings for concepts such as success-
ful ageing and active ageing are highlighted.
WOMENS ATTITUDES AND EXPECTATIONS
TOWARDS PENSION SAVING FOR RETIREMENT IN
THE UK
L.Foster, M.Heneghan, University of Sheffield, Sheffield,
United Kingdom
Gender differences in the accumulation of pension sav-
ings in the UK and beyond are well documented. Such work
has concluded that while differing lifetime work profiles (and
family history) explained much of the difference, other fac-
tors may also be significant. This work, funded by the Fawcett
Society in association with Scottish Widows, explores some
of these factors through the use of 30 semi-structured inter-
views and a focus group with women (aged 2439) about
their attitudes and motivations towards pension saving. It
identified various themes. These include a lack of knowledge
about pension provision, exacerbated by a shortage of relat-
able and understandable advice in assisting with pension
decisions. There was also a tendency to sequence saving, first
paying down any debts accumulated at university, and then
saving for housing and children, before finally beginning to
focus on retirement. The interviews also elucidated a number
of observations around the impact of motherhood and child-
care with many participants expecting to rely on the pension
of their partner in retirement. Women also often alluded to
male roles in their pension making decisions, in particular,
their father as a key source of advice. Whilst often taking
a lead role in other household financial decisions, many
women expressed the superior knowledge of their male
partners around pensions. These practices may make pen-
sion provision appear to be a masculine domain. Following a
discussion of these themes this poster will explore potential
policy mechanisms to enhance womens pension saving for
retirement.
PREDICTING FINANCIAL DISTRESS IN NURSING
HOMES: AN APPLICATION OF THE ALTMAN
Z-SCORE MODEL
J.Lord, R.Weech-Maldonado, G.Davlyatov, University of
Alabama at Birmingham, Birmingham, Alabama
From 2000 through 2013, there have been 1,223 nursing
home closures. Nursing home closures have a negative impact
on the displaced residents health and the local community
(i.e. lost jobs). There are multiple factors that attribute to a
nursing home closure; however, financial performance plays
a significant role.
The purpose of this paper is to examine the probability
of nursing home failure via the Altmans Z-Score bankruptcy
prediction model. The Altman Z-score model is a discrimi-
nant function derived from a multiple discriminant analysis
(MDA). The MDA generates a weighted linear function of the
financial ratios that best discriminates between the group of
firms in financial distress and those not in financial distress.
Financial ratios include income and balance sheet ratios to
assess the organizations liquidity, profitability, efficiency and
insolvency. This study will require the establishment and vali-
dation of new weight coefficients in order to properly predict
if the organization is financially healthy or risky. This study
186
utilized facility level data from the Medicare Cost Reports
from 2000 to 2013. The sample size will be approximately
15,600 facilities per year. Hospital-based skilled nursing facil-
ities, government facilities and nursing homes that receive no
Medicare will be excluded from the study.
The validated Altmans Z-score model for nursing homes
can serve as a tool for policymakers to identify nursing
homes under financial distress. This can facilitate interven-
tions targeting nursing homes that are at risk of closure.
FROM THE CFO TO THE BEDSIDE: AN
EXAMINATION OF NURSING HOME FINANCIAL
DISTRESS ON QUALITY
J.Lord, R.Weech-Maldonado, G.Davlyatov, University of
Alabama at Birmingham, Birmingham, Alabama
From 2000 through 2013, there have been 1,223 nurs-
ing home closures. Nursing home closures have been shown
to have a negative impact on the displaced residents health.
Displaced nursing home residents often face significant det-
rimental health effects, such as, a decrease in social engage-
ment and with activities of daily living. Nursing homes that
typically close do so because of financial difficulties.
This paper will examine the quality of care delivered
in nursing homes under financial distress. This study will
use 20002013 data from the Medicare Cost Reports,
the Online Survey Certification of Automated Records
(OSCAR), Certification and Survey Provider Enhanced
Reports (CASPER), Long-Term Care (LTC) Focus, and the
Area Resource File. The sample size will be approximately
15,600 facilities per year. The dependent variables consist of
quality variables that include RN, LPN, and CNA staffing
ratios, residents with catheters, restraints, pressure ulcers,
bowel incontinence, bladder incontinence, hospitalizations,
re-hospitalizations, and facility quality of care deficiencies.
The independent variable will consist of a dichotomous vari-
able identifying where a nursing home is in financial distress
as calculated by the validated Altman Z-score. Control vari-
ables include for-profit status, size, acuity index, and mar-
ket competition (Herfindahl Index). Data are analyzed using
fixed effects regression and lagged independent variables.
If financial distress is correlated with inferior resident
quality care, this should illuminate some reasons for dispari-
ties in the delivery of care of long-term care. Understanding
how organizational performance is correlated with resident
care quality has the potential to provide insights on how to
address and improve patient care delivery.
THE 2015 ELDER ECONOMIC SECURITY STANDARD
INDEX: GEOGRAPHIC AND DEMOGRAPHIC
ASPECTS
Y.Li1, P.Xu1, J.E.Mutchler1, J.Lyu3, 1. Gerontology,
UMass Boston, Boston, Massachusetts, 3. Institute of Aging,
Hallym University, Chuncheon, Korea (the Republic of)
The Elder Economic Security Standard Index (Index) offers
a cost of living standard for independent, community-dwelling
singles and couples aged 65 and older, calculated for every
county in the United States. The Index includes local cost of
housing, food, transportation, healthcare, and other expenses.
Annual costs of living are calculated under three housing sce-
narios: homeowners with a mortgage, homeowners without a
mortgage, and renters. Across these scenarios, the Index shows
Innovation in Aging, 2017, Vol. 1, No. S1
that cost of living increased 1% - 7% for seniors from 2011
to 2015. National summaries indicate that for singles in good
health, annual Index values range from $19,872 to $30,516;
for couples, they range from $30,288 to $40,932. Single
homeowners in good health and without a mortgage have the
lowest cost, whereas couple homeowners in poor health and
with a mortgage have the highest cost of living. We illustrate
spatial variation in cost of living for older adults using maps
and spatial analysis techniques. Further analysis highlights
gaps between cost of living and the typical Social Security
benefit; these gaps also differ substantially across geographic
areas. Locations in which the cost of living for seniors has
increased most markedly between 2011 and 2015 are identi-
fied. We also identify gender, race, and age segments within the
older population that are most substantially impacted by spa-
tial inequality in cost of living for older adults. Resources for
adults who are older, female, or of a racial or ethnic minority
group are more likely to fall below the Index value.
EXAMINING ORGANIZATIONAL AND MARKET
FACTORS ASSOCIATED WITH NURSING HOME
FINANCIAL DISTRESS
J.Lord, R.Weech-Maldonado, G.Davlyatov, University of
Alabama at Birmingham, Birmingham, Alabama
From 2000 through 2013, there have been 1,223 nursing
home closures. Nursing home closures have a negative effect
on the health of the displaced resident as well as adverse
societal implications (i.e. lost jobs and reduced access). This
paper will focus on the market and organizational contex-
tual factors associated with nursing homes that are under
financial distress.
This study will use 20002014 data from the Medicare
Cost Reports, the Online Survey Certification of Automated
Records (OSCAR), Certification and Survey Provider
Enhanced Reports (CASPER), Long-Term Care (LTC) Focus,
and the Area Resource File. Organizational factors such as
chain affiliation, for-profit status, staffing, occupancy rates,
acuity index, payer-mix, age of facility, and other related
organizational factors will be explored. The market forces
like a countys level unemployment, per capita income, per-
cent of minority population, education levels, community
size (rural vs. metropolitan), managed care penetration,
Medicaid reimbursements and level of competition will also
be explored. The independent variable will consist of nurs-
ing homes in financial distress as calculated by the validated
Altman Z-score. Using regression analysis with state and
year fixed effects, the study will examine the impact of these
factors on nursing home financial distress.
Unfortunately, nursing home closures do not impact all
communities the same. Nursing home closures may dispro-
portionately impact certain ethnic/socio-economic areas. The
identification of market and organizational contextual factors
that are predictors of financial distress can complement pre-
diction models based on financial indicators, and further assist
policymakers in targeting nursing homes at risk of closure.
BARRIERS AND FACILITATORS OF RETIREMENT
SAVINGS FOR PRE-RETIREES IN THE UNITED STATES
L.Sullivan, Brandeis University, Waltham, Massachusetts
The retirement landscape is undergoing significant changes
in the United States as employer benefits are increasingly
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
being scaled-back and public social insurance programs for
older adults face growing financial costs. Much public policy
dialogue today focuses on shifting more and more of the bur-
den of preparing for retirement onto individuals. However,
many households have limited retirement savings and six in
ten older households (65+) receive the majority of income
from Social Security benefits. In the current context, more
knowledge is needed regarding the experiences of house-
holds as they save for retirement. This paper aims to enhance
our understanding of the factors that aid or hinder individual
savings for retirement. Using semi-structured interviews to
collect qualitative data regarding the savings experiences
of 16 pre-retirees (ages 5065), the research explores the
underlying dynamics of retirement savings for households
approaching retirement. Findings reveal four substantial bar-
riers to retirement savings including: 1.) insufficient financial
knowledge; 2.) difficulties with intertemporal decision-mak-
ing; 3.) low capacity to save; and 4.) economic shocks during
the life course. The two key facilitators of secure retirement
prospects were: 1.) inheritance; and 2.) defined-benefit pen-
sions for those who had stable careers with a single employer.
With traditional pensions on the decline and many families
without family wealth, the savings barriers outweigh the
facilitators for most families in the sample. The discussion
highlights the limitations of policy proposals that rely pri-
marily on individual savings solutions for upcoming cohorts
of retirees and suggests the importance of bolstering public
programs such as Social Security.
SESSION 545 (POSTER)
EXPERIENCES OF OLDER ADULTS AND CAREGIVERS
HOW DO ELDERLY PEOPLE IN NEED OF CARE
EXPERIENCE TRANSITION TO ALONG-TERM CARE
FACILITY?
K.Krug, C.Boldt, S.Strupeit, Nursing Science, Munich
University of Applied Sciences, Munich, Germany
As the average length of stay of nursing home residents is
decreasing, more elderly people are experiencing the transi-
tion to a nursing home. This is a critical life event for those
affected. The purpose of this study was to examine how
elderly people in need of care experience transition to a
long term care facility Fifteen elderly people in Bavaria, who
recently moved to a long term care facility, were interviewed
about their experiences during the process of admission.
They were asked to speak about the problems they were fac-
ing and how they managed to adapt to their new living situ-
ation. The theoretical background of this study was based on
the diathesisstress-model and the action-theoretical-model
about the transition to a nursing home. The nursing home
residents were facing great changes in their lives. They had to
leave their home, had to choose from among their properties
those, which should be disposed of or earmark any proper-
ties, they may wish to bring with them.
The greatest problems were to find social contact among
the other residents and how to deal with the nursing staff
shortage and great losses among their new social setting.
It was concluded that nursing staff plays an important
role for new nursing home residents, as they are the first
IAGG 2017 World Congress
187
social contacts to make. Nurses should observe their behav-
ior and support them when in need.
RESIDENTS SATISFACTION WITH CROSS-
CULTURAL CARE IN RESIDENTIAL CARE HOMES:
ACROSS-SECTIONAL STUDY
L.Xiao1, E.Willis1, A.Harrington1, D.Gillham1, A.De
Bellis1, W.Morey2, L.Jeffers3, 1. School of Nursing &
Midwifery, Flinders University of Australia, Adelaide, South
Australia, Australia, 2. Resthaven Inc. Australia, Adelaide,
South Australia, Australia, 3. AnglicareSA Inc. Australia,
Adelaide, South Australia, Australia
Introduction: In Australia residents in aged care homes
and staff who care for them come from diverse cultural and
linguistic backgrounds. This characteristic of diversity chal-
lenges aged care service providers to provide high-quality
care for residents.
Method: The aim of this study was to examine the level of
satisfaction with cross-cultural care services from Australian-
born and Overseas-born residents. A cross-sectional survey
was used to collect data in four care homes. A residential
cross-cultural care service questionnaire was used in the
survey. Two open-ended questions were included to give
residents to comment on their perceptions of cross-cultural
interactions with staff.
Results: In total, 123 residents completed the survey with
a return rate of 31.1%. The median age of residents was
87 years of age. The length of stay in the care home was
12 months. Overseas-born residents made up 28% of the
participants in the survey and they were from 10 countries.
There was no significant difference between the Australian-
born group and the Overseas-born group in terms of sat-
isfaction with a whole range of care services. There were
three categories identified from residents comments: (1) the
need to improve cross-cultural communication with staff, (2)
the need to meet dietary preference for residents, (3) needs-
based training programs for staff to improve cross-cultural
integrations.
Conclusion: Australian-born and the Overseas-born resi-
dents may experience similar challenges to adapt to a cross-
cultural care environment. Regular staff training to address
residents expectations of care services is one way to foster
high-quality cross-cultural care.
SUPPORTING PEOPLE WITH DEMENTIA AND
FAMILY CARERS IN TRANSITION TO NURSING
HOME: ASYSTEMATIC REVIEW
A.Stephan1, C.Mller1,2, G.Meyer1, S.Lautenschlger3,
1. Institute for Health and Nursing Science, Martin Luther
University Halle-Wittenberg, Halle (Saale), Germany, 2.
University of Cooperative Education in Health Care and
Welfare Saarland, Saarbrcken, Germany, 3. University of
Applied Sciences, School of Social Sciences, Saarbrcken,
Germany
During the transition of people with dementia from home
to nursing home, family carers often feel insufficiently pre-
pared and burdened, and people with dementia often show
behavioral and neuropsychiatric symptoms.
A systematic review was conducted according to the
Cochrane Handbook for Intervention Reviews and the
protocol registered in PROSPERO. Reporting follows the
188
PRISMA statement. MEDLINE, CENTRAL, PsycINFO,
CINAHL, OTseeker, and PEDro, were searched, additionally
Google Scholar and ALOIS. The Cochrane Risk of Bias tool
was used for critical appraisal. The development and evalua-
tion of interventions were appraised according to recommen-
dations of the UK Medical Research Council on complex
interventions. Findings were synthesized narratively.
The search yielded 1,278 records. Five studies were
included, all performed in the US. The interventions identi-
fied were individual and family counseling via telephone or
ad hoc, addressing solely the informal carers. Data on effi-
cacy were inconsistent. Significant effects were found con-
cerning less depressive symptoms, burden, feeling of guilt,
emotional distress, overload, and influence on interactions
with staff. Other outcomes, i.e. stress, adaptation to place-
ment, role overload, role captivity, were not statistically sig-
nificantly affected. The risk of bias across studies varied from
moderate to low. Only two studies tested the feasibility of the
intervention before full scale evaluation, none evaluated the
implementation process.
We identified a small number of studies with heterogene-
ous outcomes; evidence regarding the effectiveness of psy-
chosocial interventions is thus insufficient. Reporting on the
feasibility and the implementation process of interventions
should be guaranteed, since it is crucial to evaluate the trans-
ferability across care settings.
AFRICAN AMERICAN ADRD FAMILY CAREGIVER
PERCEPTIONS OF CAREGIVING AND SELF-CARE
F.Cothran1, O.Paun1, L.L.Barnes2, 1. Rush University T.Hirata1, Y.Arai1, M.Takayama1, Y.Osawa2, Y.Abe1,
CollegeNursing, Chicago, Illinois, 2. Rush Alzheimers
Disease Center, Chicago, Illinois
Over 5 million persons are affected by Alzheimers dis-
ease or related dementia (ADRD), which is a growing public
health issue, with 75% of family caregivers providing care
in the community. There are considerable mental and physi-
cal health costs impacting ADRD family caregivers, with
research aimed at testing interventions designed to improve
health outcomes of ADRD family caregivers. However,
African American ADRD family caregivers are underrep-
resented in ADRD family caregiving intervention research,
where little is known about how they experience the car-
egiving process and manage their own mental and physical
health as a result of the caregiving process. The purpose of
this study was to examine African American ADRD fam-
ily caregivers perceptions of the caregiving experience and
self-care practices during the process of caregiving. Twenty-
four, 90-minute semi-structured individual interviews were
conducted with African American ADRD family caregivers.
Common themes will be presented, where findings will fur-
ther inform the design and implementation of a culturally
tailored intervention to meet specific needs and improve the
health of African American ADRD family caregivers.
EXPERIENCE OF ONES AGING: AGING KNOWLEDGE
AND ROLE MODELS INFLUENCE
E.Salina, C.Salan, P.Jamin, D.S.Jopp, University of a multivariate cox proportional hazard model adjusted for
Lausanne, Institute of Psychology, Lausanne, Switzerland
Social relations may impact both what we know about
aging and how we evaluate our own aging process. Yet, these
influences are empirically not well established or understood.
Innovation in Aging, 2017, Vol. 1, No. S1
Aging knowledge contributes to how we evaluate perceived
age-related changes (Moliner etal., 2008). Role models influ-
ence the way of leading our lives (Lockwood et al., 2005).
The present study examines these factors regarding their
links to aging satisfaction.
A total of 389 individuals, aged 17 to 99years (M=45.61;
57.6% females) indicated their aging knowledge sources
(i.e., TV, press, formation, family, other social contacts) and
reported which specific person they had in mind when think-
ing about aging and the valence of these role models.
Over half of the participants (53.7%) mentioned family
as main source of aging knowledge, followed by TV (5.7%)
and education (3.1%). The younger participants were, the
more they indicated that TV was their most important
source of aging knowledge (F=4.289; p<.05). Family mem-
bers were mentioned most often as role models (71.5%), and
most of them were positive (55%; negative models: 11.8%).
Individuals with family role models also reported to have
their primary aging knowledge from the family (ch2=23.38,
p<.001). Having positive role models was associated with
higher aging satisfaction. Having a positive family role model
was marginally linked to higher aging satisfaction (p=.05).
Results suggest the importance of the family for our
aging process. It is an open question how TV or education
could be used to better inform individuals about actual aging
researches.
PERSONALITY, HEALTH BEHAVIOR, AND
MORTALITY IN THE VERY OLD
T.Iinuma3, M.Fukumoto3, M.Takayama4, 1. Keio
University School of Medicine, Tokyo, Japan, 2. National
Institute of Health / National Institute on Aging, Baltimore,
Maryland, 3. Nihon University School of Dentistry,
Tokyo, Japan, 4. Keio University Science and Technology,
Yokohama, Kanagawa, Japan
Growing evidence suggests that personality trait is associ-
ated with longevity, however, the mechanistic link has not
been fully elucidated. The aim of this study was to investigate
the association between personality traits and longevity and
to investigate mediating pathways of this link in the very old.
In a cohort of 460 senior (200 men and 260 women) aged
85years or older living in the community, personality traits
were assessed with NEO five-factor inventory, which consists
of conscientiousness, agreeableness, neuroticism, openness,
and extraversion. Activity of daily living (ADL), Cognitive
function (mini-mental state examination), wellbeing
(WHO5), leisure time physical activity (time spent for walk-
ing and exercise per week), denture wearing during sleep at
night, and body mass index were assessed at the baseline, and
all-cause mortality was followed-up for 6years. Extraversion
and conscientiousness showed significant positive association
with wellbeing and physical activity, while neuroticism was
negatively associated with wellbeing and cognitive function.
Agreeableness was associated with being woman and wellbe-
ing. During the study period, 151 (32.8%) persons died. In
demographics and potential confounders, only neuroticism
was significantly associated with all-cause mortality (haz-
ard risk for the highest tertile, 1.63, 95% confident interval,
1.052.52, p=0.029). Our results suggest that extraversion
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and conscientiousness were associated with wellbeing and
health behavior, however, the two traits has limited impacts
on mortality beyond 85years. Neuroticism was significantly
associated with mortality independently from wellbeing,
cognition, and health behaviors.
SESSION 550 (POSTER)
FAMILY AND INTERGENERATIONAL
RELATIONSHIPS I
PARENT-CHILD RELATIONSHIP AND FILIAL PIETY
AFFECT PARENTAL HEALTH AND WELL-BEING
H.Hsu, Asia University, Taichung, Taiwan, Taiwan
Purpose: Filial piety and family-centered concepts were
previously the core of Taiwanese culture. However, the mean-
ing and effects of these traditional concepts may have changed
with the dramatic social evolution in Taiwan. The purpose
of this study is to examine the effects of social exchanges,
filial piety and adult childrens concept of family on the
health and wellbeing of their parents. Methods: Panel data
were obtained from the Panel Study of Family Dynamics,
years 2005 to 2011. The sample comprised parents and their
adult children who participated in the survey from 2005
to 2011. In total, 208 people and 1,336 observations were
included for analysis. Factor analysis and generalized linear
modeling with repeated measurements were applied. Results:
The parent-child relationship predicted self-rated health for
both fathers and mothers and predicted the life satisfaction
of mothers. Filial piety was positively related to the self-rated
health of mothers but was negatively related to the self-rate
health of fathers. Other dimensions of filial piety and family
concepts were not significant. Discussion: The parent-child
relationship probably matters more than filial piety in the
health and wellbeing of Taiwanese middle-aged and young
adults. Such reciprocal harmonious relationships need the
investment of time and an empathic perspective of the others
needs from both parents and adult children. Anew paradigm
of filial piety or the parent-child relationship is evolving.
BETWEEN ADULT CHILDREN AND PARENTS:
MULTIGENERATIONAL SUPPORT EXCHANGE AND
WELL-BEING IN MIDLIFE
J.Lin, C.Huang, C.Yu, National Taiwan Normal
University, Taipei, Taiwan
This study examined a typology of multigenerational sup-
port exchange of individuals in mid-life, their aging parents
and adult children. The relationships between multigenera-
tional support exchange and a mid-life individuals life sat-
isfaction were explored. Using data from the 2011 Taiwan
Social Change Survey (Institute of Sociology, Academia
Sinica, Taiwan, 2011), the Family Module consists of an
island-wide sample of 2,135 adults aged 18 years old and
above who were randomly chosen using a multi-stage strati-
fied sampling method and interviews. In this study, only sub-
jects aged between 40 and 64, with at least one aging parent
(aged 65 and above, G1) still alive and one adult child (aged
18 and above, G3) were analyzed. Four types were found
for multigenerational support exchange: (a) Give support to
aging parents, (b) Support up and down, (c) Supported by
IAGG 2017 World Congress
189
adult child, and (d) Low exchange. Middle-aged adults, who
gave support to their aging parents and adult children, the
Support up and down type, were most unsatisfied with life.
Cultural values reinforce the meaning and expectations of
intergenerational support and shape the outcomes.
DEPRESSION IN CHILDREN RAISED BY THEIR
GRANDPARENTS VS. FOSTER PARENTS: THE
IMPACT OF PARENTING STYLE
D.K.Nadorff, Psychology, Mississippi State University,
Mississippi State, Mississippi
Over 5.4 million children within the US are raised by their
grandparents, and yet, little research has been done on the
developmental, emotional, and behavioral outcomes of these
children. Most studies have used a comparison group of chil-
dren raised in typical family settings, which proves an unfair
comparison group, as so many of these custodial grandchil-
dren have been placed into their grandparents care as a
result of parental trauma. The purpose of the current study is
compare the mental health of children raised by their grand-
parents with those raised by a foster parent.
Participants were 323 grandparents raising their grand-
children, and 105 foster parents, recruited via Qualtrics
Panel Service. The mean age was 50.44 years. The sample
was 83.9% female, 58.6% were married, 17% were racial
minorities, and 52% were employed. Measures included
Angold & Costellos Mood and Feelings Questionnaire,
which assesses childrens depressive symptoms, and Fricks
Alabama Parenting Questionnaire, which assesses the
amount of warmth, consistency in discipline, and the amount
of supervision that caregivers apply while parenting their
children.
Children raised by their grandparents had significantly
lower levels of depressive symptoms than those raised by fos-
ter parents. Grandparents also reported significantly higher
levels of consistent discipline practices and higher supervi-
sion of their grandchildren. Mediation analyses found that
the relation between caregiver type and childrens depressive
symptoms was significantly mediated by both supervision
level and consistency in discipline. These results suggest that
caregivers discipline and supervision are two appropriate
targets for interventions on childrens depressive symptoms.
INHERITED STEPGRANDPARENT-
STEPGRANDCHILD RELATIONSHIPS
C.Sanner, L.H.Ganong, M.Coleman, Human
Development and Family Science, University of Missouri,
Columbia, Missouri
Stepgrandparent-stepgrandchild relationships have increased
in number. Although researchers have suggested that multigen-
erational steprelationships may be important, little is known
about the relational processes involved in the development of
these ties. Further, researchers have seldom differentiated
between stepgrandparents who are the spouse of a biological
grandparent, and those who are the parents of a stepparent
(i.e., inherited stepgrandparents). These individuals inherit
stepgrandchildren when an adult child becomes a stepparent
by marrying someone with children from a previous relation-
ship, thereby gaining a son- or daughter-in-law in addition to
stepgrandchildren through their childs remarriage. Inherited
stepgrandparents are different from other stepgrandparents
190
in that they did nothing to acquire their new status, mak-
ing the stepgrandparent-stepgrandchild relationship mutu-
ally involuntary. The purpose of this study was to explore
the development of stepgrandchildrens relationships with
inherited stepgrandparents. Interviews with 43 inherited
stepgrandchildren (aged 1935) revealed variation in quality,
frequency, and type of interactions with stepgrandparents.
Stepgrandchildren ranged from having met their stepgrand-
parents once or twice (being unable to even recall their
names) to receiving daily after-school care from stepgrand-
parents or sharing weekly family meals. These intergenera-
tional step-relationships were close when stepgrandchildren
were young when the relationships began, when relation-
ship quality between middle-generation stepparents and the
stepgrandparents were positive, and when stepgrandchildren
were receptive to stepgrandparents affinity-building efforts.
The quality of stepgrandchildrens relationships with their
stepparents, how they perceived their inherited stepgrand-
parents (i.e., as kin or not kin), and logistical conditions (e.g.,
distance, contact frequency) also were relevant. We explore
the implications of these relationships for older adults.
HISTORY OF MATERNAL CHILDHOOD
MALTREATMENT AND LATER-LIFE SOLIDARITY
WITH THE ABUSIVE MOTHER
J.Kong, Pennsylvania State University Center for Healthy
Aging, University Park, Pennsylvania
Studies based on the life course perspective have iden-
tified several mechanisms by which childhood maltreat-
ment has a long-term negative impact on the adult victims
psychological functioning. However, little is known about
whether and how later-life solidarity with the abusive par-
ent plays a role as a potential mechanism. Thus, this study
aims to address this gap in the literature by examining the
mediating effect of later-life intergenerational solidarity
with the abusive parent in the association between mater-
nal childhood maltreatment and psychological well-being/
depressive symptoms.
Using the 20042005 data from the Wisconsin
Longitudinal Study, this study employed a structural equation
modeling approach to analyze a total of 1,371 adults aged
65years old. Results showed that maternal childhood mal-
treatment was associated with lower associational, affectual,
and consensual solidarities with aging mothers. In addition,
a mediation analysis showed that the association between a
history of maternal childhood maltreatment and psychologi-
cal well-being of the adult children was significantly medi-
ated by affectual solidarity with the aging mother.
The findings of this study suggest that practitioners may
support adults with a history of childhood maltreatment
by untangling unresolved issues with their abusive parent.
Policy support should be in place to address the concerns
of adults with a history of childhood maltreatment through
systematic and societal efforts.
MARITAL QUALITY OF GRANDPARENTS CARING
FOR GRANDCHILDREN
S.Wang, Gerontology, University of Massachusetts Boston,
Boston, Massachusetts
High quality of marital relations has protective effects
on older adults mental and physical well-being. However,
Innovation in Aging, 2017, Vol. 1, No. S1
few studies examined how providing grandchild care affect
grandparents marital quality. This study distinguished three
grandchild care types and examined their associations with
grandparents marital quality.
The sample consists of married grandparents aged 45 and
over from the 2008, 2010 and 2012 waves of the Health and
Retirement Study (N=6181, 52% females, mean age=68).
Grandparent caregivers were categorized as primary caregiv-
ers (living only with grandchildren), co-parenting caregivers
(living with adult children and grandchildren), and babysit-
ting caregivers (not living with grandchildren but providing
care). Babysitting care hours over the past two years were
differentiated as high (more than 500 hours), modest (200 to
500 hours), low (less than 200 hours), and none (reference
group). Marital quality was measured by perceived closeness
with spouse.
Primary caregivers reported significantly lower marital
quality than grandparents providing no care. Among grand-
parents with high care hours (500+), grandmothers are less
likely to report close marital relations than grandmothers
providing no care, whereas there is no association for grand-
fathers. Higher marital quality is also associated with older
couples better health and fewer dependent children in the
household.
Findings suggest that high intensity of grandchild care can
undermine marital relations, especially from wives perspec-
tive. Support groups may target primary grandparent caregiv-
ers and grandmothers who provide high levels of grandchild
care to relieve their care burden. Family therapists may take
grandchild care responsibilities into consideration when pro-
viding counsel to older couples.
AGING FILIPINO IMMIGRANTS GENERATIVITY:
COLLECTIVISTIC IDEOLOGY AND
SOCIOEMOTIONAL DEVELOPMENT
D.A.Augustine1, D.C.Lewis1, K.L.Bower1, S.Young2, 1.
University of Georgia, Athens, Georgia, 2. Point Forward,
Redwood City, California
This poster presents findings from a qualitative study
with transnational Filipino families. Researchers conducted
individual and dyadic interviews with 14 Filipino immigrant
elders residing in the United States (U.S.). Filipino collectiv-
istic ideologies of interdependence and a focus on family led
to reliance of Filipino immigrant elders on social supports in
both in the Philippines and in the U.S. These transnational
support systems eased stressors associated with immigra-
tion and settlement experiences. However, these ideologies,
which support a lifestyle of close personal relationships,
also spurred participants development of guilt. Aging far
from their homeland, participants cultivated a socioemo-
tional ramification associated with their immigration to the
U.S.while also maintaining transnational relationships with
family and friends in the Philippines. Participants regretted
absences from relatives and friends life events (marriages,
birthdays, deaths). The avoidance of daily life struggles in
the Philippines, while increasing their quality of life in the
U.S., further exacerbated feelings of guilt. The combination
of guilt and a collectivist ideology of altruism strongly influ-
enced the generativity of participants as they reached mid-
life. Preserving their immigration journeys and sacrifices,
they strive to pass on knowledge and experiences to the next
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
generation by educating their children about their Filipino
cultural heritage and establishing programs that simultane-
ously benefit the younger generation and friends and fam-
ily remaining in the Philippines. This research adds valuable
information for those studying the intersection of aging and
migration. It provides insights for professionals whose aim is
to support successful aging of immigrant elders.
CARING FOR GRANDCHILDREN AND
GRANDPARENTS PHYSICAL AND MENTAL HEALTH
CHANGE
J.Yoo1, A.Karraker2, D.Russell1, 1. Iowa State University,
Ames, Iowa, 2. National Institute on Aging, Bethesda,
Maryland
Grandparent caregiving for grandchildren is an impor-
tant component of intergenerational relationships that may
have consequences for grandparent health. Many Asian soci-
etiesincluding South Koreaare aging, and more grand-
parents are providing care for grandchildren. However, the
impacts of caregiving for grandparents health and well-
being in South Korea are not well-known. Using the Korean
Longitudinal Study of Aging (KLoSA), we examined how
the transition to caring for grandchildren influenced a vari-
ety of outcomes related to the health and life satisfaction
of grandparents. The participants of this study were 6,372
KLoSA grandparents who had one or more grandchildren
from waves 14. Outcome variables included grandparents
self-reported health, Activities of Daily Living (ADL), and
Instrumental ADL (IADL), as well as grandparents reported
health satisfaction, relationship satisfaction with children,
and overall life-satisfaction. We used fixed effects regression
analyses to estimate differences in health and life-satisfaction
among grandparents who did and did not provide care to
grandchildren over consecutive two waves. Our results dem-
onstrate that the health impacts of caring for grandchildren
are complex for grandparents. Compared with grandparents
who do not care for grandchildren, grandparent caregivers
have more difficulties with ADL and IADL. Self-reported
health and health satisfaction of grandchild caregivers, how-
ever, are not significantly different from non-caregiver grand-
parents. Grandparent caregivers report greater satisfaction
with their relationship with their children as well as with
their overall quality of life compared to grandparents who
do not care for grandchildren. Taken together, these findings
suggest that grandchild care has costs and benefits for the
well-being of grandparents.
LOOKING FOR LOVE: ONLINE PROFILE CONTENT
OF OLDER AND YOUNGER GAY, LESBIAN, AND
HETEROSEXUAL ADULTS
E.Davis, K.L.Fingerman, University of Texas at Austin,
Austin, Texas
Research on romantic relationship formation has focused
primarily on young, heterosexual adults. Of the limited
research on dating in late life, even fewer studies address
the dating motivations and preferences of older adults who
identify as gay or lesbian. Nonetheless, adults of different
ages and sexual orientations may have different motivations
when seeking dating partners. These differences in motiva-
tion may be evident in their self-presentations on dating web-
sites. Consistent with developmental theories, older adults
IAGG 2017 World Congress
191
may be more likely to emphasize existing ties with family
and friends, while younger adults may emphasize themselves
and their achievements. Additionally, heterosexual adults
may be more focused on topics related to traditional mate
value, such as occupation, while individuals seeking same-
sex partners may be more likely to discuss sexuality and less
likely to emphasize family relationships. The current study
sampled 400 profiles from a popular dating website. Themes
in these profiles were identified using Linguistic Inquiry and
Word Count (LIWC; Pennebaker, Booth & Francis, 2007).
Regression analyses revealed that younger adults were more
likely to mention the self, as evidenced by a greater propor-
tion of first person singular pronouns (I, me) compared to
older adults. However, older adults were not more likely
to mention ties to friends and family. Further, heterosexual
adults were not more likely to mention their occupations
than gay or lesbian adults, but gay and lesbian adults were
more likely to discuss sexuality in their profiles and less likely
to mention family. Results are discussed in terms of evolu-
tionary and developmental theories.
AN INTERNET-BASED, MULTIGENERATIONAL
INTERVENTION TO ENHANCE KNOWLEDGE
ABOUT CARE PREFERENCES
B.D.Carpenter, E.Kozlov, Psychological & Brain Sciences,
Washington University in St. Louis, St. Louis, Missouri
Family members find it difficult to communicate about
end-of-life care preferences. Yet accurate knowledge about
care preferences can enhance a range of outcomes for both
patients and family caregivers. In this study we developed
and evaluated an Internet-based, multigenerational inter-
vention used with 40 later-life families (130 individuals) to
enhance knowledge about care preferences. Conducting this
kind of applied research over the Internet presents a range of
benefits but also challenges. In this presentation we review
both, and share results from the completed intervention.
Overall, there was a wide range of knowledge about family
members care preferences, with intraclasscorrelations sug-
gesting poor to good knowledge. The intervention enhanced
knowledge about care preferences in some families but not
others, suggesting the value of tailoring communication tools
to address unique features of families. This research provides
an example of one methodology among the many differ-
ent approaches likely needed to enhance communication in
families.
FAMILIES ACROSS BORDERS: ELDERCARE IN
MEXICAN-ORIGIN FAMILIES WITH CHILDREN IN
THE U.S.
J.C.Sechrist, Sociology, McMurry University, Abilene, Texas
In the nascent body of transnational elder caregiving lit-
erature, the empirical data primarily come from studies in
Australia and Europe and focus on caregiving at great physi-
cal distances. Much less is known about transnational elder-
care in the Americas. This study utilizes data from 1,930
parents about their 11,159 non-resident children from the
baseline survey of the Mexican Health and Aging Study to
examine within-family social support and care Mexican par-
ents receive from their adult children when at least one of
those children reside in the United States. The findings indi-
cate that of those parents receiving financial help from at
192
least one child, 80% of the parents report that the help is
from a child residing in the U.S. On the other hand, only
12.4% of parents receiving household support receive that
type of support from a child in the U.S. Of those adult
children residing in the U.S., males are more likely to send
remittances, but there is no gender differences in U.S. chil-
dren who provide household support. Further, the larger the
sibling network, the less likely U.S.children are to provide
either financial or household support. This study indicates
the primary contribution U.S. resident children make to
their parents is monetary, yet there are many who are also
attempting to contribute physically to the care of parents
in Mexico. The within family dynamics of Mexican parents
with children living in the United States warrants continued
examination in order to better understand the support sys-
tems of these aging parents.
ADULT CHILDRENS PERCEPTIONS OF UNWANTED
ADVICE FROM AGING PARENTS
H.Wang1, K.Kim1, S.Zarit2, K.L.Fingerman3, 1. ences the parent-adult child relationship quality. Further,
University of Massachusetts Boston, Boston, Massachusetts,
2. Pennsylvania State University, University Park,
Pennsylvania, 3. University of Texas at Austin, Austin, Texas
Parents and adult children often provide advice to
one another in everyday interactions. However, few stud-
ies have examined how received advice is perceived (i.e.,
whether the advice was solicited or not). Unwanted advice
can be a source of tensions in parent-child interactions,
and may represent longstanding problems in dyadic rela-
tionships. Using data from Family Exchange Study (Wave
2), the current study examined how adult childrens per-
ceptions of unwanted advice from parents are associated
with life situations and relationship characteristics. Adult
children (N = 381, aged 4565) reported how often they
perceived unwanted advice from each parent (N = 491).
Multilevel models revealed that adult children were more
likely to perceive unwanted advice from aging parents
when they suffer major life problems (e.g., divorce, major
health problem, addiction). This association was also mod-
erated by adult childrens relationship quality with older
parents. Thus, adult children suffering problems were
less likely to perceive advice from parents as unwanted
when they had better relationships with parents. Our find-
ings will contribute to the literature by considering how
received support is perceived in parent-child relationships,
which can be critical in understanding the implications of
intergenerational support for well-being.
ADULT CHILDRENS JOB LOSS AND PARENT-CHILD
RELATIONSHIP QUALITY: THE ROLE OF PARENTS
EVALUATIONS
D.Kim, M.Gilligan, Iowa State University, Ames, Iowa
The life course concept of linked-lives indicates that
intergenerational relationships are shaped by the life events
of individual family members. In this paper, we examined
how adult childrens job loss during the Great Recession
impacted parent-adult child relationship quality. In particu-
lar, we focused on how employed parents experienced adult
childrens job loss. In addition, we examined the mediating
role of parents evaluation of themselves and their children
Innovation in Aging, 2017, Vol. 1, No. S1
in the association between job loss and parent-child relation-
ship quality.
This study draws on 396 parents (M age =66.44, SD=5.71)
from the MIDUS wave3 (20132014). All of the parents
were employed and reported on whether their children expe-
rienced job loss in the last year (M age =41.34, SD=8.26).
To explore how the employment status of children affects
the relationship quality between employed parents and their
children, we performed linear regression analysis. We con-
ducted mediation analysis to examine the role of parents
evaluation of themselves and their children.
Regression analysis demonstrated that the employment
status of children had a negative effect on the quality of par-
ent-child relationship (=-.107, p<.05). Mediation analysis
indicated that parents positive evaluation of themselves and
their negative evaluation of their children helped to explain
the association between adult childrens employment status
and the quality of parent-child relationships.
These findings indicate that adult childrens job loss influ-
parents evaluation of themselves and their children mediates
this association. Taken together, this research highlights the
linked lives between parents and adult children.
GRANDPARENTS PERCEPTIONS OF THEIR ROLE AS
SOCIALIZING AGENTS: AQUALITATIVE STUDY
C.Noriega1, J.Lopez1, R.Dominguez-Bilbao2, C.Velasco1,
1. CEU San Pablo University, Madrid, Madrid, Spain, 2.
Universidad Rey Juan Carlos, Madrid, Spain
Although most research has focused on grandparents
intensive care engagement, the most common scenario is
grandparents providing auxiliary care. Value transmission
and caring are the two most important functions devel-
oped by grandparents, but grandparents socializing role
has not been studied extensively. Grounded theory method
was used to explore how grandparents with grandchildren
in primary school perceive their role as socializing agents.
6 focus-group discussions were developed to collect data.
A total of 42 grandparents from Madrid participated in
this study. The mean age was 71.42years old, 55% of par-
ticipants were women, and they were providing care daily
(47.62%) or weekly (52.38%). Data were analyzed by three
researchers using the constant comparative method. Four
themes emerged from data: 1) participants stressed they
were not responsible for their grandchildrens education, but
recognized the importance of getting involved supporting
their adult children parental role, 2)they stated the need to
transmit traditional values, combining warmth and involve-
ment to help grandchildren internalize these values, which
they perceived are in decline in current society, 3) partici-
pants perceived grandchildren helped them to feel active and
useful, increased their life purpose and gave them a second
chance to repair the mistakes made with their own chil-
dren, and 4) some grandparents emphasized some difficul-
ties, such as burden and role ambiguity. Policies recognizing
grandparents contribution to current families and that favor
close intergenerational relationships are needed. It should be
developed intervention programs that help grandparents to
perform their role more successfully and to deal with pos-
sible family conflicts.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 193

GRANDCHILD CARE, GENDER, AND FURTHER men and unmarried women have lower risk levels. Contrary
ROLE OCCUPATIONS: IMPLICATIONS FOR to the protection approach, unmarried men recorded a lower
GRANDPARENTS HEALTH likelihood of obesity in relation to the body mass index of
M.Ates1,3, K.Mahne2, M.Wetzel1, 1. Doctoral Programme married men. Accordingly, the assumptions of marriage pro-
GROW, University of Cologne, Cologne, Germany, 2. tective effect on the smoking behavior of men and women
German Centre of Gerontology, Berlin, 12101, Germany, 3. could be confirmed. In particular, longitudinal studies are
Doctoral Programme GROW, Cologne, 50931, Germany necessary for future studies to improve causality analysis and
Several studies report significant associations between for the avoidance or control of selection mechanisms.
grandchild care and grandparents health. Auxiliary care is
considered to have a positive influence on health outcomes. SESSION 555 (POSTER)
The relevant literature applies role enhancement theory to
explain this link because multiple role occupation might
FRAILTY I
buffer stress emerging from particular roles and promote rel-
evant health resources like self-expression and social support.
BENEFIT OF MANAGING FRAILTY IN DIFFERENT
Considering role enhancement, we hypothesize that
CLINICAL SETTINGS: RESULTS FROM THE
grandmothers face stronger benefits from grandchild care
FRAILCLINIC PROJECT
than grandfathers do. We argue that due to gendered role
A.Pardo, M.Checa, J.Gonzalesturin, T.Guevara,
expectations, women are challenged to manage multiple role
J.Carnicero, S.S.Alamo, L.Rodrguez-Maas, Hospital
occupations. The most recent wave of the German Aging
Universitario de Getafe, Getafe, Madrid, Spain
Survey (DEAS) shows, that an increasing share of grand-
One of the aims of FRAILCLINIC is assessing the feasi-
parents combine grandchild care and active employment.
bility of programs designed to manage frail older patients
Especially more elderly women are integrating into labour
attended in different in-hospital settings.
market, while they are still responsible for domestic work
Participants were selected from Cardiology, Major
or informal care. The current analysis will therefore apply
Surgery, and Emergency Room Departments in hospitals
three waves of the DEAS to illuminate the intersections
in three different European countries. Results here shown
between auxiliary grandchild care, gender and further role
come from 109 patients (57 in intervention group) from
occupations.
Spain. Patients were characterized as frail if they met the
Controlling for relevant covariates and health at baseline,
Frieds criteria or the FRAIL criteria. Patients randomized to
preliminary analysis with linear regression models show:
intervention group received a full Geriatric Assessment and
Grandparents who repeatedly care for their grandchildren
recommendations were made by a geriatrician to be imple-
within six years face significant better self-rated health
mented by the treating physician.
(=0.16, p<0.05) and physical functioning (=4.7, p<0.01)
Mean age was 83.4 (SD 5.3) and 61% were female. 61%
than non-caregiving grandparents. Further analysis will test
of all patients were classified as frail using both Frieds cri-
if grandchild care effects differ by gender and if expected dif-
teria and the Frail scale. Risk of delirium was identified in
ferences are driven by multiple role occupation. Furthermore,
30% of patients; polipharmacy in 87.5%, constipation in
longitudinal analysis will illuminate whether associations
38.6%, urinary incontinence in 43.8% and visual depriva-
between grandchild care and health can be interpreted as
tion in 60%. There were no differences in any of the previous
a causal effect. The analysis will additionally apply a latent
variables between control and intervention groups.
health measure combining several self-reported and observer-
In Surgery, the recommendations were fully (100%)
measured health information.
implemented by the treating physicians. This figure was
lower in the Emergency Room (89.4%) and Cardiology
GENDER DIFFERENCES IN THE RELATIONSHIP
(50%). Patients in the intervention branch tend to be dis-
BETWEEN MARITAL STATUS AND HEALTH-RISK
charged to their homes more often than those in the control
BEHAVIOUR IN GERMANY
group (97.4% vs 83.7%; p<0.01): 100% vs. 75% in Surgery,
R.Hilz, Gerontological Research on Well-Being (GROW),
100% vs. 78.7% in Cardiology and 95.6% vs. 89.4% in
University of Cologne, Cologne, Germany
Emergency Room.
Compared to investigations in America, only a few
Geriatricians recommendations show a different rate of
European studies examined gender differences in the effect of
acceptance by hospital setting, although they improve the
family circumstances on risky health behaviour by older peo-
outcome of frail older patients.
ple. In this context, this research deals with the question of
Supported by Grant 20131208, DG-SANTE. EU.
whether a higher health-related risk behavior exists among
unmarried men and women in Germany. On the one hand,
ASSOCIATION OF FRAILTY PHENOTYPE AND
empirical findings indicate a significant effectiveness of mar-
MISTREATMENT
riage as a protective effect. On the other hand, studies dis-
S.D.Pia, J.M.Garca, J.Avila-Funes, Geriatrics, Instituto
prove this causal connection and emphasize selection effects.
Nacional de Ciencias Mdicas y Nutricin Salvador
To analyse the protection effect of marriage on smoking hab-
Zubirn, Mexico City, Mexico City, Mexico
its and body weight, the cross-sectional study used two waves
The phenotype of frailty has been related with increased
from the German Ageing Survey (DEAS). The results of the
vulnerability for the development of health-related adverse
regression models show the highest probability for an active
outcomes that could lead to social consequences such as
smoking behavior at divorced and separated living men and
mistreatment. The association between these two geriatric
women compared to married people. By contrast, widowed

IAGG 2017 World Congress

194
syndromes has not been widely studied. Therefore the objec-
tive of this this cross-sectional study was to determine the
association between frailty phenotype and mistreatment. 852
community-dwelling subjects aged 70 and older participat-
ing in the Mexican Study of Nutritional and Psychosocial
Markers of Frailty were included. Mistreatment was
defined as one positive answer in the validated Geriatric
Mistreatment Scale and Frailty was defined according to the
phenotype proposed by Fried etal. The association between
frailty phenotype and mistreatment was determined as the
main outcome to construct a multivariate logistic regression
analysis. The final model was adjusted by age, sex, cogni-
tion, depression and disability. Mean age of participants was
77.71 years (SD=6.07) and 54.81% were women. Frailty
phenotype and mistreatment prevalences were 13.85% and
19.95% respectively. The unadjusted results showed a posi-
tive association between these two phenomena [Odds Ratio
(OR) =1.63; 95%CI 1.00 to 2.66, p=0.05]. However, there
was no association in the final model (OR=0.86; 95%IC
0.47 to 1.57, p=0.63). The results showed that there is a posi-
tive association between frailty phenotype and mistreatment,
nevertheless there are confounders such as depression and
disability that seem more strongly associated with the latter.
However, frailty cannot be excluded as a possible determi-
nant of mistreatment in this population.
THE ASSOCIATION BETWEEN SARCOPENIA AND
LUNG FUNCTION IN OLDER AUSTRALIANS
S.C.Yu1,2,3, T.Nguyen2, R.Adams4, R.Visvanathan1,2,3, 1. medical records were excluded. Review of medical records
National Health and Medical Council Centre of Research
Excellence Trans-disciplinary Frailty Research To Achieve
Health Aging, School of Medicine, Faculty of Health
Science, University of Adelaide, Adelaide, South Australia,
Australia, 2. Adelaide Geriatrics Training and Research with
Aged Care (GTRAC) Centre, School of Medicine, Faculty
of Health Science, University of Adelaide, Adelaide, South
Australia, Australia, 3. Aged and Extended Care Services,
The Queen Elizabeth Hospital, Central Adelaide Local
Health Network, South Australia, Adelaide, South Australia,
Australia, 4. Health Observatory, School of Medicine,
Faculty of Health Science, University of Adelaide, Adelaide,
South Australia, Australia
The relationship of sarcopenia and lung function is uncer-
tain. The aim of the current study is to compare the relation-
ship between sarcopenia using three different definitions for
low appendicular skeletal muscle mass(ASM) in combina-
tion with low grip strength and lung function in older com-
munity dweller. Participants(65 years old) were from the
North West Adelaide Health Study. Measurements included
anthropometric measurements, spirometry and dual energy
x-ray absorptiometry of body composition. Sarcopenia was
defined as low muscle mass and low muscle strength(<30kg
for men and <20kg for women). Low muscle mass was
defined as either: a)ASM adjusted to height squared, b)ASM
adjusted to height and fat mass;or c)ASM adjusted for body
mass index(BMI). There were 470(53.4% women) sub-
jects. Forced expiratory volume(FEV1[L]) and forced vital
capacity(FVC[L]) were significantly correlated with grip
strength and the three low ASM definition. The associations
were adjusted for age, gender, smoking and physical activity.
After adjustment, ASM adjusted to BMI(-coefficient -0.33,
Innovation in Aging, 2017, Vol. 1, No. S1
P<0.001 for FEV1 and -coefficient -0.50, P<0.001) and fat
mass definition(-coefficient -0.26, P=0.04 for FEV1 and
-coefficient -0.31, P=0.05 for FVC) of sarcopenia remained
an independent predictor of lower FEV1 and FVC. No asso-
ciation between sarcopenia and FEV1(-coefficient -0.05,
P=0.52) and FVC(-coefficient -0.01, P=0.90) when ASM
adjusted to height definition was used. Association between
sarcopenia and lung functions are noted with some but
not all definitions of sarcopenia. As there is a relationship
between fat mass and lung function, sarcopenia definitions
that account for fat mass may be more relevant in clinical
practice.
NUMBER OF MEDICATIONS INCREASES IN
COMMUNITY DWELLING OLDER PEOPLE
ACCORDING TO THE FRAILTY STATUS
S.Lin1, I.Aprahamian1, N.O.Cezar1, S.Elmadijian2,
A.Siqueira1, M.Brito1, M.S.Yassuda1, C.K.Suemoto1, 1.
Universidade de So Paulo, So Paulo, So Paulo, Brasil,
So Paulo, Brazil, 2. Universidade Anhembi Morumbi, So
Paulo, So Paulo, Brasil, So Paulo, Brazil
Polypharmacy is a concern in geriatric practice. This
study evaluated if there is difference in pharmacologi-
cal treatment in a community dwelling frail population.
Observational transversal study in a geriatric outpatient
facility of tertiary hospital. Patients evaluated from March
till September of 2015 were included. Being unable to
answer telephone call, FRAIL questionnaire, or having no
provided: age, sex, schooling level, hypertension, diabetes,
dyslipidemia, heart failure, ischemic heart disease, stroke,
osteoporosis, depression, dementia, cancer, chronic obstruc-
tive pulmonary disease, asthma, Mini Mental, Geriatric
Depression Scale, and body mass index. Laboratory included
hemoglobin, creatinine, fasting glucose, glycosylated hemo-
globin. Medication dispensing program provided medica-
tion in use. Data was collected admitting 12months before
the frailty assessment which used FRAIL questionnaire,
(robust=0, pre-frail=12 and frail 35). Proxy or patient
were interviewed by telephone call. Logistic regression with
adjustment for age and sex was performed to evaluate dif-
ference in medication.
1185 elderly were elected, 374 were excluded, reiman-
ing 811 participants. Age was 81.6 (7.2) years, 72,9%
female. 13,8% were robust, 48,5% pre-frail and 37,7%
frail. Depression among frail elderly, was 13,4% in robust,
48,5% in pre-frail and 38,1% in frail, p<0,00001. The same
occurred to dementia. The other comorbidities had high
prevalence but not difference. Total number of medication in
use was 8,3 (3,2), logistic regression compared frail elderly
to robust showed difference. In the adjusted model, the coef-
ficient was 2,2, p<0,0001, CI 95% 1,5-2,9. There was no
difference comparing robust to pre-frail.
ASSOCIATION OF FRAILTY WITH VITAMIN D AND
PROCOLLAGEN TYPE IN PROPEPTIDE IN ELDERLY
WOMEN
V.Alekna1, A.Mastaviciute1, J.Kilaite1, M.Tamulaitiene1,2,
1. Faculty of Medicine of Vilnius University, Vilnius, Please
select region, state or province, Lithuania, 2. National
Osteoporosis Center, Vilnius, Lithuania
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Objective: This study was aimed to investigate the asso-
ciation between frailty, vitamin D and procollagen type IN
propeptide (P1NP) in elderly women.
Methods: Women over 60 years of age with no vita-
min D supplementation were included. Frailty status was
defined using Frieds criteria, and participants were classified
as robust, prefrail and frail if they scored 0, 12, 3 points,
respectively. Vitamin D and P1NP concentrations in serum
were measured with Cobas E411. Multinomial logistic
regression was used to determine the associations.
Results: Of 161 women included, 103 were robust,
30 prefrail and 28 frail, with mean age 69.46.2 years,
70.87.9 and 75.86 years, respectively. Vitamin D level K.Motokawa, A.Edahiro, M.Shirobe, J.Yasuda,
was lowest (13.296.15ng/ml) in frailty group and highest
(17.578.19ng/ml) in robust women. Unadjusted analysis
in frailty versus robust group (reference category robust)
showed that higher levels of vitamin D were statistically
significantly associated with being robust (OR: 0.91, 95%
CI: 0.85; 0.97; p=0.009), prefrailty versus robust group
showed that higher levels of P1NP were statistically signifi-
cantly associated with being prefrail (OR: 1.01, 95% CI: 1.0;
1.03; p=0.036).After adjusting for the age, the association
between frailty and vitamin D was not statistically signifi-
cant. However, the association between prefrailty and P1NP
was still statistically significant (OR: 1.02, 95% CI: 1.0;
1.03; p=0.04).
Conclusion: In elderly women, higher level of vitamin D
is not related to being robust, and higher level of procollagen
type IN propeptide is associated with prefrailty.
PREVALENCE OF SARCOPENIA AND ITS
ASSOCIATED FACTORS: THE IMPACT OF DIFFERENT
CUTOFF VALUES
V.G.Moreira1,2, J.S.Nascimento1,2, R.A.Loureno1,2, 1.
Internal Medicine, Universidade do estado do Rio de
Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil, 2. Pontifcia
Universidade Catlica do Rio de Janeiro, Rio de Janeiro,
Rio de Janeiro, Brazil
Aim: To estimate the prevalence of sarcopenia and its
associated factors in community-dwelling elderly living in
Rio de Janeiro, Brazil, and to discuss the impact of different
handgrip strength and gait speed cutoff values on sarcopenia
frequencies.
Method: The health habits, functional capacity, and
anthropometric measures of 745 individuals 65 years old
and older from the Frailty in Brazilian Older People study
were analyzed. They were classified into four diagnostic
strata: no sarcopenia; pre-sarcopenia; sarcopenia; severe
sarcopenia. Univariate and multivariate regression analy-
ses were performed. Handgrip strength and gait speed cut-
off thresholds tailored to the sample population and those
proposed through a consensus of experts by the European
Working Group on Sarcopenia in Older People were used to
compare sarcopenia prevalences.
Results: The average age was 76.6 years, 70.3% were
female, and 61.9% were Caucasian. The sarcopenia preva-
lence was 10.7 and 18% using the sample-tailored and the
European consensus cutoff values, respectively. Sarcopenia
was associated with advanced age (OR: 37.2; 95% CI: 12.3
112.4), Caucasian race (OR: 1.81; 95% CI: 1.023.52), sin-
gle marital status (OR: 6; 95% CI: 2.216.39), low income
IAGG 2017 World Congress
195
(OR: 3.64; 95% CI: 2.588.39), and comorbidities (OR:
3.26; 95% CI: 1.288.3).
Conclusion: In this study, the estimated prevalence of
sarcopenia was similar to those reported in most studies
once tailored handgrip strength and gait speed values were
adopted. Ahigher prevalence was observed when the cutoff
values suggested by the European consensus were used. This
indicates that sarcopenia frequencies must be estimated using
population-specific reference values.
RELATIONSHIP BETWEEN FRAILTY AND DIETARY
VARIETY AMONG OLDER ADULTS
H.Hirano, S.Obuchi, H.Kawai, Y.Watanabe, Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan
Objectives: Frailty is an important precursor of the need
for long-term care. This study aimed to find requirements
for dietary support or intervention from basic data as well
as nutritional status obtained from the frailty older adults.
Therefore, we clarified the differences in body composition
and nutritional status according to severity of frailty.
Methods: The present study was carried out in 2014, and
consisted of 747 individuals over 65 years. The participants
completed the Kihon checklist, which is widely used to assess
frailty in Japan. The Kihon checklist was categorized into 3
groups: Robust (3 score), Pre-frailty (47 score), Frailty (8
score). Survey items included basic information (sex, age,
serum albumin level), multi frequency bioelectrical impedance
analysis (body composition), food frequency questionnaire
(dietary variety), brief self-administered diet history question-
naire (nutritional intake), and grip strength, 10-m walk time
(physical function). Ordered logistic regression analysis was
used to examine the associations of dietary variety with frailty.
Results: According to the Kihon checklist, 11.6% of the
study participants were considered as frailty. Frailty were
independently associated with dietary variety score and
serum albumin.
Conclusion: Dietary variety and serum albumin were
significantly associated with frailty in community -dwelling
older adults. The causal relationship should be examined in
a prospective study.
FRAILTY TRANSITIONS AMONG OLDER ADULTS
H.R.Stocker1,2, R.Peterson1,2, N.Toosizadeh1,2,
C.Wendel1,2, M.Fain1,2, J.J.Mohler1,2, 1. Arizona Center on
Aging, University of Arizona, Tucson, Arizona, 2. Division
of Geriatrics, General Internal Medicine, and Palliative
Medicine, University of Arizona, Tucson, Arizona
Purpose: Frailty is a geriatric syndrome associated with
increased risk of adverse health outcomes. To better under-
stand the dynamic process of frailty, our objectives were to
evaluate baseline and six-month follow-up frailty transitions
and the components associated with these changes in the
Arizona Frailty Cohort.
Methods: One hundred and nineteen community partici-
pants ( 65 years) had two home visits, six months apart.
Fried Frailty Index was measured at baseline and six month
visits. Transitions in Fried category and components (i.e.
unintentional weight loss, self-reported exhaustion, grip
strength, walking speed, and physical activity) driving these
transitions were assessed.
196
Results: Six-month frailty progression was observed
in 13 individuals (11%) with 8 (7%) transitioning from
non-frail to pre-frail and 5 (4%) from pre-frail to frail.
Twenty-eight individuals (24%) observed frailty regression
with 17 (14%) transitioning from pre-frail to non-frail and
11 (9%) from frail to pre-frail. Decreased walking speed
(38%) and low activity (80%) contributed to the transi-
tions from non-frail to pre-frail and from pre-frail to frail,
respectively. In the regression from pre-frail to non-frail
increased walking speed (53%) was common, and in the
regression from frail to pre-frail increased activity level
(45%) and decreased self-reported exhaustion (73%) were
common.
Conclusions: Change in walking speed was most com-
mon among the non-frail to/from pre-frail, whereas change
in activity level was common in pre-frail to/from frail transi-
tions. These results illustrate that 1)gait changes may occur
earlier than other criteria in frailty progression, and 2)frailty
is a dynamic state and should be measured regularly.
THE MULTIDIMENSIONAL INSTRUMENT TO
ACCESS FRAILTY SYNDROME IN ELDERLY FROM
PRIMARY CARE SETTING
C.H.Schwanke1, Z.C.Lindso2, T.Resende1, 1. Institute
of Geriatrics and Gerontology, Pontifical Catholic
University of Rio Grande do Sul, Porto Alegre, RS, Brazil, 2.
Universidade Federal de Pelotas, Pelotas, Brazil
Introduction: Several authors have studied the frailty syn-
drome (FS) but few studies are focused on basic health care
especially in Brazil. The aim of the study was to develop and
validate a multidimensional instrument tracking FS in elderly
patients in primary care.
Methods: A cross-sectional study enrolling 355 elderly
participants of the Multidimensional Study of the Elderly in
Porto Alegre from the Family Health Strategies (EMISUS).
The clinical criteria for the phenotype of FS was the modi-
fied Fried (without physical activity; 0 points= no frail indi-
viduals/1 point= pre-frail/2 or more points= frail). For the
development of the instrument were selected 10 dimensions
(social, age, sensory, depressed mood, cognition, number of
medications, ADL/IADL, balance, urinary incontinence and
nutrition) categorized as present or not.
Results: Throught multiple logistic regression (Forward
Wald method), considering as he dependente variable the
Fried phenotype (0= no frail and 1= pre-frail/frail) and
as independent variables the 10 dimensions, we found as
independent predictors variables the following dimensions:
undernutrition (OR= 2,66), polipharmacy (OR=1,92),
dependence (OR=4,58), urinary incontinence (OR=1,88)
and inbalance (OR= 3,32). We created the multidimen-
sional instrument tracking frailty syndrome (IMSIFI) and
established the cutt-off point 1 to discriminate no frail to
pre-frail/frail individuals (sensibility= 0,759 and specific-
ity= 0,563). The area under the ROC curve was 0,713. The
phenotype more common was no frail (44.5%) by Fried
criteria and pre-frail/frail (72.9%) by IMSIFI. Both instru-
ments (Fried and IMSIFI) were associated with functional
capacity.
Conclusion: IMSIFI is an simple, objective, and quick
instrument for the context of primary care.
Innovation in Aging, 2017, Vol. 1, No. S1
A MULTIFACTORIAL INTERDISCIPLINARY
INTERVENTION IN PRE-FRAIL OLDER PEOPLE:
RANDOMISED TRIAL
I.Cameron1, N.Fairhall1, B.John2, K.Lockwood1,
N.Monaghan1, C.Sherrington1, S.Lord3, S.Kurrle1, 1.
University of Sydney, St Leonards, New South Wales,
Australia, 2. Hornsby Ku-ring-gai Health Service, Hornsby,
New South Wales, Australia, 3. University of New South
Wales, Randwick, New South Wales, Australia
The study aim was to determine whether an interven-
tion could reduce pre frailty and improve mobility disability.
We conducted a single centre, randomised, controlled trial
among older people who were pre frail in Sydney, Australia.
One group received an intervention targeting the identi-
fied characteristics of frailty, while the comparison group
received the usual healthcare and support services. Outcomes
were assessed by a rater masked to treatment allocation at
4 and 12 months after study entry. The primary outcomes
were frailty criteria with reference to the Cardiovascular
Health Study criteria, and mobility as assessed by the lower
extremity continuous summary performance score (CSPS)
calculated from the Short Physical Performance Battery.
Secondary outcomes were also assessed. Atotal of 194 par-
ticipants (84%) completed the study. Overall, 38% of partic-
ipants were men and the mean (SD) age was 81.5years (5.3).
In the intention-to-treat analysis, the mean between group
difference in frailty criteria was .062 at 12months (95% CI
-0.24 to 0.36, p=0.7). The change score on the CSPS favoured
the intervention group at 4months (0.11, 95% CI 0.004 to
0.215, p=0.042) but there was no between group difference
at 12months. There were no major differences between the
groups with respect to secondary outcomes. This interven-
tion trial for pre frail older people did not show a benefit on
frailty of a multifactorial interdisciplinary intervention. The
same intervention had positive effects in frail older people
and the reasons for the difference are currently unclear. Trial
registration: ACTRN12613000043730
FRAILTY AS PREDICTOR OF MORTALITY IN
INSTITUTIONALIZED OLDER ADULTS.
M.Martinez Reig1,2, A.Avedao Cespedes1,2,
M.Mas Romero1,2, E.Gomez Jimenez1,2, L.Palazon
Valcarcel1,2, R.Ceres Martinez1,2, P.Abizanda Soler1,2,
J.Olivercarbonell1,2, 1. Department of Geriatrics, University
Hospital Albacete, Albacete, Spain, 2. UDM Geriatria,
Albacete, Spain
This longitudinal observational cohort study was con-
ducted in two Spanish nursing homes. Of the 331 subjects
who agreed to participate we obtained valid data of 295 sub-
jects. Frailty was defined by the presence of three or more
Fried criteria: unintentional weight loss, low energy, exhaus-
tion, slowness, and low physical activity. Mortality during the
follow-up period (20122015) was recorded. Demographic
data, comorbidity assessed by the Charlson index and disa-
bility in basic activities of daily living using the Barthel index
were recorded at baseline. All data were analyzed using the
SPSS 15.0 program.The association between frailty and mor-
tality was determined by Cox proportionalhazard analysis
and logistic regression adjusted for age, sex, Barthel index,
Charlson index, and body mass index (BMI). Mean age of the
cohort was 83.9 (SD 6.8), with 213 women (65.1%). Mean
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Barthel index was 54.1 (SD 36.7), BMI 27.5 (SD 5.3) and
Charlson index 1.8 (SD 1.6). 218 (66.9%) were frail and 108
(33.1%) non-frail. At follow-up, 128 subjects died, most of
whom (81.2%) were frail. Frailty was associated with higher
mortality (OR 2.3; CI 95% 1.24.6) adjusted for all study
covariables. The adjusted probability of survival using Cox
proportional hazard analysis showed greater adjusted risk of
mortality for frail subjects (HR 1.8; CI 95% 1.12.9) during
the three years of follow-up. To conclude, frailty is related to
three-year mortality in institutionalized older adults.
PREVALENCE AND CORRELATES OF FRAILTY IN
COLOMBO DISTRICT, SRI LANKA
N.Samarutilake1, D.N.Samaraweera2, A.Lokubalasooriya3,
1. Healthcare Quality and Safety, Ministry of Health, Sri
Lanka, Colombo, Sri Lanka, 2. Base Hospital Pimbura,
Sri Lanka, Colombo, Sri Lanka, 3. Family Health Bureau,
Colombo, Sri Lanka
Newly developed validated frailty assessment instrument
(FAI) was used to assess the prevalence of frailty in Colombo
district, Sri Lanka. Criteria to diagnose frailty were developed
giving weights according to the magnitude of the eigenvalues
of principal components in domains of FAI yielded from fac-
tor analysis. Cross sectional descriptive and analytical study
was conducted among 1620 elders selected by multistage
cluster sampling method. Prevalence of frailty in Colombo
district was 14.9% (95%CI:13.2%- 16.6%). Prevalence
rates of frailty were higher in males (17.7%, 95%CI:15.0%
- 20.4%) and elders below the age of 75 years (11.3%,
95%CI: 9.4% - 13.2%) than females (12.4%, 95%CI:
10.2% - 14.6%) and elders aged 75years or more (21.6%,
95%CI: 18.2% - 25.0%). Age, gender, marital status, educa-
tion, past medical history, physical activities, nutrition, Body
Mass Index (BMI), activities of daily living (ADL) and instru-
mental activities of daily living (IADL), memory, living index,
environment index, economic status, depression, duration of
non communicable diseases (NCDs), number of drugs using,
social contacts, social support and consumption of medical
facilities during the preceding six months are significantly
associated with frailty status at 5% level. However, number
of drugs using (OR0.86, 95%CI:0.770.95), admissions
to hospitals (OR4.86, 95%CI:2.928.08), age (OR1.06,
95%CI:1.0 1.09), IADL (OR1.13, 95%CI:1.091.18),
unsatisfactory environment (OR 3.46, 95%CI: 2.175.51)
and economic dependency (OR7.09, 95%CI:2.8717.51)
were significant correlates at 5% level in logistic regression
models. Prevalence rates are relatively high and early inter-
ventions to prevent frailty are recommended.
PROVIDING SOCIAL SUPPORTS CAN REDUCE
MORTALITY RISK AMONG PRE-FRAIL OLDER
ADULTS IN TAIWAN
C.Liao1,2,3, C.Yeh4, S.Lee5, M.Lee3,6, 1. Department of
Family Medicine, Taichung Armed Forces General Hospital,
Taichung, Taiwan, 2. National Defense Medical Center,
Taipei, Taiwan, 3. Institute of Medicine, Chung Shan
Medical University, Taichung, Taiwan, 4. School of Public
Health, Chung Shan Medical University, Taichung, Taiwan,
5. School of Nursing, Chung Shan Medical University,
Taichung, Taiwan, 6. Department of Family Medicine,
Taichung Hospital, Taichung, Taiwan
IAGG 2017 World Congress
197
Objective: To determine the association of providing
or receiving social support on mortality risk among the
elderly with pre-frailty or frailty. Method: In this notional
longitudinal study, data were retrieved from the Taiwan
Longitudinal Study on Aging (TLSA) from 1996 to 2007.
Data for 1492 males and 1177 females (total 2669) aged
67 years were collected. Participants were divided into
three groups: no frail older adults, pre-frail older adults and
frail older adults. These elderly received social supports,
and they also actively provided social supports to others.
The study was examined using Cox regression analysis
to evaluate the association between providing or receiv-
ing social support on mortality of pre-frail or frail older
adults after adjusting several covariates. Results: Results
showed the average age of these participants was 73.8
(SD=5.5) years, and more than half of the participants were
male (55.9%). The number and percentage of frail elderly,
pre-frail elderly and frail elderly groups were 402(16.9%),
1501(63.1%) and 474(19.9%) respectively. Final results
of the multivariate Cox regression analysis showed a sig-
nificant association between providing social supports with
lower mortality rates among the pre-frail older adults after
adjusting several covariates. [hazard ratio (HR) = 0.886;
95% confidence interval (CI) = 0.8140.964; p = 0.005].
Conclusion: Providing social support to others may pro-
long life expectancy of the pre-frail older adults.
INFLUENCE OF STATIN USE ON THE PHYSICAL
FUNCTION AMONG COMMUNITY-DWELLING
OLDER JAPANESE ADULTS
H.Kawai1, K.Ihara2, T.Kera1, H.Yoshida1, H.Hirano1,
Y.Fujiwara1, S.Obuchi1, 1. Tokyo Metropolitan Geriatric
Hospital and Institute of Gerontology, Tokyo, Japan, 2.
Department of Public Health, Toho University School of
Medicine, Tokyo, Japan
Statin-induced myopathy is one of the muscle-related
side effects of statins. However, some positive effects such
as improved walking speed in patients with cardiovascu-
lar diseases and reduced risk of frailty have been reported
to be associated with statin use. The objective of this
study was to examine the association between statin use
and physical function among community-dwelling older
Japanese adults.
The subjects were 1022 community-dwelling older
adults aged 6588 years, who participated in comprehen-
sive health check-ups from 2013 to 2015. Statin use in the
subjects was checked by copying data from their medicine
notebooks. The differences in skeletal muscle index (SMI),
grip strength, gait speed, timed up-and-go test (TUG),
one-legged stance, knee extension torque, and low-density
lipoprotein (LDL) cholesterol between statin users and non-
users were analyzed by t-test. Multiple regression analyses
were also conducted to examine the association of statin
use with physical function.
Among the 381 men and 559 women whose medica-
tion could be checked from their medicine notebooks, 93
men (24.4%) and 154 women (27.5%) were statin recipi-
ents. Some physical functions declined significantly in statin
recipients compared to those in non-recipients. LDL choles-
terol levels reduced significantly in statin recipients. Multiple
regression analysis with controlling for age and number of
198
medicines showed statin use is independent factor in decline
of grip strength, gait speed, and one-legged stance.
It was suggested that statin use might be associated with
physical function in community-dwelling older adults.
SARCOPENIA IN UKRAINIAN OLDER WOMEN
V.Povoroznyuk, N.Dzerovych, R.Povoroznyuk, D.F. analysis and 7 improving to non-frail. To conclude, frailty
Chebotarev Institute of Gerontology NAMS Ukraine, Kyiv,
Ukraine
The aim of this study was to evaluate the frequency of
sarcopenia in the healthy Ukrainian women.
Materials and methods: 390 healthy women aged
2087years (mean age 57.5015.99years) were examined. LEVELS AMONG COMMUNITY-DWELLING ELDERLY
The lean and fat masses were measured by the DXA method
(Prodigy, GEHC Lunar, Madison, WI, USA). Appendicular
skeletal mass (ASM) was measured at all the four limbs with
DXA. Weve also calculated the appendicular skeletal mass
index (ASMI) according to the formula: ASM/height (kg/
m2). Low muscle mass values conform to the following defi-
nitions: European guidelines (ASMI <5.5kg/m2) (EWGSOP,
2010), less than 20% of sex-specific normal population
and two SD below the mean of the young adult Ukrainian
females (2039 yrs). We also assessed handgrip strength and
measured gait speed. The sarcopenia was determined using
EWGSOP-suggested algorithm.
Results: The ASMI values corresponding to a cutoff of
low muscle mass by the definitions used were as follows:
<5.5kg/m2 (European guidelines), <5.7kg/m2 (<20th percen-
tile of sex specific population), <4.8kg/m2 (two SD below the
mean of young Ukrainian females aged 2039 yrs). The fre-
quency of low muscle mass in women aged 65 yrs and older
based on the above three criteria was 12%, 16% and 1.7%,
respectively. The frequency of sarcopenia increased with age:
in women 5059 yrs 5.1%, 6069 yrs 3.7%, 7079 yrs Galicia (Spain). According to Fried criteria, 71.8% of the par-
18.4%, 80-80 yrs 30.8%. The mean frequency of sarco-
penia in women aged 65 yrs and older was 21.3%.
Conclusion: The mean frequency of sarcopenia in
Ukrainian older women was 21.3%.
TRANSITIONS IN FRAILTY STATES AMONG
INSTITUTIONALIZED OLDER ADULTS IN ATHREE-
YEAR PERIOD
M.Martinez Reig1,2, A.Avedao Cespedes1,2, may help to prevent the onset of disabilities and dependence.
M.Mas Romero1,2, E.Gomez Jimenez1,2, L.Palazon If we do not act, the three-quarters of our population will
Valcarcel1,2, R.Ceres Martinez1,2, P.Abizanda Soler1,2,
J.Olivercarbonell1,2, 1. Department of Geriatrics, University
Hospital Albacete, Albacete, Spain, 2. UDM Geriatria,
Albacete, Spain
Longitudinal cohort which included 326 institutionalized
subjects aged 65 and over. Frailty was defined by the presence
of three or more Fried criteria. Frailty state was recorded at
baseline, after one year of follow-up and after three years of
follow-up. Mean age of the cohort was 83.9with 213 women
(65.1%). At baseline, 218 subjects were frail (66.9%).
Among these, 39 died after one year of follow-up and 23
subjects had missing data. 138 of the frail subjects remained
frail after oneyear of follow-up with 74 remaining frail after
three years and 2 subjects improving to non-frail. 18 of the
frail subjects at baseline improve to non-frail after one year
of follow-up with 7 of them worsening to frail at three-year
analysis and 4 remaining non-frail. At baseline, 108 subjects
Innovation in Aging, 2017, Vol. 1, No. S1
were non-frail (33.1%). Among these, 11 died after oneyear
of follow-up and 15 had missing data. 57 of the non-frail
subjects remained non-frail after one year of follow-up with
26 remaining non-frail after three years and 13 worsening
to frail state. 25 of the non-frail subjects worsened to frail
after one year with 10 of them remaining frail at three-year
is a dynamic state which changes over time. To determine
frailty status in institutionalized older adults may help to
implement prevention or intervention programs.
IMPORTANCE OF PROGRESSION BETWEEN FRAILTY
R.Lpez-Lpez1, J.Milln-Calenti1, L.Lorenzo-Lpez1,
A.Bujn1, C.Diego-Diez1, E.Psaro2, A.Maseda1, 1.
Gerontology Research Group, Instituto de Investigacin
Biomdica de ACorua (INIBIC), Complexo Hospitalario
Universitario de ACorua (CHUAC), SERGAS,
Universidade da Corua., A Corua, Spain, 2. DICOMOSA
Group, Department of Psychology, Area of Psychobiology,
Universidade da Corua., A Corua, Spain
Previous longitudinal studies have revealed a relationship
between frailty and mortality in community-dwelling older
adults. It is crucial to identify older adults who are at risk of
pre-frailty since they have more than twice the risk of becom-
ing frail compared with non-frail individuals. Moreover, evi-
dence suggests that pre-frail elderly may respond better to
intervention than frail subjects. However, the clinical charac-
teristics of pre-frailty have been investigated to a lesser extent
compared to frailty.
Our cross-sectional study evaluates the prevalence and
clinical characteristics of pre-frailty in a community-dwelling
representative sample of 749 older adults (aged 65) from
ticipants were pre-frail, mainly because of low grip strength
(95.0%), 3.7% were frail, and 24.4% were non-frail. Pre-
frailty prevalence was higher in females and in individuals
aged 65 to 79, with no differences between geographical set-
tings. At the same time, mortality significantly increased in
frailty group.
The high prevalence of pre-frailty is a relevant finding
because it can give insights into associated risk factors and it
progress to frailty in a short period of time. In this context,
pre-frailty status could be used as a preventive marker being
an optimal target for interventions.
Funding: Xunta de Galicia (GPC2014/082).
SESSION 560 (POSTER)
GERIATRIC WORKFORCE I
REPRESENTING OLD AGE IN THE MEDIA AND
POPULAR DISCOURSE
S.Pickard, University of Liverpool, Liverpool, United
Kingdom
This paper looks at representations of old age in the
media, policy and medicine and their role in shaping the role
and meaning of old age more generally. Taking a historical
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Innovation in Aging, 2017, Vol. 1, No. S1
view, it traces the bifurcation of good and bad old age into
todays distinction between biological versus chronological
ageing reflecting in the youthfulness of the third age versus
the senescence of the fourth. However, since 2008 in par-
ticular the chronological or calendar classification has been
assuming priority in the UK in particular in discussions of
austerity politics, intergenerational justice, and the decision
to leave the EU, where we find a strong theme of blaming the
old as obstructive to the well-being and progress of younger
generations (and by implication society as a whole). This
development in the progressive press in particular has been
taking the form of substituting age war for classconflict as
a foundational structure for social inequality. We look at the
role medicine and science as well as counter images found
in different socio-historical contexts and in the media might
help with imagining a more positive role for old age and a
more harmonious relationship between ages and stages more
generally.
AGENCY THROUGH MEDIA IN THE EVERYDAY LIFE
OF NURSING HOME RESIDENTS
C.E.Swane, EGV Foundation (Social Inclusion of Older
Adults), Copenhagen V, Denmark
Old people in nursing homes embody the notion of the
fourth age, as recipients of personal care, medicine, meals,
and organised activities in an institutional setting. People in
nursing homes are also part of a society in which media have
become a regular feature of everyday life (Mark Deuze 2011,
Stig Hjarvard 2016). Based on ethnographic fieldwork in
three Danish nursing homes, this paper explores ill and frail
old peoples subjective interaction with media technologies
and material objects bracketing for a moment aspects of
care practices (Swane 2017).
Empirical data were constructed through ethnographic
fieldwork conducted in three Danish municipal nursing
homes in winter 201415. The material has the form of notes
from talks, observations, photos, voice and video recordings
and transcribed qualitative interviews with totally 39 resi-
dents, primarily in their private residences.
Embodiment and agency are central analytical concepts
for analysing residents use of particular media artefacts
when the body is in pain and loses functionality. With the-
ories of domestication (Roger Silverstone 1994) and bio-
graphical situation (Alfred Schutz 1962), the paper reveals
how media are meaningful and important for residents in
making an institutional dwelling their home. E.g. subscrib-
ing to a newspaper even with a very poor eyesight, by mainly
reading headlines in order to remain oriented to the world
around, as one of few autonomous routines of everyday life.
In conclusion, old peoples interaction with media seems
to bridge the gap between institutionalisation and a long lifes
preferences and participation in social and cultural worlds.
OLD AGE AND OLDER PEOPLE ON WEBSITES
BELONGING TO GROUPS OF THE EXTREME RIGHT
IN SWEDEN
M.Nilsson, University of Gothenburg, Gothenburgh,
Sweden
Across Europe nationalism and the influence of extreme
right groups is growing, and perhaps contrary to what many
think, old age and ageing is everpresent in this process.
IAGG 2017 World Congress
199
Traditionally the discourse of the extreme right, such as fas-
cists and national socialists, have valorized youth, strength
and violence as instruments for the rebirth of a degenerated
society. In this traditional discourse of the extreme right old
age and ageing, and the ageing of society, is seen as part of
the degeneration of society. However, during the last decades
alternative representations of old age and older people in the
discourse of the extreme right have emerged. Older people
are here seen as having built society; as citizens that have
done their duty and therefore should be rewarded in the
form of good care and a high standard of living. The aim of
this paper is in relation to the above to provide an analysis
of how older people and old age is represented in articles and
discussions on websites belonging to groups of the extreme
right in Sweden. Aspecific focus is devoted to the interplay
between representations of old age age in general public dis-
course and that expressed by actors of the extreme right.
COMPARISON BETWEEN MEDIA REPORTS AND
ACTUAL SITUATION ON PREPARATION FOR AGING
AND DEATH IN JAPAN
Y.Kimura, Yokohama National University, Yokohama,
Kanagawa, Japan
Backgrounds
With the aging of society there is need and also a trend
of preparation for aging and death. In Japan, this trend is
called SHU-KATSU coined by the media in 2009. Originally,
most subjects of SHU-KATSU were about funeral and grave.
Nowadays, SHU-KATSU is defined as activities in prepara-
tion for funeral, grave, inheritance, medical and nursing care,
and any planning for aging and death. Stakeholders say that
SHU-KATSU is not only deciding about the relevant things
of death but find out what one wants to do in rest of life.
The purpose of this study is to clarify the current meaning
of SHU-KATSU. In this study the main points covered by the
media are compared to actual preparations of elderly people
covered by researchers.
Methods
Articles by Asahi-Newspaper were analyzed the by fol-
lowing steps.
1) Articles including the keyword SHU-KATSU were
selected from a database.
2) The articles were categorized and text mined by the
context of keywords and relative to the number of characters.
Results
There are some differences between the content covered
in the media and the intention of the elderly.
In the mass media, funeral and grave are still the main
subjects. On the other hand, psychological subjects such as
views of life and death and spiritual or emotional side of
life are poor.
In contrast in previous studies, the elderly tend to hope
for a simple funeral and grave. They also tend to hope for an
opportunity to learnabout death and the preparation for it.
THE TRENDS IN GLOBAL STANDARDIZATION
OF TRADITIONAL MEDICINE: AREVIEW ON THE
MEETINGS OF ISO/TC249
K.Ozaki1, T.Namiki5, M.Kageyama2,3,6, Y.Nakamura1,
H.Rakugi4, 1. Department of Geriatric Medicine, Itami
City Hospital, Itami, Japan, 2. Kageyama Clinic, Sakai,
200
Japan, 3. Dept. of Obstetrics and Gynecology, Osaka City
Univ. Graduate School of Medicine, Osaka, Japan, 4. Dept.
of Geriatric and General Medicine, Osaka Univ. Graduate
School of Medicine, Suita, Japan, 5. Dept. of Japanese-
Oriental (Kampo) Medicine, Chiba Univ. Graduate School
of Medicine, Chiba, Japan, 6. Dept. of Gynecology and
Obstetrics, Kyoto Univ. Graduate School of Medicine,
Kyoto, Japan
Background/Objectives: Recently, international stand-
ardization has become a priority in the healthcare busi-
ness, as the need to reduce variance of patient care under
rapid increase of social security costs because of the aging
population. The pace of globalization in the field of tradi-
tional medicine has surged since the establishment of a new
Technical Committee (TC) as TC249 Traditional Chinese
Medicine (provisional) at the International Organization
for Standardization (ISO) in 2009. The following paragraphs
review the current situation of standardization of traditional
Chinese medicine (TCM) at the general meetings of in ISO/
TC249.
Methods: The ISO/TC249 standards and standard pro-
jects on the ISO website were searched, and new standard
proposals information was collected from the proceedings
at the meetings of ISO/TC249.
Results: Six standards were published under the respon-
sibility of ISO/TC249 (as of June 2016), such as (1)
TCM-Ginseng seeds and seedlings-Part 1: Panax ginseng
C.A.Meyer, (2) Sterile acupuncture needles for single use,
(3) TCM-Determination of heavy metals in herbal medi-
cines used in TCM, (4) TCMHerbal decoction apparatus, (5)
TCM-General requirements of moxibustion devices, and (6)
TCM-Coding system for Chinese medicines-Part 1:Coding
rules for Chinese medicines. A rapid development of inter-
national standardization in TCM has been observed in
ISO/TC249, although inadequacy in proposing a countrys
domestic standards as the international standards without
respect for the rules of laws or existing standards has been
pointed out. Agreement was achieved that discussion of edu-
cation standardization for students on TCM is beyond the
scope of TC249.
Conclusions: This paper has briefly described the pre-
sent status of international efforts to standardize traditional
medicine.
AGING AND INTERDISCIPLINARITY IN THE
CLASSROOMS OF UNDERGRADUATE COURSES: AN
EXPERIENCE REPORT
V.Bohm, V.Herdia, Universidade de Caxias do Sul, Caxias
do Sul, Rio Grande do Sul, Brazil
Demands arising from the aging population require
competent professionals in their areas of training, but also
have interdisciplinary attitude. This paper aims to share
successful interdisciplinary practice at graduation, which
is presented through an experience report. In 2002, aware
of the shortage of subjects on human aging in curricula,
the University of Caxias do Sul / RS / Brazil began offering
an elective entitled Longevity: Life and Society, who had
five teachers involved. In these 15years of experience, new
arrangements were made to meet the perceived changes in
society and advances in knowledge about aging. There are
four teachers who currently teach, keeping the key feature:
Innovation in Aging, 2017, Vol. 1, No. S1
interdisciplinarity, both faculty and students, it is offered
to various areas of training. There are four central axes
that structure the discipline: sociological, discussing active
aging and institutions, including long-term care facilities
and family; psychological, addressing major theories and
aspects of subjectivity in age; biological, understanding
the functioning and changes of the body during life, and
the axis of public policies, bringing the subject as citizen
rights and duties. The course ends with the integration of
axes presented in a final seminar, where students take the
articulation of contents having as guiding the life of an
old man interviewed during the semester. The results of
this practice are positive, as students report to understand
the human aging expanded form, identify labor camps
and realize the need for interdisciplinary performances in
future interventions.
THE PILOT STUDY ON EFFECTS OF FORMAL
CAREGIVER EDUCATIONAL TRAINING PROGRAM
IN KOREA
Y.Park, S.Bae, Kyungbok University, Pocheon-si,
Gyeonggi-do, Korea (the Republic of)
The purpose of this study was identify the effects of
the educational training program of formal caregivers
who personally take care of persons with dementia at
present in Korea. The study is one-group pre-posttest pre-
experimental design and 14 formal caregiver educational
trainees participated. The formal caregiver trainees had
educational training provided to pass the national licens-
ing examination in Korea, and the training was progressed
for four hours every day for eight weeks. To measure the
effects of the educational training program for the for-
mal giver, Inventory of Geriatric Nursing Self Efficacy
(IGNSE), Dementia Attitude Scale (DAS), and the mock
test scores are used. IGNSE, DAS, the mock test scores
were measured before and after the formal caregiver edu-
cational training program. After the educational training
program, it was not significant in IGNSE (t=0.12, p=.904),
but Dementia Attitude Stability Scale (t=.7.48, p<.001)
and Dementia Attitude Total Score Scale (t=6.78, p<.001)
were significantly decreased. Also, in the mock tests for
the national licensing completion, the theory test score
(t=-10.75, p<.001) and the practice test score (t=-10.36,
p<.001) were significantly increased. The formal caregiver
educational training program is helpful for the national
licensing examination. However, it affected negatively in
self-efficacy and Dementia Attitude of the formal caregiver
for personal care for persons with dementia. Therefore, it
is required to improve the formal caregiver educational
training program for increasing self-efficacy and dementia
attitude of the formal caregivers who personally take care
of persons with dementia.
EXPERIENCE REPORT FOR APSYCHOGERIATRIC
INTERVENTION BETWEEN BRAZILIANS ELDERLY
PARTICIPANTS
F.Negreiros, L.F.Araujo, J.de Oliveira Santos, T.Vieira
de Morais, M.de Souza Vasconcelos, D.da Silva Sampaio,
A.Aguiar Trevia Salgado, D.da Silva Azevedo,
Psychology, Federal University of Piaui, Parnaiba, Piaui,
Brazil
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Innovation in Aging, 2017, Vol. 1, No. S1
The increase in life expectancy has led to a higher num-
ber of elderly people in Brazil, and therefore, the search
for senior centers has intensified. The profile of elderly
people who attend these groups is associated with senes-
cence and active aging. Thus, the objective of this study
was to describe the socio-demographic profile of the mem-
bers of a Brazilian group and to highlight their relevant
characteristics. The sample consisted of 54 elderly people,
predominantly female (83.3%) with a mean age of 67.98
(SD=7.96). The data collection was conducted through
individual interviews and/or group activities. As a result,
it was possible to notice the predominance of low-income
participants, but without vulnerabilities. The individuals
reported effective improvement in their health conditions
after they started regularly participating in senior centers.
It was found that octogenarians had lower participation
rates. However, this scenario is likely to change, due to
the rising number of elderly people who are reaching this
stage of life and seeking to join these groups. They are
likely to become physically, psychologically and socially
more active. In the long term, the expansion of these ser-
vices is important, and universities that participate will
have the opportunity to spread knowledge and reduce
taboos among the general population.
GERONTOLOGY AS ACAREER: EVIDENCE FROM
COGNITIVE IMPROVEMENT IN ACOGNITIVE
TRAINING GROUP
L.Pelegrini, F.G.Casemiro, S.Pavarini, L.C.Alves, Using the ARAIV measure demonstrated that differential
P.Castro, A.C.Grato, M.R.Cominetti, Federal University use of observation status by hospitals likely impacts pub-
of Sao Carlos, Sao Carlos, Sao Paulo, Brazil
Background: The population aging process is a world-
wide phenomenon. Projections show that by 2030, there
will be more seniors than children. Capable and skilled pro-
fessionals are necessary in order to deal with such demo-
graphic transition. Purpose: to discuss gerontology and the
gerontologist as an important career for both present and
future. Methods: 10 older adults from an Open University
for seniors were tested before and after a cognitive train-
ing intervention. Gerontologists did this intervention in 20
sessions, which happened once per week during one hour.
Achange detection task was used to evaluate the effects of
the intervention. The test had 21 trials and was adapted to a
tablet device. Results: 9 participants were female; the mean
age was 71.5years ( 8.3); the mean for years of education
was 11.3 years ( 4.8). The average reaction time on the
pre-intervention measure was 5.9sec (3.35), and 3.67sec
(1.21) on post-intervention; the difference between pre
and post-intervention was statistically significant (t=2.666;
p=0.026). The mean of correct answers was 12.1 ( 1.9)
and 11.8 ( 3.2) on pre and post-intervention assessments,
respectively. There was no statistical difference between
these results (t=0.335; p=0.745). Conclusion: This study
suggests that the professional performance of gerontologists
can unfold in improvements to the elderly public. Because of
their interdisciplinary characteristic, gerontologists tend to
be, and can be, accepted and employed in a wide variety of
institutes/organizations.
IAGG 2017 World Congress
201
READMISSION METRICS DO NOT CAPTURE ALL
BURDENSOME HOSPITAL STAYS: INTRODUCING
THE ARAIV MEASURE
R.Gardner1,2, B.Morphis2, R.Youssef2, 1. Alpert Medical
School of Brown University, Providence, Rhode Island, 2.
Healthcentric Advisors, Providence, Rhode Island
Care transitions are a time of vulnerability for older
adults; the readmission rate within 30 days of hospital
admission is the metric most commonly used to assess qual-
ity of care coordination. In the US, hospitals readmission
rates are publicly reported and hospitals face penalties from
Medicare for excess readmissions. Despite its prevalence as
a care coordination measure, the readmission metric is lim-
ited in its ability to capture all return visits to the hospital.
Hospital stays coded as observation status are not included
in the readmission metric, either as an index hospital stay or
as a readmission. The exclusion of observations stays may
incentivize hospitals to preferentially select observation sta-
tus for their patients to avoid readmission penalties and may
prevent an accurate assessment of care coordination. This
study sought to examine the impact of including observation
stays in the readmission metric, recognizing that any stay
in the hospital is disproportionately burdensome to older
adults. Using FFS Medicare claims data for the New England
region of the US, we calculated the standard readmission rate
for all beneficiaries and compared it to a readmission rate
that included observation stays. The latter measure was enti-
tled the All Revisits after Any Index Visit (ARAIV) measure.
licly reported readmission rates. Given these findings and the
fact that patients receiving care under observation status are
often clinically indistinguishable from those who are fully
admitted, we recommend that readmission metrics include
observation stays.
HEALTHY LIFE EXPECTANCIES OF THE OLDER
ADULT POPULATION OF SINGAPORE
S.Kang5, Y.Saito2, A.Chan3,4,5, V.Yong2, 2. Nihon
University, Tokyo, Japan, 3. Health Services and Systems
Research, DukeNUS Medical School, Singapore, Singapore,
4. Centre of Ageing Research and Education, DukeNUS,
Singapore, Singapore, 5. Singapore University of Social
Sciences, Singapore, Singapore, 5. Department of Sociology,
National University of Singapore, Singapore, Singapore
The Singapore resident population aged 65 and older
is living longer, but research has cautioned that gains in
life expectancy are not always positive. In order to better
understand this development, there is a need to disaggre-
gate healthy and unhealthy life expectancies. Research by
gender suggests that while females fare better compared to
their males counterparts with regard to the prevalence of dis-
eases and disease-free life expectancy; they are disadvantaged
when compared with their male counterparts with regard to
impairments and functional disabilities. With available data
on selected chronic diseases, impairments and functional
disabilities of the older adult population in Singapore, this
study seeks to add to this body of discussion. It seeks to
achieve three objectives: (1) to provide follow-up analyses
on health expectancies by gender for both chronic diseases,
impairments and functional disabilities; (2) understand how
202 Innovation in Aging, 2017, Vol. 1, No. S1

existing healthcare policy for the older adult population Stanford Geriatric Education Center Faculty Development
provides support in light of research results and observa- Program in Ethnogeriatrics (FDPE) to expand their knowl-
tions; and (3) suggesting additional policy initiatives that edge, skills, and attitudes in caring for elders from diverse
could further compliment or enhance these existing policy ethnic populations and in teaching ethnogeriatrics. Each year
implements. This study utilises the prevalence-based Sullivan from 2011 to 2015 eight to eleven faculty trainees completed
method to calculate the lifetime free of disease and impair- the 160-hour program. The FDPE model consisted of:
ment for the older adult population surveyed. The datasets 1. Four days of intensive onsite training on-campus at
employed for this study are cross-sectional data obtained Stanford University School of Medicine which included
from the National Survey of Senior Citizen from 2005 and eight modules using didactic sessions, interactive workshops,
2011. resource sessions, and 25 assigned readings;
2. Online self-paced learning based on 15 learning mod-
SESSION 565 (POSTER) ules and 22 recorded webinars on ethnogeriatric topics;
3. Eleven monthly two-hour group meetings by confer-
ence call with faculty and trainees in which trainees reported
GERONTOLOGY AND GERIATRICS EDUCATION I
on and discussed assigned modules and webinars; and
4. Individual capstone projects in ethnogeriatrics sup-
GERIATRIC FELLOW PACE ROTATION: LEARNING
ported by monthly mentoring sessions with assigned faculty
ABOUT MANAGED CARE AND MEDICAL
members.
DIRECTORSHIP PRINCIPLES
Onsite modules included: Exploring Health Literacy,
T.Suh1,2,3, P.Mullan1, C.Vitale1,3, 1. Internal Medicine,
Ethnogeriatrics, and Health Disparities; Aging and Culture;
University of Michigan, Ann Arbor, Michigan, 2. Huron
Health Literacy in Patient Centered Health Care; Creating
Valley PACE, Ypsilanti, Michigan, 3. Ann Arbor VA
Health Messages for Low Literacy Elders; Patient and
Hospital, Ann Arbor, Michigan
Relationship Centered Communications; Working with
A clinical rotation was developed for University of
Interpreters and Translators; Improving Ethnogeriatric
Michigan geriatric fellows in partnership with Huron Valley
Health Care; Strategies for Teaching Cultural Humility/
PACE (Program for All-Inclusive Care of the Elderly). Given
Competence.
the rapid growth of PACE nationally and especially in the
Significant improvement among the faculty trainees was
state of Michigan, it was felt that it was important for U-M
found in all of the 29 self-rated pre/post and post-hoc-pre/
geriatric fellows to have the opportunity to learn princi-
post measures of the learning objectives. Capstone projects
ples of managed care and medical directorship while still
resulted in 18 new curriculum units in ethnogeriatric top-
in training.
ics, 10 new clinical interventions with diverse elders, and 2
This PACE rotation allows geriatric fellows to participate
research projects in ethnogeriatrics.
in frail elder care in a variety of clinical settings including
clinic, hospital, skilled nursing facility and home. Fellows
A FOUNDATION AND COLLEGE COLLABORATION
have the opportunity to talk with all members of the PACE
TO PREPARE PHD NURSE FACULTY: ACHIEVEMENTS
interdisciplinary team about their roles in the PACE model
AND CHALLENGES
and attend various interdisciplinary team meetings. The
L.E.Benefield1,2, 1. University of Oklahoma Health Sciences
PACE Medical Director introduces fellows to medical direc-
Center, Oklahoma City, Oklahoma, 2. Reynolds Center of
torship principles through attendance at leadership meetings
Geriatric Nursing Excellence, Oklahoma City, Oklahoma
and one-on-one conversations as well as principles of man-
A multi-year partnership between a private foundation
aged care through attendance at managed care meetings and
and the University of Oklahoma Health Sciences Center
discussions and demonstrations of the authorization process.
College of Nursing achieved core objectives:new highly-
At the end of the academic year, each fellow gives a talk
qualified PhD nurse faculty with geriatric focus and commit-
during a Division conference about how frail community-
ment to academic careers, a highly customized yet replicable
dwelling older adults age in place in another country as
interdisciplinary mentorship model, development and dis-
compared to the U.S. PACE model. Results of retrospec-
seminate of shared-use geriatric educational materials for
tive pre-post surveys of fellows perceived skills in assessing
faculty and providers, and pilot funding for interdisciplinary
PACE eligibility, working in a capitated model and effectively
research aimed to support aging in place. Within a case study
leading an interdisciplinary team will be presented, capturing
model, strategies for achieving success are presented within
the learners insight gained as the concept of aging in place is
a timeline stressing seminal decisions that fostered success
explored internationally.
or imposed temporary barriers. In addition, the mentorship
model engaging PhD students with national and interna-
FACULTY DEVELOPMENT IN ETHNOGERIATRICS
tional experts, community constituents and older persons
G.Yeo1, N.N.Hikoyeda1, M.R.McBride1, M.Tzuang1,3,
during formative stages of research and professional role
M.R.Grudzen1, K.Mehta1,2, 1. Stanford University,
development is reviewed. Lessons learned in working with
Stanford, California, 2. University of California, San
a foundation funding the project, and methods of applying
Francisco, San Francisco, California, 3. Johns Hopkins
dimensions of the model to enhance current or developing
University, Baltimore, Maryland
programs, whether resource rich or resource restricted, will
Thirty-three faculty members in eight health care disci-
be detailed.
plines from fourteen U.S.states devoted 160 hours each in the

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
DECISION-MAKING CAPACITY ASSESSMENT (DMCA)
TRAINING FOR PHYSICIANS
L.Charles3, J.Parmar1,3, B.M.Dobbs3, S.Brmault-Phillips2,
O.Babenko3, P.Tian3, 1. Network of Excellence in Seniors
Health and Wellness, Covenant Health, Edmonton,
Alberta, Canada, 2. Department of Occupational Therapy,
University of Alberta, Edmonton, Alberta, Canada, 3.
Department of Family Medicine, University of Alberta,
Edmonton, Alberta, Canada
Context: Many physicians do not feel prepared to do
DMCAs. Hence, we developed and administered an inter-
active DMCA Workshop to familiarize physicians with con-
cepts of capacity, a protocol, documents, and case studies.
Objective: To determine the effect of the DMCA Workshop
on physicians confidence and comfort with decision-making
capacity assessments.
Design: Pre-test-post-test design. We administered a ques-
tionnaire before and after the Workshop. The questionnaire
asked participants to rate their agreement (4-point Likert-
type scale) on 15 statements regarding awareness, confi-
dence, and understanding of core concepts of capacity.
Participants: 137 physicians who attended workshops
Intervention: A 3-hour DMCA Workshop accredited by
the College of Family Physicians Canada.
Outcome Measures: (1) Mean ratings on the question-
naire items; (2) Demographic data (age, sex, years of prac-
tice, prior DMCA training).
Analysis: Descriptive statistics (mean, SD); Sign Test to
compare pre- and post-workshop ratings; ANOVA to deter-
mine differences in ratings across demographics.
Results: There were 137 participants with an average age
of 46 years: 55% females; 64% with 6 years of medical
practice; and 54% with no prior DMCA training. The post-
workshop ratings were mostly Agrees and Strongly Agrees
(Mean ratings: 3.094.27; Range: 14). The highest posi-
tive differences were seen for problem solving techniques,
understanding a trigger, knowledge and skill-set in regards to
capacity assessments, standardized approach, and awareness
of legislative acts. Among the participants, those without
prior DMCA training exhibited the largest change in pre-
versus post-workshop ratings (p<0.05).
Conclusion: This study has shown that a DMCA
Workshop was effective in training Family Physicians.
DECISION-MAKING CAPACITY ASSESSMENT
EDUCATION FOR PHYSICIANS: CURRENT STATE
AND FUTURE DIRECTIONS
L.Charles1, J.Parmar1,2, S.Brmault-Phillips3, B.M.Dobbs1,
L.Sacrey5, B.Sluggett4, 1. Department of Family
Medicine, University of Alberta, Edmonton, Alberta,
Canada, 2. Network of Excellence in Seniors Health and
Wellness, Covenant Health, Edmonton, Alberta, Canada,
3. Department of Occupational Therapy, University
of Alberta, Edmonton, Alberta, Canada, 4. Faculty of
Rehabilitation Medicine, University of Alberta, Edmonton,
Alberta, Canada, 5. Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, Alberta, Canada
Objective: To examine the training needs of family physi-
cians (FPs) regarding Decision-Making Capacity Assessments
(DMCAs) and ways in which training materials, based on a
DMCA Model, might be adapted for use by FPs.
IAGG 2017 World Congress
203
Setting: FPs practicing in a variety of settings: Primary
Care, Day Programs, Home Living, Supportive/Assisted
Living, Long-term Care, Restorative Care, Geriatric Clinic,
and Geriatric inpatient/rehabilitation units in the Edmonton
Zone, Alberta.
Participants: FPs who chose to attend a focus group on
DMCAs.
Methods: A scoping review of the literature to examine
the current status of physician education regarding assess-
ment of decision-making capacity (DMC), and a focus group
and interviews with FPs to ascertain the educational needs of
FPs in this area.
Main findings: Based on the scoping review of the lit-
erature, four main themes emerged: increasing saliency of
DMCAs due to an aging population, sub-optimal DMCA
training for physicians, inconsistent approaches to DMCA,
and tension between autonomy and protection.
The findings of the focus groups and interviews indicate
that, while FPs working as independent practitioners or
on inter-professional (IP) teams are motivated to engage in
DMCAs and utilize the DMCA Model for those assessments,
several factors impede them from conducting DMCAs. The
most notable factors are a lack of education, isolation from
IP teams, uneasiness around managing conflict with families,
fear of liability, and concerns regarding remuneration.
Conclusion: This research project has helped to inform
ways to better train and support FPs conducting DMCAs.
BRIDGING GAPS: PRE-PROFESSIONAL HEALTH
SCIENCE STUDENTS ENGAGING OLDER ADULTS IN
PUBLIC HOUSING
M.Milidonis2, S.Giuffre1, V.O.Cox1, A.Kuehn1, 1.
Cleveland State University, Cleveland, Ohio, 2. Cleveland
State University, Cleveland, Ohio
Intergenerational and cross cultural communication is an
important skill for pre-professional undergraduate health
science students. The purpose of this study was to evalu-
ate the effect of a reflective teaching/learning experience
on knowledge of aging and empathy. Breytspraak Facts on
Aging quiz and Kiersma-Chen Empathy Scale (KCES) were
the outcome measures in this pilot study. Undergraduate pre-
professional healthcare students were recruited with snow-
ball sampling. Students interviewed a community dwelling
older adult living in low-income senior housing. Phone inter-
views identified life and music preferences. Students com-
pleted a post-interview reflection, anticipated best teaching
strategy and downloaded individualized music onto MP3
players before teaching older adults how to use MP3 players.
Students took post tests and participated in a focus groups.
Six students were on average 20years old; female and with
2.5 years college education. All participants have previ-
ously worked with older adults and identified having a close
relationship with an older adult. Nonparametric test iden-
tify the KCES empathy scores changed (p =03) with all stu-
dents showing improvement in empathy. No improvement
was found Facts on Aging Quiz. Similar themes emerged in
the focus group session. These results identify the benefit of
reflective experiential learning in changing student empathy
for culturally diverse older adults. Student knowledge about
aging did not change with this experiential learning.
204
AGING: RETHINKING WHAT AND HOW WE TEACH
S.Hirst, C.Seneviratne, C.Mannion, University of Calgary,
Calgary, Alberta, Canada
Due to changing demographics, it is increasingly neces-
sary for professional nurses to acquire competency in the
care of older adults. The specialty of gerontological nursing
is caught among health care directives, physician assisted
suicide, the position of older adults in society, practice set-
ting challenges (i.e., staffing requirements, workload, blend
of staff skill levels), various interests in curricula revisions,
and career development. The specialty developed relatively
recently in practice and even more recently in education, and
as such often lacks the structural and institutional support
needed for it to flourish.
Described in this poster, through a descriptive case
study, is a curriculum re-design initiative undertaken by a
Universitys Faculty of Nursing (Alberta, Canada). The
Faculty restructured its undergraduate nursing curriculum
to integrate aging content and related clinical experiences
throughout its four year program. It was cognizant of the
mandate, through legislation, to educate a generalist nurse
at the undergraduate level of nursing education. At the same
time, it asked how do we best provide aging content to our
undergraduate students?
The purpose of this case study is to further understanding
of an integrative approach to facilitate learning opportuni-
ties for undergraduate nursing students. Adescription of the
work done by the Faculty in moving the integration of aging
content from the spark of an idea to reality is provided. The
benefits for students are described through feedback from
them and from faculty members. Recommendations for con-
tinued enhancement of the program, specific to aging con-
tent, are included.
PAL-S: APILOT PROGRAM TO INTEGRATE
GERIATRICS EDUCATION IN MEDICAL SCHOOL
CURRICULUM
G.Gnanasekaran1,2, E.Russell2, 1. University Hospitals
of Cleveland, Cleveland, Ohio, 2. Case Western Reserve
University, Cleveland, Ohio
Integrating geriatric skills earlier in medical school
training is vital to prepare for the upcoming challenges of
an aging population. PAL-S program (Patient Advocate
Liaison-Student Program) will target first year and second
year medical students, through an innovative approach of
interprofessional education in acquiring geriatric skills.
The program trains student volunteers as Patient Advocate
Liaisons (PAL-S) who serve as liaisons for elderly patients
through their hospital course. The students thereby effec-
tively improve their confidence and communication skills
in elderly patient care. The recruited students are trained in
elderly care, using online geriatric module, small group ses-
sions led by facilitators with geriatric expertise, and hands
on clinical experience by interprofessional education.The
program will improve communication skills and confidence
level in understanding comprehensive care of older patients
by effectively interacting and collaborating with interdis-
ciplinary staff. A pilot program was conducted with eight
medical students from Case Western Reserve University.
Innovation in Aging, 2017, Vol. 1, No. S1
Pre- and post-program surveys were conducted using a
subjective rating scale and analyzed utilizing a two-tailed,
paired t-test at P< .05. The program was able to improve
the learners confidence in caring and communicating, with
older patients. The PAL-S program improved confidence
and communication skill sets in elderly patient care for
1st and 2nd year medical students. The program would lay
foundation to integrate geriatrics within foundational stud-
ies block, longitudinal themes and core clinical components
of the medical school curriculum
SARCOPENIA, TELOMERE LENGTH AND
MORTALITY: NHANES 19992002
J.A.Batsis1, T.A.Mackenzie1, R.T.Emeny1, P.Rippberger3,
F.Lopez-Jimenez2, S.Bartels1, 1. Medicine, Geisel School
of Medicine at Dartmouth, Lebanon, New Hampshire, 2.
Mayo Clinic, Rochester, Minnesota, 3. University of New
England College of Osteopathic Medicine, Biddeford,
Maine
Background: Sarcopenia is defined as the loss of muscle
mass or function with aging and is associated with adverse
outcomes. Telomere shortening is associated with chronic
diseases yet its relationship with sarcopenia is unknown.
Methods: Adults 60years from the 19992002
National Health and Nutrition Examination Surveys with
body composition measures were identified. Appendicular
lean mass (ALM) was defined as fat-free mass of all four
limbs. Sarcopenia was defined using the two Foundation
for the National Institute of Health definitions: reduced
ALM (men<19.75;females<15.02kg); or ALM divided by
body mass index (BMI) (ASM:BMI<0.789;<0.512,respecti
vely). Telomere length relative to standard reference DNA
(T/S ratio) was assessed using quantitative PCR. Weighted
regression models predicted telomere length with sarco-
penia (referent=no sarcopenia) after adjusting for covari-
ates, including age. We tested a (telomere)x(sarcopenia)
interaction, ultimately stratifying by the presence/absence
of sarcopenia using proportional hazard modeling (HR
[95% CI]).
Results: We identified 2,672 subjects. Mean age was
70.9years (55.5% female). Prevalence of ALM and
ALM:BMI sarcopenia was 29.2 and 22.1%. No adjusted
differences were observed in telomere length in those with/
without sarcopenia (ALM: 0.90 vs. 0.92;p=0.74, ALM:BMI
0.89 vs. 0.92;p=0.24). Deaths were higher with sarco-
penia (ALM: 46.4 vs.33.4%;p<0.001; ALM:BMI: 46.7
vs.33.2%;p<0.001). We observed a modest interaction
between sarcopenia/telomere length using both definitions
(ALM p=0.03;ALM:BMI p=0.04). In the presence of sar-
copenia, telomere length was not associated with mortality
(ALM definition: HR 1.11 [0.67,1.82],p=0.68; ALM:BMI:
HR 0.97 [0.53,1.77], p=0.91). Telomere length was inversely
associated with mortality in individuals without sarcopenia
(ALM: HR 0.59 [0.40,0.86],p=0.007; ALM:BMI: HR 0.62
[0.42,0.91];p=0.01).
Conclusions: In older adults, telomere length was no
different based on sarcopenia status. However, sarcopenia
negated the known protective relationship of telomere length
with mortality after adjusting for age.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
GERIATRIC EDUCATION FROM THE PERSPECTIVE
OF TWO RESIDENCY PROGRAMS: PUERTO RICO
EXPERIENCE
M.E.Bidot-San Antonio, Medicine, Medical Sciences
Campus, University of Puerto Rico, San Juan, Puerto Rico
The health care needs and the continuous services demand
by the elderly population in Puerto Rico require physicians
possess clinical competences in geriatric. The research ques-
tions were: How two geriatric residency programs, below
Family Medicine and Internal Medicine from the Medical
Sciences Campus, University of Puerto Rico, have responded
the geriatric education trends? and Which are the internal
and external influences that have affected the residency pro-
grams according to the Academic Plan Model of Stark and
Lattuca (1997)? The research was qualitative and a histori-
cal designed was applied. The methodologies to collect the
information were documents review and an elite interview to
11 subjects represented by directors of both residency pro-
grams, faculty members and deans. It was found the trends in
geriatric education, such as: progress in the physicians train-
ing, changes in education approaches and the accreditation
process to residency programs, among others. The residency
programs are well structured and the external influences are
related to changes of social and economic factors. In conclu-
sion, the programs have responded to the geriatric education
trends in the following areas: education of the geriatricians,
the accreditation of both programs, and training in geriat-
rics to other specialist in medicine, the use of diverse clinical
settings to develop their clinical practice and in the integra-
tion of an interdisciplinary approach in their curricula. The
internal influences have affected positively the residency pro-
grams. On the other hand, the external influences that affect
negatively the geriatrics education were the lack of funds and
the implementation of managed care.
TRAINING IMPROVED STUDENTS COMFORT
LEVEL AND COMPETENCY WITH VALUE AND
PREFERENCE-BASED PRESCRIBING
H.Y.Cheng, E.Bradley, University of Virginia, School of
Medicine, Charlottesville, Virginia
When clinicians treat older adults with age-related phar-
macokinetics and pharmacodynamics, drug-drug, drug-dis-
ease interactions, polypharmacy, and comorbidity, they face
great challenges with value and preference-based prescrib-
ing/deprescribing. It was unknown whether a structured
training program could improve fourth year medical stu-
dents attitudes, comfort level and competency on value- and
preference-based prescribing/de-prescribing for older adults.
All 4th year medical students rotated through a two-
week required geriatrics clerkship and attended two, 1.5
hour-workshops on value and preference-based prescribing/
deprescribing. They were assigned to either the intervention
(the author as a primary preceptor) or control group (other
attending as a primary preceptor) alphabetically by their
last names. Only the intervention group received structured
teaching on medication review at the bedside and reported
to the author. Attitude, comfort level and competency on
value- and preference-based prescribing/deprescribing were
assessed by five questions. The authors tested 1) improve-
ment of fourth medical students attitude, comfort level and
competency on value- and preference-based prescribing/
IAGG 2017 World Congress
205
de-prescribing for older adults; 2) whether such improve-
ment is greater in the intervention group.
One hundred and forty seven students participated in the
pilot curriculum. Fifty-nine were assigned to the intervention
and 88 to the control group. At the end of geriatrics clerk-
ship, all students significantly improved their comfort level
and competency on value- and preference-based prescribing/
de-prescribing for older adults, but not attitude. There was
no difference between intervention and control groups.
This curriculum for fourth year medical students can sig-
nificantly improve students comfort level and competency
on value- and preference-based prescribing for older adults.
MEDBIQUITOUS CURRICULUM IN GERIATRICS
CLERKSHIP: INSTRUCTIONAL AND ASSESSMENT
METHODS AND RESOURCES
H.Y.Cheng, University of Virginia, School of Medicine,
Charlottesville, Virginia
MedBiquitous curriculum inventory developed by AAMC
is used to standardize instructional and assessment methods
and resource types for all clerkship except geriatrics clerk-
ship. University of Virginia is one of few medical schools in
U.S.that has required geriatrics clerkship and started to apply
MedBiquitous curriculum framework to geriatrics clerkship
and to align this framework with 26 minimum geriatrics
competencies (MGC) for fourth year medical students.
Forty eight learning objectives (LOs) and what to teach
in geriatrics for fourth year medical students in geriatrics
clerkship were aligned with 26 MGC (Academic Med 2009
and 2008 Institute of Medicine) and matched to keywords.
LOs were achieved by a variety of instructional methods
(learning activities) including case-based instruction/work-
shop, flipped classroom, clinical experience including geri-
atrics clinic, nursing home, palliative care service (inpatient,
outpatient and community), inpatient geriatric unit, tran-
sitional care hospital, and acute rehabilitation hospital,
geriatrics research presentation, self-study of online learn-
ing modules, standardized patients, and primary preceptor-
ship. LOs were supported by multiple resources including:
online geriatrics learning modules, watching DVD, EMR,
printed materials (rotation pocket book), real patient,
searchable electronic databases, and simulation center.
LOs were assessed by a variety of methods including clini-
cal documentation review of progress notes, online clinical
performance rating evaluation and checklist, geriatrics shelf
examine, final exam, standardized patient test, oral patient
presentation, geriatrics research presentation, mid- and
final rotation feedback.
The author feels MedBiquitous curriculum inventory is a
great framework to develop and organize geriatrics clerkship
and to align MGC for medical students.
A LONGITUDINAL GERIATRIC TRAINING
CURRICULUM IN MEDICAL SCHOOL: THE
GERI-TRACK
R.Puttagunta1,2, G.Salmeron2, A.M.Woods2, A.Major2,
A.D.Garcia2, G.E.Taffet2, 1. Geisinger Health Systems,
Danville, Pennsylvania, 2. Baylor College of Medicine,
Houston, Texas
Though the role of aging in disease is detailed in medi-
cal education, the intricacies of managing a geriatric patient
206 Innovation in Aging, 2017, Vol. 1, No. S1

is often a lost art. The Baylor College of Medicine (BCM) effective and efficient way to impart geriatrics knowledge. In
Section of Geriatrics sponsors a medical school geriatrics addition to distance/on-line learning, webGEMs have been
pathway, Geri-Track. In the 1st year, a monthly lecture successfully used for flipped learning teaching also.
series integrates geriatric topics with basic science cur- Although a laborious process, the creation of a national,
riculum. During the 2nd year, a semester-long, GeriSkills web-based, geriatrics education curriculum for can result in
Workshop focuses on common clinical geriatric issues. The thousands of trainees being taught core geriatrics competen-
3rd year, GeriHomes/GeriLACE yearlong clinical course cies with excellent student evaluations.
incorporates weekly visits to patients homes with com-
munity resources. The track concludes with a month-long SESSION 570 (POSTER)
rotation in clinical geriatrics. We report the 10year history
and outcomes of the BCM Geriatrics track and its success
HEALTH AND SOCIAL SERVICES INTERVENTIONS
as a longitudinal undergraduate medical education program.
Feedback surveys from participants were compared over a
THE FORWARD BUNDLEA NOVEL TOOL TO
10year period. In addition, graduates and participants of the
IMPROVE THE CARE OF PATIENTS FEEDING AT RISK
track were asked to evaluate their Geri-Track experience and
P.J.Sommerville, A.Lang, S.Carrington, J.Birns, Geriatrics,
its influence on their medical career.
St. Thomass Hospital, London, England, London, United
From 2003 to 2013, 29 medical students completed the
Kingdom
Geri-Track, and 3 have completed a geriatric fellowship.
Care of patients with a permanently unsafe swallow who
Graduates represent 11 different specialties with the most
are inappropriate for tube feeding is extremely challeng-
common being internal medicine (31%), family medicine,
ing. Feeding with acknowledged risk may be an appropriate
neurology and anesthesiology (13.8% each). All students
strategy but without clear decision making and communica-
that participated in the clinical components of the track
tion patients may spend unnecessarily long nil by mouth
found it beneficial for their career. Participation per activity
(NBM), they or their family may experience significant anxi-
ranged from 1064 students for lecture and 321 for clinical
eties, advance care plans may not be made, and feeding plans
experiences.
may not be properly communicated to downstream care
A four year long specialized geriatrics track during medi-
providers.
cal school is an attractive option to increase student interest
The FORWARD bundle (Feeding via the Oral Route With
in geriatrics and has potential to increase geriatricians.
Acknowledged Risk of Deterioration) was developed accord-
ing to the Plan-Do-Study-Act model of iterative quality
CREATION AND USE OF ANATIONAL,
improvement. It systematised best practice in risk feeding in
COMPETENCY BASED GERIATRICS EDUCATION
a flow chart, facilitating patient identification, decision-mak-
CURRICULUM: WEBGEMS
ing, implementation of oral feeding and further management.
A.Shah1, K.Callahan3, C.Usiak2, K.Sauvigne2,
Patients fed at risk were evaluated in sequential 6 month
R.M.Leipzig2, N.Marshall2, C.Howe4, 1. Community
periods before and after introduction of FORWARD. The
Internal Medicine, Mayo Clinic, Phoenix, Arizona, 2.
primary outcome measure was time NBM. Further data were
Mount Sinai, New York, New York, 3. Wake Forest,
collected on documentation of capacity, best interest discus-
Winston-Salem, North Carolina, 4. University of Arizona,
sions and discussions with relatives, and patient, relative and
Tucson, Arizona
staff feedback.
In 2007 Association of American Medical Colleges
Mean time NBM sustainably decreased after FORWARD
(AAMC) and the John A. Hartford Foundation hosted
was initiated (3.1 days (n=20) versus 1.5 days (n=17);
a National Consensus Conference on Competencies in
0.6days (n=20); 0.3days (n=20) (p<0.05). There was a sus-
Geriatric Education, leading to the creation of a set of 26
tained increase in documentation of capacity assessments
minimum medical student geriatrics competencies. Teaching
(40% versus 94.1%; 90%; 95%), best interest discussions
these competencies has proved to be challenging due to lack
(85% versus 100%; 100%; 100%) and discussions with
of sufficient geriatrics educators at all medical schools and
next of kin (45% versus 100%; 95%; 100%). Patient and
time in the medical school curriculum.
carer feedback reported perceived improved quality of life
To meet this challenge, in 2010, a group of educators
associated with the decision for feeding with risk using
came together to create the webGEMs curriculum (web-
FORWARD. Staff feedback highlighted increased confidence
based Geriatrics Education Modules) and developed 25 peer-
with feeding and improved communication, documentation
reviewed online case-based modules linked to the AAMC
and knowledge.
geriatrics competencies, available at POGOe.org. We have
tracked use of the modules along with responses to voluntary
EFFECT OF HOUSE CALL PROGRAM ON
end-of-module evaluations.
MEDICARE COST IN HIGH-RISK OLDER ADULTS:
To date, more than 8,000 medical, nurse practitioner, and
RETROSPECTIVE COHORT STUDY
physician assistant students have completed over 30,000
R.Rothbaum1, L.Romanovsky1, S.Gordon1, T.Raia1,
total cases, spending an average of 33 minutes per case.
A.Abrams1, D.Kim1,2,3, 1. Beth Israel Deaconess Medical
7827 case evaluations have been completed, with 71% of
Center, Boston, Massachusetts, 2. Brigham and Womens
responses rating the cases as good to excellent overall, 88%
Hospital, Boston, Massachusetts, 3. Harvard Medical
saying the case taught the key issues that a student should
School, Boston, Massachusetts
need on the topic, and 79% rating the case as a valuable use
of the students time. Faculty rate the webGEMs has a highly

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
House call programs may save health care costs in high-
risk patients. This retrospective cohort study aimed to eval-
uate the effect of a house call program on health care costs
and utilization in Medicare beneficiaries who received care
at Beth Israel Deaconess Medical Center, Boston, MA. In
November 2012-June 2013, 548 beneficiaries who were at
high risk for hospitalizations were contacted for a house
call program; 307 who agreed received at least monthly
home visits by nurse practitioners who collaborated with
their physicians for disease management and care coordina-
tion. The remaining 241 beneficiaries received usual care
without home visits or care coordination. The outcomes of
interest were changes in the 12-month total Medicare part
A and B cost and health care utilization before and after
their contact date. Compared with the usual care group,
the house call group was older (82 vs. 79 years) and had
higher burden of chronic conditions. After propensity score
matching, the average total Medicare cost per member per
month increased by $494 in the house call group ($1875 to
$2369) vs. $47 in the usual care group ($1845 to $1892)
(p=0.01). The number of emergency room visits, hospi-
talizations, skilled nursing facility admissions did not dif-
fer between the groups; home health agency use per 100
person-months changed by 125days in the house call group
(313 to 438days) vs. -48days (309 to 261days) (p=0.01).
In conclusion, our house call program was associated with
increased health care cost and home health agency use.
SOCIAL CAPITAL INTERVENTIONS TARGETING
OLDER PEOPLE AND THEIR HEALTH IMPACT:
ASYSTEMATIC REVIEW
L.Coll-Planas1,3, F.Nyqvist2, T.Puig3,4, G.Urrtia3,5, (public sector). Nurses, club leaders and health committee
R.Montesern3,6, 1. Fundaci Salut i Envelliment - UAB,
Barcelona, Spain, 2. bo Akademi University. Faculty
of Education and Welfare Studies, Social Policy, Vaasa,
Finland, 3. Institute of Biomedical Research (IIB Sant Pau),
Barcelona, Spain, 4. Servicio de Epidemiologa Clnica
y Salud Pblica, Hospital de la Santa Creu i Sant Pau,
Universitat Autnoma de Barcelona, Barcelona, Spain, 5.
CIBER de Epidemiologa y Salud Pblica (CIBERESP),
Madrid, Spain, 6. Equip dAtenci Primria Sardenya, EAP
Sardenya, Barcelona, Spain
Observational studies show that social capital is a pro-
tective health factor. Therefore, we aim to assess the health
impact of social capital interventions targeting older adults.
We conducted a systematic review based on a logic model
and assessed effectiveness using vote-counting and stand-
ardised decision rules. Studies were retrieved from Medline,
Embase, CINAHL, PsycINFO, Cochrane Central Register of
Controlled Trials and Web of Science from January 1980 up
to July 2015. We included randomized controlled trials tar-
geting participants over the age of 60 or with a mean age of
over 65 and focused on social capital or its components (i.e.,
social network, social support, social participation or social
engagement). The comparison group should not include any
social capital component. We focused on health outcomes
and assessed risk of bias. The review protocol was regis-
tered in PROSPERO (ref. CRD42014015362). We examined
17,341 abstracts and included a total of 73 papers report-
ing 36 randomized controlled trials. There was a big hetero-
geneity across studies and positive effects were reported in
IAGG 2017 World Congress
207
different contexts, participants characteristics and interven-
tion designs and in a wide variety of patient-reported out-
comes and objective measures. Nevertheless, according to
outcomes reported in five or more trials, social capital inter-
ventions showed mixed effects on quality of life, well-being
and self-perceived health and were generally ineffective on
loneliness, mood and mortality. Our review supports the
potential of social capital interventions to reach comprehen-
sive health effects in older adults while highlighting the lack
of quality and comparability between trials.
A PILOT TRIAL FOR COMMUNITY EMPOWERMENT
THROUGH NURSE-LED COUNSELING CENTERS
D.Shin1,2, S.Bae1,3, Y.Choi1,3, M.Kang4, 1. Hallym
University, Chuncheon, Korea (the Republic of), 2. Research
Institute of Nursing Science, ChunCheon, Kangwondo,
Korea (the Republic of), 3. Institute of Health Service
Research, Chuncheon, Kangwondo, Korea (the Republic of),
4. Ewha Womans University, Seoul, Korea (the Republic of)
Nurse-led counseling centers (NLCCs) have been estab-
lished in Gu, a town-sized urban district in South Korea.
The purpose of the NLCCs was empowering residents, culti-
vating their leadership and mobilizing community resources
to prevent chronic dieases and manage their health. Clubs
and health-committees were organized to fulfill the purpose.
We examined its feasibility guided by the ADEPT models
four determinants such as goals, obligations, resources and
opportunities. Four focus-group interviews have been con-
ducted in October to November 2013. Participants were
sixteen nurses, eight club leaders who were senior residents
(private sector), and fifteen health-committee members of Gu
members represented different perspectives toward goals of
the NLCCs. Further, participants defined their roles based on
their goal perceptions. Due to lack of agreements on goals
and obligations, nurses felt overwhelmed and exhausted with
unespected roles, while other two groups felt that they have
been asked to do tasks that they were not responsible for. For
the resources, participants reported that the Gu had enough
to empower residents, but they felt that the resources needed
to be distributed more efficiently. Among three opportu-
nities, organizational and public opportunities increased
while political one did not. The NLCCs posed potentials for
empowering senior residents and communities. Establishing
channels among nurses, private and public sectors was essen-
tial to increase sustainability of the NLCC.
LIFE STORY BOARDS, PERSON-CENTRED CARE,
AND PATIENTS LIVING WITH DEMENTIA:
AQUALITATIVE STUDY
S.P.Hammond, A.Ruseell, P.Fisher, Norwich Medical
School, University of East Anglia, Norwich, United
Kingdom
With disease modifying drugs remaining beyond the hori-
zon, providing better care for people living with dementia
remains high on the international agenda. Person-Centred
Care (PCC) approaches emphasise the social context in
which care is provided by one human being to another.
One approach to enhance PCC is to use Life Story Work
(LSW). This involves discussing, gathering, and recording
208
information that represents important aspects of the patients
lived history, current beliefs and preferences.
In the United Kingdom (UK) booklets such as This is me
encourage social care professionals to see the person living
with dementia as an individual and deliver PCC tailored to
the persons needs. Such booklets are one method to enact
the principles of PCC. A less researched is to develop Life
Story Boards (LSB). LSB are visually more accessible and
impactful. This paper reports on a 3 year study exploring
opportunities for a LSB intervention in a UK 24 bed special-
ist inpatient dementia care unit.
Utilising a participatory approach, this exploratory
study trained seven clinical support workers to engage in
the co-production of LSB with people living with demen-
tia. Semi-structured interviews were undertaken pre and
post-intervention implementation. From a thematic analy-
sis, we will discuss; care workers experiences of LSB crea-
tion, how PCC was and/or was not experienced and how
the context impacted upon the fidelity, dose and reach of
the intervention. We will close by highlighting how LSB
provides a route into embedding a more PCC culture and
illustrates opportunities for transferability to wider inter-
national contexts.
THE GERI-BRIEFCASEAN E-HEALTH INSTRUMENT
WITH THE POTENTIAL OF AVOIDING ACUTE
ADMISSION
K.Andersen-Ranberg1,2,3, A.Fournaise2, J.Nielsen2,3,
S.Jakobsen2,3, 1. Institute of Public Health, University
of Southern Denmark, Odense, Denmark, 2. Region
of Southern Denmark, Odense, Denmark, 3. Odense
University Hospital, Odense, Denmark
As advancing age is accompanied by increasing mor-
bidity, the ageing populations ahead will be a challenge to
future health care costs. One way to keep health care costs
at bay is to reduce avoidable admission of older adults.
In Denmark, all frail citizens may receive means-tested
municipal home health care service. When a frail older
person shows signs of failing health, the community nurse
is the first to judge the situation. But older persons may
have subtle symptoms, and the pathological picture may
be blurred by comorbid conditions. It may thus be hard
for the community nurse to decide whether an older per-
sons failing health needs acute attendance by a physician
or not. However, in-home objective clinical assessment by
Point of Care (POC) testing followed by real-time upload
of test results to a joint IT-platform, which can be accessed
by the treating physician, may qualify decision-making. In
consequence, this may lead to timely treatment and poten-
tially avoidance of acute admission. We report the devel-
opment and real-life testing of the GERI-briefcase, a
portable, handheld POC instrument connected to an inter-
face which uploads collected data to a joint IT-platform.
The IT-platform is accessible for both community nurses,
primary and secondary care physicians. We show that the
GERI-briefcase may be used by trained community nurses
in the homes of older adults, and that it streamlines com-
munication across the primary and secondary health care
sectors. The effect on avoiding acute admissions is currently
being investigated in Svendborg Municipality, Region of
Southern Denmark.
Innovation in Aging, 2017, Vol. 1, No. S1
EFFECT OF APRIMARY CARE VIRTUAL WARD ON
THE READMISSION RATES OF OLDER PATIENTS
POST DISCHARGE
I.Vedel1,3, G.Arsenault-Lapierre1, M.Ladores2, H.Saad2,
N.Sourial1,3, J.Gagnon3, V.DSouza2, B.Kremer2, 1. Lady
Davis Institute, Jewish General Hospital, Montreal, Quebec,
Canada, 2. Herzl Family Practice Center, Jewish General
Hospital, Montreal, Quebec, Canada, 3. Department of
Family Medicine, McGill University, Montreal, Quebec,
Canada
Transitional care programs to reduce readmissions have
had mixed results. Interventions led by primary care physi-
cians may have a better impact. Our objective is to evaluate
the impact of a Family Medicine-based Virtual Ward (VW)
intervention at the Jewish General Hospital in reducing the
emergency room (ER) visits, readmissions and the length of
stay of older patients.
Our study is quasi-experimental with a historical control
group. All 42 patients who received the intervention between
July 1st 2014 and June 30th 2015 were included. These patients
were compared to all 68 consecutive historical controls dis-
charged from the hospital one year prior. Inclusion criteria
were: 65years or older, having a family doctor at the clinic,
a high risk of readmission (LACE score above 10)and being
discharged to home/senior residence. The patients charts
were reviewed to determine rates of ER visits and readmis-
sions at 30, 60, and 90days after discharge and cumulative
length of stay (LOS) for all readmissions within 90days.
Clinically meaningful decreases in ER visits, readmis-
sion rates and LOS were observed in the VW group com-
pared to the control group; however, these differences were
not statistically significant. ER visits at 30, 60, and 90days
were decreased by 2%-17%. Readmissions were decreased
by 22%-26%. LOS at 90 days was decreased by 35%.
Replication in a larger sample is warranted to confirm these
findings.
A PHOTOGRAPHY INTERVENTION FOR OLDER
ADULTS
D.J.Yoder, Gerontology Institute, Georgia State University,
Douglasville, Georgia
In the United States, there are 10,000 people turning 65
every day and we will soon have the largest percentage of
our population over 65 that our country has ever known.
This will provide many challenges for our medical commu-
nity, caregiving networks and government programs. Keeping
older adults healthy and able to function independently will
reduce the strain on the community and allow us to target
our resources where they can make the most impact. I pro-
pose an intervention that teaches digital photography, basic
photo editing and computer skills to older adults to improve
cognitive function, increase overall happiness and improve
physical health. Research has shown that learning a new skill
can improve brain function and cognitive reserve, enhancing
social ties leads to increased levels of happiness, and physical
activity improves both cognitive function and happiness lev-
els. Photography incorporates all of these activities and can be
modified to suit the interests and abilities of virtually anyone.
Ipropose a test with a quota sample of 810 individuals includ-
ing a balance of genders, races and ethnicities, sexual orienta-
tions, and income levels to understand the impact this project
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
could have on people of different statuses. At the conclusion
of this intervention, people should be able to send email, share
photos on social media and search the web for information.
Teaching these skills can help keep them connected with fam-
ily and friends and give them access to information and social
networks that otherwise may not be available.
SESSION 575 (POSTER)
IMMUNOLOGY AND VACCINES
ANTIBODY RESPONSES TO 23-VALENT
PNEUMOCOCCAL POLYSACCHARIDE VACCINE
AFTER PRIMARY AND REVACCINATION
K.Kawakami1, H.Kishino2, S.Kanazu2, N.Toshimuzu2,
R.Yokokawa2, K.Takahashi2, M.Kohn3, L.Musey3, 1.
Nagasaki Kawatana Medical Center, Nagasaki, Japan, 2.
MSD KK, Tokyo, Japan, 3. Merck and Co. Inc, Kenilworth,
New Jersey
Despite increasing risk for pneumococcal disease with
advancing age, many countries recommend only a single dose
of pneumococcal polysaccharide vaccine (PPSV23) for older
adults. Concerns about the possibility of declining response
to revaccination with age have hindered the adoption of a
revaccination policy. We examined antibody responses by
age after primary vaccination and revaccination in a cohort
of adults aged 7089years.
We measured serotype-specific IgG geometric mean
concentrations (IgG, 14 serotypes) and opsonophagocytic
activity geometric mean titers (OPA, 6 serotypes) 4 weeks
after vaccination in a community-based cohort vaccinated
>= 5years earlier (N=161) or never vaccinated (N=81) with
PPSV23. Subjects were aggregated into 4 groups using 5-year
age increments for analysis.
Across age groups IgG and OPA in the primary vaccina-
tion and revaccination groups were not significantly differ-
ent. Within each age group and for all serotypes there were
no significant differences between the primary and revacci-
nation groups, with the exception of the group aged 7074
for which IgG for serotypes 23F and 19A and OPA for sero-
type 6B were higher in the primary vaccination group than
the revaccination group.
IgG and OPA after PPSV23 did not decline with age
between 70 and 89 years. For all age groups, patients
responded similarly to primary and revaccination. The gen-
erally comparable levels of IgG and OPA for the serotypes
tested after primary vaccination and revaccination regardless
of age supports the value of revaccination with PPV23, even
to older adults.
RESPONSES TO 23-VALENT PNEUMOCOCCAL
POLYSACCHARIDE VACCINE IN ADULTS 7079 WITH
CHRONIC DISEASES
K.Kawakami2, H.Kishino3, S.Kanazu3, N.Toshimizu3,
R.Yokokawa3, K.Takahashi3, M.Kohn1, L.Musey1, 1.
Merck and Co. Inc, Kenilworth, New Jersey, 2. Nagasaski
Kawatana Medical Center, Nagasaki, Japan, 3. MSD K.K.,
Tokyo, Japan
Many countries recommend that adults with chronic
disease be vaccinated with pneumococcal polysaccharide
IAGG 2017 World Congress
209
vaccine (PPSV23) because of their increased risk for pneu-
mococcal disease. To explore the immunogenicity of PPSV23
in these patients we examined antibody responses in adults
age 7089 with chronic disease after primary vaccination
and revaccination compared to healthy adults in this same
age group
We measured serotype-specific IgG geometric mean con-
centrations (GMC, 14 serotypes) and opsonophagocytic
activity titers (OPA, 6 serotypes) 4 weeks after vaccination
in a community-based cohort vaccinated >= 5years earlier
(N=161) or never vaccinated (N=81) with PPSV23.
For each serotype the GMC and OPA titers did not dif-
fer significantly between each of the groups with co-morbid
conditions and the group without any of those conditions,
with the exception of significantly higher GMC titers against
serotype 7F in the revaccination groups with lung disease
and heart disease, and serotype 3 in the revaccination group
with heart disease. The GMC also were not significantly dif-
ferent between those with 0, 1 and 23 of these conditions.
GMC and OPA responses to PPSV23 vaccination and
revaccination in older patients with heart disease, lung dis-
ease or diabetes mellitus were not significantly different from
older patients without these conditions, even if they had
more than one of these condition or if they had been previ-
ously vaccinated. These results support the recommendation
to vaccinate these patients at increased risk with PPSV23.
THE NEED FOR BETTER VACCINES FOR OLDER
ADULTS
W.Schaffner1,2, S.Gravenstein3, 1. National Foundation
for Infectious Diseases, Bethesda, Maryland, 2. Vanderbilt
University School of Medicine, Nashville, Tennessee, 3. Case
Western Reserve University, Cleveland, Ohio
Seasonal influenza (flu) and respiratory syncytial virus
(RSV) are the two leading causes of medically significant res-
piratory tract illnesses in older adults in the United States.
The viruses circulate alongside other winter respiratory
viruses and are often indistinguishable from each other based
on clinical presentation alone. Although the impact of influ-
enza in older populations is well recognized among health-
care professionals (HCPs) and the public health community,
there is an under-appreciation of the impact of RSV, which is
estimated to cause nearly as many annual deaths in US adults
age 65years and older as influenza Ainfections.
Standard influenza vaccines do not provide optimal
protection for older patients due to age-related immune
senescence. Newer influenza vaccines, designed to provide
a stronger immune response in older adults, have become
available in recent years. There is currently no licensed vac-
cine available to protect against RSV, but, several promising
candidate RSV vaccines are on the horizon to protect popu-
lations at increased risk of serious RSV outcomes, including
those age 65years and older.
The National Foundation for Infectious Diseases (NFID)
convened experts to address prevention and treatment
of both influenza and RSV in older adults and is develop-
ing outcomes reports. In the coming months, NFID will be
developing strategies, content, and tools to support optimal
prevention strategies against influenza and public health and
HCP communities that are better prepared to address RSV
prevention when vaccines do become available in the US.
210
ZOSTER VACCINE LIVE: REVIEW OF
POSTMARKETING SAFETY BY DECADE OF LIFE
E.Willis, M.Woodward, E.Brown, Z.Popmihajlov, Merck
& Co., Inc., Kennilworth, New Jersey
Zoster Vaccine Live (ZVL) was approved in 2006 for the
prevention of herpes zoster (HZ) and post herpetic neuralgia
in individuals 50years-of-age. To describe the safety profile
of ZVL by decade of life, spontaneous postmarketing adverse
event (AE) reports received for ZVL from 02-May-2006 to
01-Nov-2015 from healthcare providers (HCP) worldwide
for patients age 50 were reviewed. Atotal of 11342 reports,
containing 28188 AEs, were identified. The majority of the
reports were from those 6069 (48%) years followed by
7079 (28%), 5059 (14%); and 80years (10%). Overall,
injection site reaction (ISR) (n=6788; 24%) and herpes zos-
ter (HZ) (n=2577; 9%) were the most frequently reported
AEs. ISR was the leading AE in ages 5079 and HZ in those
80years. Median time to onset (TTO) from vaccination to
AE for ISR was 2days. In slightly over half of the reports of
HZ, TTO was 14days postvaccination. HZ was also the
most frequently reported serious AE among all age groups. In
the majority (75%), HZ was considered serious because the
HCP reported the event to be either medically significant or
disabling. Sixteen events (<1%) of disseminated HZ (DHZ)
in ages 5059 (n=1), 6069 (n=5), 7079 (n=6) and 80years
(n=4) were reported; 40% of the patients were reported to be
immunosuppressed. The remaining AEs were reported simi-
larly across the age groups. This review indicated that DHZ
was reported very rarely and the most frequently reported
AEs for ZVL were similar by decade of life.
EFFECTIVENESS OF LIVE ZOSTER VACCINE IN
PREVENTING POSTHERPETIC NEURALGIA (PHN)
R.Baxter2, J.Bartlett2, B.Fireman2, M.Marks1,
J.Hansen2, L.Aukes2, E.Bresnitz1, P.Saddier1, 1.
Pharmacoepidemiology, Merck and Co. Inc., North Wales,
Pennsylvania, 2. Kaiser Permanente Vaccine Study Center,
Oakland, California
A single dose, live attenuated zoster vaccine, is licensed in
>50 countries for the prevention of herpes zoster and PHN.
Duration of protection is being evaluated in a long-term
observational study. We previously reported that vaccine
effectiveness (VE) to prevent zoster tended to decline over
time and was on average 4550% over 5 years in people
60 (60+) years. We present here the results of VE against
PHN. The study is conducted in a large US healthcare plan
as an open cohort that members enter unvaccinated when
they become age-eligible for vaccination. PHN cases among
vaccinated and unvaccinated zoster cases were identified as
having a PHN-specific diagnosis code 90 days after first
zoster diagnosis code. VE against PHN was estimated using
Cox regression adjusting for sex, birth year, race/ethnic-
ity, healthcare use, comorbidities and immunocompromise
status. From 2007 to 2013, >300,000 subjects were vacci-
nated (coverage >40% in 60+) and ~42,000 zoster episodes
occurred. VE against PHN was 83% (95% CI 7390%) in
the first year, decreased in the second year, and then remained
relatively stable through year 5, with an overall VE of ~70%
in all 60+ age groups (6069, 7079, and 80+ years at vac-
cination); among people vaccinated at 80+, VE was 71%
(5482%). Overall VE against PHN was ~70% in all 60+
Innovation in Aging, 2017, Vol. 1, No. S1
age groups. VE against PHN and zoster in people vaccinated
at 80+ was similar to younger 60+ groups, supporting vac-
cination of all eligible people, including the elderly who are
at increased risk of zoster and PHN.
REFERENCE RANGES OF LYMPHOCYTE SUBSETS IN
NON-FRAIL OLDER ADULTS
B.Laffon1, M.Snchez-Flores1, D.Marcos-Prez1,
A.Maseda2, L.Lorenzo-Lpez2, J.Milln-Calenti2,
V.Valdiglesias1, E.Psaro1, 1. DICOMOSA Group,
Department of Psychology, Area of Psychobiology,
Universidade da Corua, A Coruna, Spain, 2. Gerontology
Research Group, Instituto de Investigacin Biomdica de
ACorua (INIBIC), Complexo Hospitalario Universitario
de ACorua (CHUAC), SERGAS, Universidade da Corua,
A Coruna, Spain
Aging is associated with progressive changes in several
key physiological systems including the immune system,
which is continuously remodeled over the life course, a pro-
cess known as immunosenescence. Nevertheless, reference
ranges currently used for immunological biomarkers do not
specifically differentiate the older adults group. Thus, the aim
of this study was to establish reference ranges for lympho-
cyte subsets in non-frail older individuals, and to determine
the influence of certain physiological or lifestyle factors.
Percentage of the lymphocyte subpopulations were analyzed
in peripheral blood from 144 older subjects (aged 6595)
by flow cytometry, and reference ranges were calculated. The
individual status as non-frail or pre-frail did not affect the
immunological parameters, but a clear influence of age and
gender was observed for some of them. Results obtained will
serve as a basis to determine the usefulness of lymphocyte
subsets as immunological biomarkers of frailty.
Funding: Xunta de Galicia (R2014/021).
DISPARITIES IN INFLUENZA IMMUNIZATION
STATUS AMONG POST-ACUTE AND LONG-TERM
CARE PATIENTS/RESIDENTS
C.Byrne, L.A.Palmer, D.H.Barch, N.M.Jarrett,
A.Helburn, H.Neumann, L.Smith, RTI International,
Research Triangle Park, North Carolina
Influenza is associated with morbidity and mortality in
at-risk populations. Individuals admitted for post-acute or
long-term care may be especially susceptible to adverse out-
comes. The CDC recommends annual influenza vaccination
for everyone over 6months old unless medically contraindi-
cated. The quality measure, Percent of Residents or Patients
Assessed and Appropriately Given the Seasonal Influenza
Vaccine, is intended to encourage nursing homes (NHs),
inpatient rehabilitation facilities (IRFs), and long-term care
hospitals (LTCHs) to address this important aspect of clini-
cal care. We analyzed assessment data for these three set-
tings for the 201415 IVS (n= 1,780,510 MDS 3.0; 251,403
IRF-PAI; 100,545 LTCH CARE Data Set). The majority of
patients and residents were assessed and when appropriate,
vaccinated (80% in NHs; 91% in IRFs; 73% in LTCHs);
however, disparities by demographic markers were observed
when examining rates of vaccine receipt and rates of vac-
cine refusals. Chi-square tests of independence found sig-
nificant relationships between vaccination status and patient
characteristics of sex, race, ethnicity, and age (p < .01 for
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
all categories). Men, whites, and older individuals were
more likely to receive the vaccine and women, minorities,
and younger individuals were more likely to decline in these
settings. Multiple logistic regression analyses of immuniza-
tion status showed that, even when adjusting for selected
patient- and facility-level covariates, these disparities were
still present. Our research found little change a decade after
disparities in nursing home residents vaccination status
were first observed. Disparities in vaccination still need to be
addressed, now for all three of these settings.
IMMUNE RISK PROFILE (IRP) AND MORBITY
PHENOTYPE OF INDEPENDENT OLDEST OLD
M.Caldeira, M.Brunialti, R.Salomo, C.Mello Almada RESEARCHCONCEPTUAL AND PRACTICAL
Filho, M.Cendoroglo, Geriatric, Universidade Federal de
Sao Paulo, Indaiatuba, Sao Paulo, Brazil
Backgroud: The Immune Risk Profile (IRP) is defined as
inversion of lymphocytes T CD4 / CD8. IRP+ is present in
1315% of the studies and is associated with functional limi-
tations and mortality in elderly. Methods: We invited elderly
aged 80 and over, community-dwelling, with good cognition,
no acute diseases and with chronic diseases under control.
We analyzed CD4 and CD8 lymphocytes and the morbid-
ity phenotype considered was: Hypertension, Heart disease,
Diabetes, Stroke, nonskin Cancer, skin Cancer, Osteoporosis,
Thyroid disease, Parkinsons disease and Chronic Obstructive
Pulmonary disease. We classified the oldest old according to
the age of diagnoses in: survivors10 and delayers10 (at least
one of 10 diseases before or after 80years old respectively),
escapers10 (none of 10 diseases), survivors3 and delayers3
(heart disease, stroke, nonskin cancer before or after 80years
old respectively) and escapers3 (none of 3 diseases). Results:
There were no differences between the distribution of dis-
eases in survivors10, delayers10 and escapers10 and also sur-
vivors3, delayers3 and escapers3 according to sex. The CD4/
CD8<1 was present in 9 % of subjects, with a mean age of
85,6years. From 224 independent oldest old, 162 of survi-
vors3 + delayers3 and 42 of escapers3 were PIR- (p= 0,0039).
Conclusion: PIR was more frequent in independent oldest
old besides the presence of diseases and maybe is a marker of
independent longevity.
SESSION 580 (POSTER)
INVOLVEMENT IN THE COMMUNITY THROUGH
VOLUNTEERING AND CIVIC ENGAGEMENT II
SOCIAL ACTIVATION OF SOCIALLY ISOLATED
ELDERLY BY VOLUNTEERS
P.Bos, University of Humanistic Studies Utrecht, Utrecht,
Netherlands
This paper is based on an evaluative ethnographic study
among elderly persons in the city of Rotterdam in the
Netherlands. Data are collected among 55+ citizens who are
admitted to a social work-program because of their prob-
lematic social isolation and/or loneliness. The program offers
each client a volunteer who visits the client on a weekly basis.
In-depth interviews in combination with thick descriptions,
collected through participant observations and focus groups
offer insights from both perspectives (clients and volunteers).
IAGG 2017 World Congress
211
The study reveals a wide array of expectations, hopes and
frustrations. Several clients appeared unmatchable because
of heavy needs. Many volunteers experience mismatches
and declining motivation. Volunteers balance distance ver-
sus proximity or intimacy, sustainable relationships versus
temporality, practical assistance versus social support. The
increasing number of unmatchable clients requires reconsid-
erations and readjustments in terms of screening and selec-
tion of volunteers and clients. The operational volunteer staff
needs intensive coaching to adjust and improve skills and to
uphold motivation.
OLDER CITIZENS ENGAGEMENT IN AGE
CONSIDERATIONS
R.OSullivan1,2, B.Murtagh3, 1. Institute of Public Health
in Ireland, Belfast, United Kingdom, 2. Ulster University,
Belfast, Northern Ireland, United Kingdom, 3. Queens
University Belfast, Belfast, Northern Ireland, United
Kingdom
The research community are increasingly being encour-
aged (both financially and morally) to connect with the rele-
vant players from government, the non-profit sector, business
and especially older people themselves. However, we need to
understand and debate to a much greater degree how older
citizens involvement in research can be appropriate, mean-
ingful and beneficial. This mixed methods research combines
a review of literature and practices on user involvement, an
e-survey of practitioners in the age sector (n50) and 18 semi-
structured interviews with researchers, government and non-
profit sector representatives. The paper presents a review of
the nature of user involvement in research and how this can
be strengthened to improve the quality of work and the poten-
tial for stronger impact. This presentation sets out a review
of the conceptual and practical basis of user involvement in
research on issues and topics relevant to older adults; the
types, levels and value of different methods of user involve-
ment; the reasons why older people and their representa-
tive organisations get involved, the attitudes of researchers
and practitioners to older citizens involvement. The paper
utilises Foucaults theory of power, provides a typology of
researchers perspectives on user involvement and concludes
with a set of good practice guidelines for researchers wishing
to maximize involvement.
BARRIERS TO OLDER PEOPLES PARTICIPATION IN
SENIORS INTEREST ORGANISATIONS: ACROSS-
CULTURAL STUDY
R.Serrat1, J.Warburton3, A.Petriwskyj2, F.Villar1, 1.
Cognition, Development, and Educational Psychology,
University of Barcelona, Barcelona, Barcelona, Spain,
2. The University of Queenland, Brisbane, Queensland,
Australia, 3. La Trobe University, Wodonga, Victoria,
Australia
Older peoples active political participation is a core com-
ponent of the active ageing model, which recognizes seniors
right to have a say in decisions directly affecting their lives.
This often occurs through seniors interest organisations;
however, research into older peoples volunteering for politi-
cal organizations is very limited. One important dimension
on which evidence is missing is the understandings of those
212
in responsible roles about the challenges to recruitment and
retention. This evidence is fundamental to understanding and
developing practice among these volunteer leaders. Further,
given the nature of this participation, socio-political context
may be an important influence on their beliefs and practice.
This study explores the perceptions of older people in
such responsible roles within seniors interest organizations,
across two different socio-political contexts, about their own
barriers to continued volunteering, and the barriers they per-
ceive for others to become involved. The sample comprised
52 participants from nine Australian and five Spanish sen-
iors interest organisations. Aquestionnaire including open-
ended questions regarding perceived barriers to recruitment
and retention in seniors organisations was used for data
collection.
Analysis of findings showed three key categories relating
to practical and resource issues, beliefs and attitudes towards
participation, and organizational and contextual issues.
However, there were considerable differences between the
volunteer leaders perceptions of barriers to others recruit-
ment and their own retention. Moreover, similarities and dif-
ferences across the two countries highlight the importance of
considering the influence of diverse socio-political contexts.
Implications for seniors interest organizations and future
research are discussed.
FACTORS RELATING TO SATISFACTION
AND MOTIVATION OF DISTRICT WELFARE
COMMISSIONERS IN JAPAN.
Y.Sugihara, Tokyo Metropolitan University, Hachioji-shi,
Tokyo, Japan
Formal volunteering offers broad benefits to the commu-
nity. Therefore, understanding the strategy for the recruit-
ment and retention of volunteers has been considered as an
important policy issue. In Japan, district welfare commis-
sioners are important formal volunteers that deal with com-
munity care and support. However, there are few people that
willingly undertake work as the commissioners. This study
examined factors associated with the satisfaction and moti-
vation to continue working of district welfare commission-
ers, with a focus on the roles of psychosocial gains, role
strain, and support from others. Questionnaires were sent
by mail to district welfare commissioners (N=1,936) living
in Tokyo in 2012 (response rate: 69.5%). The results from
structural equation modeling showed that those having high
psychosocial gains such as feelings of fulfillment about their
activities had a high level of satisfaction and motivation to
continue working, whereas those feeling role conflicts (e.g. I
am assigned meaningless work.) and role ambiguity (e.g. I
dont know what to do.) had a low level of satisfaction and
motivation. Role overload was not significantly related to the
level of satisfaction and motivation. Although support from
municipal offices, community support centers and other
sources did not have direct effects on satisfaction and moti-
vation, consultation and information support from them had
indirect effects mediated by an increase in psychosocial gains
and a decrease in role conflicts and ambiguity. These results
suggest the importance of managing psychosocial gains and
role conflict/ambiguity and promoting backup support for
the retention of district welfare commissioners.
Innovation in Aging, 2017, Vol. 1, No. S1
ENGAGING OLDER ADULTS AND THEIR
CAREGIVERS IN INNOVATION ECOSYSTEMS FOR
HEALTH AND AGING
H.McNeil1, J.McMurray2, K.Byrne1, K.Grindrod1,
A.McKinnon3, P.T.Stolee1, 1. School of Public Health and
Health Systems, University of Waterloo, Waterloo, Ontario,
Canada, 2. Wilfrid Laurier University, Waterloo, Ontario,
Canada, 3. Arthritis Research Canada, Richmond, British
Columbia, Canada
Innovation for health and aging offers potential ben-
efits for the well-being of older adults and their caregivers.
Regional Innovation Ecosystems (RIEs), involving a triple
helix of industry, government and academic stakeholders,
have been proposed to support development and commer-
cialization of innovations. We sought to understand how
older adults and their caregivers contribute their perspec-
tives to RIEs for health and aging, and whether their role
could be enhanced through an evolution of the triple helix
partnership. Athree-phase integrated mixed-methods study,
emphasizing stakeholder engagement was conducted. Phase
one involved a scoping review on user engagement in RIEs.
Building on this, phase two engaged older adults and their
caregivers (n=15), and representatives from the triple helix
(n=21) in individual and group interviews. Following Kane
and Trochims (2007) Concept Mapping methodology, phase
three integrated themes into a framework of priorities. We
found that there is currently little meaningful involvement of
older adults and their caregivers in RIEs. Evolving the triple
helix theoretical framework to accommodate the growing
importance of meaningful engagement of older adults and
their caregivers will require a recognition of the need for
diversity of representation, consideration of barriers such as
system constraints and traditional partnerships, and appre-
ciation of multiple roles that older adults could play in health
and aging innovation. This study identified directions and
strategies for enhanced engagement in RIEs for health and
aging. We are continuing to collaborate with project stake-
holders to develop RIEs that can support the health and well-
being of older adults and their caregivers.
BABY-BOOMERS VOLUNTEERING IN NON-PROFIT
ORGANIZATIONS OFFERING HOME SUPPORT
J.Castonguay1,2,3, M.Beaulieu1,3,4, A.Svigny2, 1. Facult
des lettres et sciences humaines, Universit de Sherbrooke,
Lvis, Quebec, Canada, 2. CIUSSS de la Capitale-Nationale
Centre dexcellence sur le vieillissement de Qubec,
Qubec, Quebec, Canada, 3. Centre de recherche sur le
vieillissement du CIUSSS de lEstrie CHUS, Sherbrooke,
Quebec, Canada, 4. Chaire de recherche sur la maltraitance
envers les personnes anes, Sherbrooke, Quebec, Canada
Non-profit organizations, important actors in the field of
home support, are facing challenges such as recruiting and
retaining volunteers. In view of the ageing population, this
situation is worrisome: these organizations essentially rely
on volunteer action. The imminent wave of baby-boomers
entering retirement may improve the situation. However, free
time and volunteering are not synonymous.
This poster will report the findings of a study which
sought: 1) to identify individual and organizational fac-
tors that facilitate and/or hinder baby-boomers volunteer-
ing in non-profit organizations; 2)to better understand the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
interactions between them; and 3)to create a model of baby-
boomers volunteering.
This descriptive and comprehensive study is based
on qualitative methods and a contemporary Straussian
grounded theory approach, and is guided by an integration
of the Bronfenbrenners ecosystemic approach and the vol-
unteer process model. The theoretical sample consists of 34
participants: volunteers, non-volunteers and volunteer coor-
dinators. Semi-structured interviews are conducted and sup-
plemented by non-technical literature.
For each stage of the volunteering process (antecedents,
experiences, consequences), individual factors (e.g.: knowl-
edge, availability, capacities, motivations) and organizational
factors (e.g.: mission, activities, organizational structure,
support) represent barriers and/or facilitators according to
their intervention context. Some factors play a key role at a
specific moment, while others appear transverse to the vol-
unteering process. However, individual and organizational
factors do not act alone; they interact with interpersonal and
social factors.
Despite the benefits associated to volunteering, it is impor-
tant to remain critical concerning its promotion. Pernicious
shifts may happen such as a normalization and an instru-
mentalization of volunteering.
ECONOMIC RESOURCES AND VOLUNTEERING IN
LATER LIFE: DOES RACE MATTER?
Y.Chen1, H.Shen2, 1. Washington University in St. Louis,
St. Louis, Missouri, 2. University of Missouri-St. Louis, St.
Louis, Missouri
Many important factors predicting volunteering in old
age have been identified. For instance, evidence suggests that
older adults who are healthier are more likely to volunteer.
However, the effects of economic resources on volunteering
remain inconclusive. Guided by the cumulative disadvan-
tage theory, the present study investigates (1) whether the
associations between economic resources and volunteering
differ by types of economic resources (income, net worth,
financial assets, home and car ownership), and (2) whether
such relationships vary by race. Using data from the 2010
Health and Retirement Study, 9,859 community-dwelling
older adults who were 65+ and self-identified as non-His-
panic White or non-Hispanic Black/African-American were
included. Two hierarchical multinomial logistic regression
models (one for Whites and the other for Blacks), control-
ling for socio-demographics and health, were utilized to
assess the relationships between different types of economic
resources and volunteering: non-volunteering (reference),
informal-volunteering only, formal-volunteering only, and
both types. Results showed that different types of economic
resources were associated with different types of volunteer-
ing that older people engaged in: income was not related to
any types of volunteering; owning a car and greater financial
assets increased the likelihood of both types of volunteering.
For Whites, financial assets were positively associated with
formal-volunteering only, but for Blacks, greater financial
assets increased the likelihood of informal-volunteering only.
Findings suggest the importance of looking at different types
of assets in understanding volunteering for older adults. It
is equally important to consider different types of economic
IAGG 2017 World Congress
213
resources when encouraging volunteering among older white
and black adults.
INTERGENERATIONAL RECIPROCITY: THE ROLE
OF SPIRITUALITY AMONG AFRICAN AMERICAN
FOSTER GRANDPARENTS
D.Ivey, N.Fields, The University of Texas at Arlington,
Arlington, Texas
Volunteering in later life is considered a major category
of productive aging. The Foster Grandparent Program (FGP)
is one of three National Senior Service Corps programs that
allows volunteers (age 55 +) to stay active by serving chil-
dren with special needs in their communities. Over forty
percent of volunteers in the FGP are from African American
(AA) backgrounds, however, little research has examined
the unique cultural experiences of this population. Although
research suggests that spiritualty and/or resilience are inte-
gral to the culture of AA elders, there is a dearth of research
exploring the role of faith among AA foster grandparents in
FGPs. Guided by gero-transcendence and transpersonal the-
ories, the purpose of this study was to qualitatively explore
the role of spirituality and resilience among AA foster grand-
parents. A researcher with expertise in the cultural aspects
of intergenerational caregiving conducted in-depth qualita-
tive interviews with a sample of foster grandparents from
African American backgrounds (N = 10). Using an induc-
tive approach through a process of thematic analysis, four
main themes suggest that foster grandparents experienced
love, kindness, bonding, and a sense of purpose through the
FGP. Findings suggest that spirituality played an important
role for foster grandparents within the context of connecting
personal faith to the volunteer experience. Participants also
reported intergenerational reciprocity and an enhanced sense
of purpose in their daily lives through the FGP volunteer
experience. We recommend strategies for culturally tailoring
FGPs to take into account the unique strengths of AA foster
grandparents, in particular, faith and spirituality.
BENEFITS AND BARRIERS FOR CHINESE
IMMIGRANT FOSTER GRANDPARENTS: AMIXED
METHODS STUDY
L.Xu, V.Miller, N.Fields, The University of Texas at
Arlington, Arlington, Texas
Objectives: The National Senior Service Corp Foster
Grandparent Program (FGP) provides volunteer opportuni-
ties for older adults to work as grandparents with children
with special needs. Although research suggests that race
and culture impact foster grandparent volunteering, there
is little research related to the experiences of Chinese elders
participating in FGP. In this study, the researchers utilized
a community-based participatory approach to explore the
benefits and barriers to volunteering as foster grandparents
in American schools from the perspective of Chinese immi-
grant elders.
Methods: Mixed methods were used for this study. Focus
groups and brief survey were conducted with Chinese fos-
ter grandparents (N=20) to qualitatively and quantitatively
explore participants experiences in the U.S. school system
working with special needs children. Descriptive analysis
and inductive content analysis was employed. Themes were
214
identified until consensus was reached among members of
the research team.
Results: Overall, the majority of participants (96%)
enjoyed participating in the FGP. Participants shared that
volunteering in the FGP was a reciprocally beneficial inter-
generational experience. Participants also suggested that par-
ticipating in the FGP provided meaningful opportunities to
help children, valuable cross-cultural learning opportunities
related to traditions/practices in the United States as well as
offered a positive social outlet and stress relief. Barriers to
FGP participation included difficulties with the English lan-
guage and cultural differences between Western and Eastern
teaching styles/classroom expectations.
Conclusions: Participation in the FGP for Chinese
immigrant elders is both beneficial and challenging.
Recommendations for culturally tailored foster grandpar-
ent training are provided along with implications for future
research.
LOW-INCOME ADULTS MOTIVATION TO BECOME
ASENIOR CORPS VOLUNTEER
A.Georges, H.Uppal, W.Fung, JBS International, Inc.,
Burlingame, California
The Corporation for National and Community Service
Senior Corps program engages low-income adults in national
service. Volunteers were surveyed prior to starting service as
a Foster Grandparent or Senior Companion and after nine
months of service. Participants (N=1,125) were females
(89%), racially diverse (45% White, 42% African American,
and 11% Hispanic), and ages 5591. A latent class analy-
sis, based on 11 items, found that while a typical volunteer
was motived by altruistic motives, some motives were more
predominant than others and some volunteers had multiple
motives. Specifically, five categories of volunteers were iden-
tified: Altruistic (15%), Personal Growth (9%), Idealistic
(21%), Social Exchange (22%), and Externally Driven
(34%). Amultinomial logistic regression analysis found that
unlike previous studies, gender and race were not significant
predictors of motivation. Findings also showed that volun-
teers with bachelors degree or higher education were more
likely to be in groups motivated by a desire to improve the
community, as well as a desire to grow personally and help
an individual. Volunteers who are separated/divorced, wid-
owed or live alone were more likely to be in the Altruistic
group than the Social Exchange group; the former identified
the desire to help someone, while the latter identified with all
motivations presented. The findings suggest that recruitment
messages based on idealistic and altruistic values may have
wider appeal for adults older than 76years and those who
are separated, divorced or live alone; and messages based on
self-oriented motives (e.g., learning, self-accomplishment)
would appeal to the more educated volunteers.
INFLUENCE OF INTERGENERATIONAL PROGRAMS
ON SOCIAL CAPITAL IN LOCAL COMMUNITY
Y.Fujiwara1, Y.Murayama1, M.Hasebe2,1, J.Yamaguchi1, sary corrective to formal accounts based primarily on survey
M.Yasunaga1, K.Nonaka1, H.Murayama3,1, 1. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan, 2.
Seigakuin University, Ageo, Japan, 3. University of Tokyo,
Tokyo, Japan
Innovation in Aging, 2017, Vol. 1, No. S1
Background & purpose: We launched an intergenera-
tional program named REPRINTS (Fujiwara et al., 2006),
in which volunteers >60 years old read picture books to
children in school setting of a local community. REPRINTS
has demonstrated reciprocal effects on senior volunteers and
children (Yasunaga etal., 2016). The aim of this study was to
clarify the relationships between intergenerational programs
and social capital among local residents.
Methods: We conducted a mail survey among randomly
selected 2,500 residents in Tama ward of Kawasaki city, aged
2084years in 2015. Of these, 978 residents (461 males and
517 females) responded the survey.
Respondents were asked about social capital and were
assessed by two items: (1) Can people be trusted in their
neighborhood? (neighborhood trust), (2) In most cases,
would people try to take advantage of their neighborhood?
(neighborhood norm). Awareness of the REPRINTS was
also assessed: Do you know the intergenerational program
REPRINTS program or its activities in this community?
Results: Among the 24 residential area in this commu-
nity, 13 intervention areas had at least a kindergarten, an
elementary school or a junior high school where REPRINTS
volunteers often visited.
Awareness of the REPRINTS was 13.8% among
respondents.
For those in their 20s and 30s, individual levels of neigh-
borhood trust and norms were significantly associated with
awareness of the REPRINTS program (p<.01). For the sam-
ple of those in their 40s, 50s and 60s over, community-lev-
els of neighborhood trust were significantly associated with
duration of the programs in the areas (p<.05).
Conclusion: A spillover effect of the intergenerational
program associated with neighborhood trust and neighbor-
hood norm in a community but differs between generations.
LET THE SUNSET GLOW: PRACTICING QUASI-
VOLUNTEERISM IN SHANGHAIS AGING
COMMUNITIES (19982016)
T.Pan, G.Shen, The Institute of Anthropological and
Ethnological Studies, Fudan University, Shanghai, Shanghai,
China
Based on field research conducted intermittently since
the late 1990s, this paper examines the innovative strate-
gies developed by staff members of the street office and its
affiliated residents committees, NGOs, social entrepreneurs
in order to generate and sustain quasi-voluntarism in ageing
communities in Huangpu District, Shanghai. In the context
of everyday community-building practices, quasi-volunteer-
ing refers to activities of giving that do not preclude volun-
teers from benefiting from their work (e.g. material rewards
or satisfaction). Through probing the local grounding of
quasi-volunteering and identifying the operational worth
of embedded adaptive wisdom, this paper attempts to bring
multiple voices of motivated social actors to bear on the local
system of eldercare management in order to provide a neces-
research and questionnaires. By way of incorporating ethno-
graphic perspectives that gives centrality to individual efforts
to endure, control, and manipulate their circumstances, this
paper seeks a deeper understanding of the strengths and
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 215

limits of located-based volunteer activities in facilitating pos- to evaluate quantitatively and semi-quantitatively protein
itive ageing and meeting the dire needs of the elderly. intake in community-dwelling elders from So Caetano do
Sul, SP, Brazil. Data from a cross-sectional study with 295
SESSION 585 (POSTER) elders over 60years, users of health facilities and community
centers for elderly. Sociodemographic, health, lifestyle and
food intake data we collected. Multiple Source Method esti-
NUTRITION AND DIET QUALITY 1
mated habitual intake for energy, macro and micronutrients.
Protein was evaluated as total intake, grams per kilogram
DIETARY PATTERNS AND ATHEROSCLEROSIS IN
of body weight (g/kg), food source and meal. Prevalence of
COMMUNITY-DWELLING OLDER MEN IN HONG
nutrient inadequacy intake was estimated using the EAR
KONG AND THE U.S.
method to define cut-off points. The survey found that most
J.Woo1,2,5, R.Chan1,2, J.Leung3, J.Shikany4, 1. Department
elderly was female (85.1%), over 70years (53.6%) and up
of Medicine and Therapeutics, The Chinese University
to four years of education (41.7%). Median protein intake
of Hong Kong, Hong Kong, Hong Kong, 2. Centre for
was 67g (or 1.05 g/kg) and inadequacy prevalence was
Nutritional Studies, The Chinese University of Hong
8.5%. Ratio of animal to vegetable protein was 2:1. The fre-
Kong, Hong Kong, Hong Kong, 3. Jockey Club Centre for
quency of elderly who consumed less than 25g of protein
Osteoporosis Care and Control, The Chinese University
in the breakfast was 98%, in the dinner 67% and 33% at
of Hong Kong, Hong Kong, Hong Kong, 4. Division of
lunch. Being that, most protein was consumed during lunch
Preventive Medicine, University of Alabama at Birmingham,
(43.0%). Milk and bakery groups had the highest relative
Birmingham, Alabama, 5. CUHK Jockey Club Institute of
contribution for protein intake at breakfast and snack meals,
Ageing, The Chinese University of Hong Kong, Hong Kong,
and meat at lunch and dinner. Higher prevalence of inad-
Hong Kong
equate micronutrient intake, except vitamin C and sodium,
Dietary pattern analysis is an alternative approach investi-
was found among elderly who consumed less protein (g/kg).
gating the association between diet and atherosclerosis. This
In conclusion, protein intake should be monitored to ensure
study examined the association of dietary patterns with preva-
the quantity, quality and adequate distribution between
lent atherosclerosis in community-dwelling men older than
meals for health promotion and prevention of fragility
65 years. We used data from the Osteoporotic Fractures in
related sarcopenia.
Men (MrOS) Hong Kong (HK) cohort (N=1768) and MrOS
US cohort (N=5006). Diet was assessed with country-specific
HIGH INTAKE OF NON-MILK EXTRINSIC SUGARS IS
food frequency questionnaire. Principal component analysis
ASSOCIATED WITH POOR NUTRIENT INTAKES IN
identified three a posterior dietary patterns: vegetables-fruits
OLDER PEOPLE
dominated, dim sum-meat-fish dominated, and fast foods
S.Jyvkorpi1, K.Pitkl1, T.M.Puranen1, T.Strandberg1,3,2,
dominated in HK site and two patterns: vegetables-fruits-
M.Bjorkman1, H.Soini1, H.Kautiainen1, M.Suominen1,
fish-poultry dominated and fast foods-red meat dominated
1. Department of General Practice and Primary Health
in US site. Anklebrachial index (ABI) was measured and a
Care, University of Helsinki, Helsinki, Finland, 2. Helsinki
cut-off value of <0.9 was used to define prevalent athero-
University Central Hospital, Helsinki, Finland, 3. University
sclerosis. Multiple logistic regression was used to assess the
of Oulu, Oulu, Finland
association between dietary patterns and ABI controlling for
Introduction: High dietary sugar intake may compro-
demographic, socio-demographic and lifestyle variables, and
mise protein and micronutrient intakes in people with low
comorbidities. There were 5% and 6.2% MrOS HK and US
energy intakes. Results on micronutrient dilution studies in
men with ABI <0.9 respectively (p=0.06). In HK site, men in
older people have been few and conflicting. We examined
the highest quartile of vegetables-fruits dominated pattern
nutritional status and nutrient intakes in connection to non-
score [age and BMI adjusted OR=0.50 (95% CI: 0.260.96),
milk extrinsic sugars(NMES) intakes in older people repre-
ptrend=0.03] showed lower likelihood of having an ABI <0.9
senting broad spectrum of both healthy and vulnerable older
compared to men in the lowest quartile. In US site, men in the
populations.
higher quartile of vegetables-fruits-fish-poultry dominated
Methods: Cross-sectional study combined five
pattern score was associated with lower odds of having an
Finnish datasets with home-dwelling(n=526) and
ABI <0.9 [age and BMI adjusted OR=0.59 (95% CI: 0.42
institutionalized(n=374) older people. Nutritional status
0.83), ptrend=0.005]. The associations were attenuated and
was assessed using Mini Nutritional Assessment(MNA) and
no longer statistically significant in the fully adjusted mod-
nutrient intakes retrieved from 13 day food records. The
els. There was no statistically significant association between
participants were divided into quartiles corresponding to
other pattern scores and ABI category in either cohort.
proportions of energy received from NMES. Energy, nutri-
ent and fiber intakes were classified according to the NMES
PROTEIN INTAKE OF BRAZILIAN ELDERLY FROM
quartiles and the participants were divided according to
SO CAETANO: AQUANTITATIVE AND SEMI-
place of residence (home, institution).
QUANTITATIVE ANALYSIS
Results: High NMES intake was associated with age,
N.Gaspareto1, A.N.Previdelli1, S.M.Lima Ribeiro2, R.C.de
female sex, poor cognition, low MNA scores, immobility
Aquino1, 1. Universidade So Judas Tadeu, So Paulo, SP,
and institutionalization. 90% of the participants in the high-
Brazil, 2. University of So Paulo, So Paulo, Brazil
est NMES quartile(Q4) were institutionalized. In institution-
Protein intake in elderly is associated with prevention or
alized participants low protein and micronutrient intakes
risk of adverse outcomes, particularly sarcopenia. We aimed
were observed in both those with low energy intakes(Q1)

IAGG 2017 World Congress

216
and in those with high NMES intakes(Q4). In home-dwelling
older people there was a linear trend of declining nutrient
intakes with increasing NMES intakes in protein and most
micronutrients.
Conclusions: Institutionalized older people had diets high
in NMES compared to home-dwelling older people. In insti-
tutionalized older people both low energy and high NMES
intakes were associated with low protein and micronutrient
intakes.
METABOLIC ABNORMALITIES IN BRAZILIAN
OLDER ADULTSSABE SURVEY
D.Dourado1, M.N.Marucci2, M.Roediger2, 1. Universidad
del Desarrollo, Santiago, Chile, 2. Universidade de Sao
Paulo, Sao Paulo, Brazil
The aim of this study is to investigate the metabolic syn-
drome components in Brazilian older adults by gender and
age groups. Cross-sectional study with data from the SABE
(Health, Well-being and Aging) Survey: epidemiological,
cohort based and home-dweling. The population included
elderly individuals ( 60years old), both sexes, selected by
probability sampling, interviewed in 2010, belonging to
three cohorts A/2000 (n = 630), B/2006 (n = 214) and C /
2010 (n=311). The variables were: gender, age, metabolic
syndrome components (MSC), identified according to the cri-
teria of the National Cholesterol Education Program-Adult
Treatment Panel III: waist circumference(WC) >102cm for
men, and >88cm for women; blood pressure (BP) 130 and/
or 85mmHg; triglycerides (TG) 150mg/dL; high density
lipoprotein cholesterol (HDL-c) <40mg/dL for men, and
<50mg/dL for women; fasting glucose (FG) >100mg/dL. Rao
& Scott test and logistic regression for complex sample with
5% significance level were used. 1155 subjects were studied,
being 60.7% women. The MS prevalence was 57.9%. The
most commom MSC was high BP (85.2%), without differ-
ence by sex and greater in >70y. The risk of high WC and low
HDL-c in women were OR=5.1 (IC95% 3,89 6.64) and
OR=1.30 (IC95% 1.02 1.66), respectively. Considering the
age, the risk to WC, FG, HDL and TG altered were higher
in the youngest ones (60-65y). BP was the most common
altered MSC. The women and the new-Brazilian-older-
adults presented more metabolic abnormalities, what is a
matter of concern to future public health policies.
PREVALENCE OF DYSPHAGIA ASSESSED BY
THE EAT-10 AND ASPIRATION PNEUMONIA IN
HOSPITALIZED OLDER ADULTS
M.Martinez Reig1,2, A.Avedao Cespedes1,2, M.Mas
Romero1,2, L.Palazon Valcarcel1,2, E.Gomez Jimenez1,2,
R.Ceres Martinez2, J.Olivercarbonell1,2, E.Cortes
Zamora1,2, 1. Department of Geriatrics, University Hospital
Albacete, Albacete, Spain, 2. UDM Geriatria, Albacete,
Spain
This longitudinal observational cohort study was con-
ducted concurrently in two Spanish acute geriatric wards
during a four month period. 280 subjects belong to hospi-
tal Aand 281 to hospital B.The presence of dysphagia was
assessed by the EAT-10. Previous diagnosis of dysphagia was
recorded at baseline, as well as thickener use before, during
the stay and at discharge. Furthermore, presence of aspira-
tion pneumonia as cause of admission and mortality related
Innovation in Aging, 2017, Vol. 1, No. S1
to aspiration pneumonia were registered. Mean age in center
Awas 85.9years with 60.7% women. 27.7% of subjects had
previous diagnosis of dysphagia with aprevalence of dyspha-
gia of 42.1% determined by EAT-10. Mean age in center B
was 87.2 years with 59.1% women. 10% of subjects had
previous diagnosis of dysphagia with aprevalence of dyspha-
gia of 59.1% determined by EAT-10. Thickener use in center
Aat admission was 15%, 30% during the stay and 11% at
discharge as registered in the discharge report. Data of thick-
ener use were not recorded at center B.In center A, aspira-
tion pneumonia was the main cause of admission in 12.1%
of subjects. During follow-up, 10.4% of subjects died with
50% of deaths related to aspiration pneumonia. In center B,
aspiration pneumonia was the main cause of admission in
9.6% of subjects. During follow-up, 11% of subjects died
with 41% of deaths related to aspiration pneumonia. Our
results showed that dysphagia is often underdiagnosed. EAT-
10 is an easy tool that should be implemented in the routine
assessment of at-risk older adults.
THE ADVERSE IMPACT OF OBESITY FOR POST-
ACUTE NURSING HOME RESIDENTS WITH HIP
FRACTURE
C.Kosar, K.Thomas, V.Mor, Brown University,
Providence, Rhode Island
Obesity is a growing problem among elder nursing home
residents. The impact of obesity on strength and mobility
may prolong disability and complicate the recovery process
for residents seeking to improve their physical function. The
purpose of the current study is to examine the impact of
obesity on short-term outcomes for residents with hip frac-
ture admitted to Medicare and Medicaid certified nursing
facilities for post-acute care. Minimum Data Set assessments
were used to identify 402,470 residents admitted between
January, 2011 and December, 2014. Residents aged <65
and who were underweight (body mass index (BMI) <18.5)
were excluded. Residents were classified as normal weight,
or having mild, moderate, or severe obesity according to
BMI cutoffs established by the World Health Organization.
Using robust Poisson regression we calculated the risk for
30-day hospital readmission, discharge home, and functional
improvement associated with each level of obesity relative
to normal weight. Models were adjusted for adjusted for
age, gender, comorbidity burden, and facility fixed effects.
Sensitivity analyses were stratified by nursing facility qual-
ity, which was defined using a case-mix adjusted 5-star rat-
ing obtained from the Centers for Medicare and Medicaid
services nursing home compare website. Mild, moderate and
severe obesity all conferred high risk for readmission, and
lowered the probability of discharge home and functional
improvement (p<0.001 for trend). Results were similar in
quality-stratified analyses. These findings suggest that dis-
tinct care planning for residents with hip fracture and obesity
may be essential to improve outcomes.
INFLUENCE OF PROTEIN INTAKE DURING WEIGHT
LOSS ON INFLAMMATORY RESPONSE OF OBESE,
FRAIL OLDER ADULTS
K.N.Porter Starr1,2, H.Mulder1, M.C.Orenduff1,
C.F.Pieper1, K.M.Huffman1,2, S.R.McDonald1,2,
C.W.Bales1,2, 1. Duke University Medical Center, Durham,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
North Carolina, 2. Durham VA Medical Center, Durham,
North Carolina
Both aging and obesity increase levels of pro-inflammatory
factors, contributing to muscle loss and a negative cycle of
functional decline. While obesity reduction improves inflam-
mation, the concomitant loss of muscle mass is a serious con-
cern in older adults. Indications that increased protein intake
preserves lean muscle during weight loss are promising, but
studies of protein effects on inflammation during weight
loss are few and their findings equivocal. Thus, we exam-
ined the influence of increased protein intake on inflamma-
tory markers in a 6-month, randomized, controlled weight
reduction study of obese (BMI 30kg/m2), older (60years)
adults with physical frailty (Short Physical Performance
Battery [SPPB] score 410), who were randomized to either a
Control weight loss diet (0.8g protein/kg/day; C-WL; n=14)
or a higher protein (animal source, 2/3rds beef) diet (1.2g
protein/kg/day; HP-WL; n=25) in a 1:2 ratio. Reduced kcal
intake in both arms and target protein intake in HP-WL were
confirmed by 3-day records. Outcomes included function by
SPPB and serum levels of 11 biomarkers of inflammatory
status. In both arms, weight loss (~8%) was achieved and
SPPB score improved, with a superior functional response
in HP-WL (P<0.05). Several markers of inflammation
improved, but only in the HP-WL group, for whom lep-
tin (P<0.001), CRP (P<0.01), and ICAM-1 (P<0.01) were
decreased and adiponectin increased (P<0.01); however, only
adiponectin trended (P<0.07) towards a difference by group.
Findings from this pilot study show beneficial inflammatory
responses to HP-WL in obese, frail older adults; however,
confirmation in a larger study is needed.
DIET QUALITY IS ASSOCIATED WITH HEALTH-
RELATED QUALITY OF LIFE IN AFRICAN AMERICAN
AND WHITE ADULTS
M.Grimes1, M.F.Kuczmarski1, M.K.Evans2,
A.B.Zonderman2, 1. Behavioral Health and Nutrition,
University of Delaware, Newark, Delaware, 2. NIA/NIH,
Baltimore, Maryland
Health-related quality of life (HRQoL) is associated with
mortality and morbidity in older adults. Diet quality has been
shown to affect HRQoL measures; however, past research
has focused on adherence to the Mediterranean diet, and few
studies have examined aging populations. The purpose of this
study was to compare HRQoL with the Healthy Eating Index
(HEI)-2010, a diet quality measure based on compliance with
US federal standards, in a racially and socioeconomically
diverse urban sample. This analysis included 1176 of 3720
participants from the Healthy Aging in Neighborhoods of
Diversity across the Life Span (HANDLS) study. Participants
were 3064 years old at baseline. Tertiles of baseline HEI-
2010 were regressed against follow-up HRQoL (physical
and mental component scores (0100) of the Short Form 12
(SF-12)) with BMI, race (African American vs White), fol-
low-up time (years), and socioeconomic status (SES) (< or
>125% of 2004 US poverty guidelines) as covariates. The
mean (SE) HEI-2010 score was 43.111.7 (out of 100),
and mean mental and physical HRQoL (SE) scores were
49.711.7 and 40.66.4, respectively. Lower HEI scores was categorized using body fat (BF%: low/high; men25%;
(p=0.002, =1.294), lower SES (p<0.001, = -4.646), longer
follow up time (p=0.047, =0.720), and African American
IAGG 2017 World Congress
217
race (p<0.001, =2.899) were associated with poorer men-
tal health. Lower HEI scores (p=0.002, =0.693) and higher
BMI (p<0.001, = -0.164) were associated with poorer
physical health. Findings corroborate past research on the
Mediterranean diet, suggesting there are several eating pat-
terns that may improve HRQoL.
COMPARISON OF WEB-BASED INTERVENTIONS FOR
WEIGHT LOSS AND WEIGHT MAINTENANCE IN
RURAL WOMEN
P.A.Hageman1, C.H.Pullen1, M.Hertzog1, B.Pozehl1,
C.Eisenhauer1, L.S.Boeckner2, 1. University of Nebraska
Medical Center, Omaha, Nebraska, 2. University of
Nebraska-Lincoln, Lincoln, Nebraska
This community-based clinical trial compared 3 web-deliv-
ered interventions, web-based only (WO) with web-based
supplemented by peer-led discussion (WD) or professional
email counseling (WE), on achieving weight loss and weight
maintenance among rural women, ages 4069. Rural women
(n=301, baseline BMI of 2845kg/m2) were randomized to
WO, WD, or WE groups. All groups received access to the
comprehensive website which included self-monitoring and
interactive features for healthy eating and activity. The pri-
mary analysis focused on each of 3 phases separately [Phase 1
guided weight loss (baseline to 6 mo); Phase 2 guided weight
loss and weight maintenance (7 to 18 mo); and Phase 3 self-
directed weight maintenance (1930 mo)]. Linear mixed
models were used for analysis. Intervention groups did not
differ from each other in mean change on body weight, with
this finding consistent across all phases and for all pairwise
comparisons. Across the groups, estimated mean weight loss
after Phase 1 ranged 4.0 to 5.5kg (4.2 to 6.2% of initial
body weight). All groups had increases (p < 0.05) in weight
after Phases 2 and 3, with average weight increases of 2kg
and 1kg after Phases 2 and 3, respectively. The lack of group
differences were potentially due to the robust nature of the
web-site available to all groups. While weight loss was mod-
est, the use of web-based interventions may be clinically rel-
evant for reaching rural women on a public health level, as
small weight reductions are linked with health benefits.
ASSOCIATION OF ADIPOSITY, TELOMERE LENGTH
AND AGE: NHANES 19992002
J.A.Batsis1, T.A.Mackenzie1, E.Vasquez2, C.M.Germain3,
R.T.Emeny1, P.Rippberger4, F.Lopez-Jimenez5, S.Bartels1,
1. Medicine, Geisel School of Medicine at Dartmouth,
Lebanon, New Hampshire, 2. SUNY Albany, Albany,
New York, 3. Duke University, Durham, North Carolina,
4. University of New England College of Osteopathic
Medicine, Biddeford, Maine, 5. Mayo Clinic, Rochester,
Minnesota
Background: Telomere shortening is associated with age
and risk of medical co-morbidity. We assessed the relation-
ship between measures of adiposity with leukocyte telomere
length and whether it is influenced by age.
Methods:Subjects with dual energy x-ray absorptiometry
(DEXA) measures were identified using the National Health
and Nutrition Examination Survey 19992002. Obesity
females 35%), body mass index (BMI) categories, and waist
circumference (WC) (low/high, men102cm; females88cm).
218
Telomere length relative to standard reference DNA (T/S
ratio) was assessed using quantitative polymerase chain
reaction. Weighted multivariable regression models evalu-
ated the association of telomere length with adiposity, both
continuously and categorically (low/normal BF%, low/high
WC,BMI 18.524.9kg/m2=referent), adjusted for age (where
indicated), race, sex, education, smoking, co-morbidities, and
physical activity. The interaction between age strata and adi-
posity was assessed and subsequent models stratified by age.
Results: We identified 7,827 subjects (4,056 female; 2672
age60years). Mean age was 46.1 years. Overall telomere
length was 1.050.01 (SE) that differed by BF% (low/high:
1.120.02 vs. 1.030.02;p<0.001), BMI (underweight
1.080.03; normal 1.090.02; overweight 1.040.02; The primary objective of this study was to examine the asso-
obese 1.030.02; p<0.001), and WC (low/high 1.090.02
vs. 1.020.02; p<0.001). Adjusted estimates between tel-
omere length and adiposity measures were: BF% (=-
0.00330.0008;p<0.001), BMI (=-0.0250.0008;p=0.005),
and WC (=-0.00110.0004;p=0.007). All age x adipos-
ity interactions were significant (p<0.001). Model esti-
mated mean difference (Age>60Age<60) was: BF%
(-0.140.01;p<0.001), BMI (-0.150.001;p<0.001), and WC
(-0.00150.0004;p<0.001). No significant association was
present between telomere length and adiposity over age60.
Conclusions: A negative association between adiposity
and telomere length was observed but age abrogates this
relationship.
HANDGRIP STRENGTH ASSOCIATED WITH DIET
QUALITY IN URBAN AFRICAN AMERICAN AND
WHITE ADULTS IN THE U.S.
E.S.Shupe1, M.F.Kuczmarski1, M.K.Evans2,
A.Zonderman2, 1. University of Delaware, Newark,
Delaware, 2. NIA/NIH, Baltimore, Maryland
Muscle mass loss and progressive declines in strength, asso-
ciated with loss of physical functioning, increase with age. Diet
quality can affect muscle strength and performance. Handgrip
strength is an indicator of total-body muscle strength and
physical performance. This study investigated the association
between diet quality and handgrip strength in 2140 African
American and White adults examined in baseline Healthy Aging
in Neighborhoods of Diversity across the Life Span study. Diet
quality was measured by Mean Adequacy Ratio (MAR) of 17
micronutrients from two dietary recalls. Handgrip strength
was assessed using the Jamar Hydraulic Hand Dynamometer.
Mean MAR (SE) scores were 73.930.31 and mean hand-
grip strength was 34.680.29. When compared across tertiles,
handgrip strength was significantly associated with MAR; with
each tertile of MAR, handgrip strength significantly improved;
(1st tertile-32.2.47, 2nd tertile-34.5.50, 3rd tertile-36.8.53).
Multiple regression models were used to explore the cross-
sectional relationship of MAR to handgrip strength, adjust-
ing for potential confounders. Model one included the main
effects (race, age, sex, and socioeconomic status (SES)), model
two included main effects and MAR as a continuous variable.
Model three included main effects, MAR and race x SES inter-
action. Being African American (= 2.1; p<0.001), younger
(= -.30; p<0.001), male (= 16.49; p<0.001), and higher
MAR scores (= .06; p<0.001) were associated with greater
handgrip strength in Model 3.SES was significantly associated
with handgrip strength in model 1; however, in model 3, SES
Innovation in Aging, 2017, Vol. 1, No. S1
and race x SES interactions were not significant. Better diet
quality is important in maintaining handgrip strength.
PHYSICAL PERFORMANCE INFLUENCED BY DIET
QUALITY IN U.S. URBAN WHITE AND AFRICAN
AMERICAN POPULATIONS
S.Reilly1, M.F.Kuczmarski1, M.K.Evans2,
A.B.Zonderman2, 1. Behavorial health and nutrition,
University of Delaware, Newark, Delaware, 2. NIA/NIH,
Baltimore, Maryland
Repeated chair stands are recognized as a measure of
lower body strength. Diet quality can effect both muscle
strength and mass, as well as risk of developing sarcopenia.
ciation of physical performance with diet quality by explor-
ing the relationship between number of completed chair
stands and diet quality in urban White and African American
adults examined in Wave 3 (20092013) of the Healthy
Aging in Neighborhoods of Diversity across the Life Span
(HANDLS) study. The HANDLS study is a prospective epi-
demiological study designed to examine the roles of race and
socioeconomic status on health disparities. Baseline wave
(20042009) examined 3720 people. Lower body strength
was measured by the number of completed repeated chair
stands (010) by 2019 participants. Diet quality was assessed
by diet diversity serving (DDS) scores (040), calculated
using two 24-hour dietary recalls. Cross-sectional linear
regression was used to determine the relationship between
number of completed repeated chair stands and DDS scores,
adjusting for the following covariates: race, socioeconomic
status (SES), age, and sex. The mean (SE) DDS score was
16.60.02, while the mean chair stands completed was
8.60.07. Being African American (=0.496; p=0.001),
higher SES status (=0.780; p<0.001), younger (=-0.064;
p<0.001), and male (=0.495; p=0.001), along with higher
DDS scores (=0.035; p=0.006) resulted in being able to
complete more chair stands. These findings provide evidence
of the importance of consuming a diet consisting of a wide
variety of foods to maintain physical performance.
THE HEALTHY NORDIC DIET AMONG OLDER
INDIVIDUALS PREDICTS INCIDENT DISABILITY IN
A10-YEAR FOLLOW-UP
M.Perl1, M.von Bonsdorff2,3, M.Salonen1,2,
J.G.Eriksson1,2,4, 1. Department of Health, National
Institute for Health and Welfare, Helsinki, Finland,
2. Folkhlsan Research Center, Helsinki, Finland, 3.
Gerontology Research Center and Department of Health
Sciences, University of Jyvskyl, Jyvskyl, Finland, 4.
Department of General Practice and Primary Health Care,
University of Helsinki, Helsinki, Finland
We investigated whether adherence to the healthy Nordic
diet among older individuals was associated with incident
disability 10 years later. We studied 972 participants from
the Helsinki Birth Cohort Study who were free of disability
at baseline. At the mean age of 61years the Nordic diet score
(NDS) was calculated based on a validated food-frequency
questionnaire that the participants filled in. Higher scores
indicated better adherence to the healthy Nordic diet. At the
mean age of 71 years, participants incident disability was
assessed using a self-reported questionnaire and was based
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
on two levels of disability: mobility difficulty (difficulty in
walking 500 m) and self-care dependence (difficulty in dress-
ing or bathing). Association between the NDS and incident
disability was tested by logistic regression analysis. In total,
92 participants (9.5%) developed difficulty in walking 500
meters and 44 participants (4.5%) developed difficulty in
dressing or bathing during 10-year follow-up. After adjust-
ing for age, BMI, educational attainment, physical activity,
smoking, and energy intake, the likelihood of having difficul-
ties in walking 500 m were lower among those in the highest
NDS fourth than among those in the lowest NDS fourth (OR
0.29, 95% CI 0.12, 0.67). In addition, the odds of having
difficulties in dressing or bathing were lower among those
in the highest NDS fourth than among those in the lowest
NDS fourth (OR 0.35, 95% CI 0.12, 0.99). In conclusion,
adherence to the healthy Nordic diet among older individu-
als predicted incident disability during a 10-year follow-up.
LATE BEDTIME AND EXPOSURE TO LIGHT AT
NIGHT ARE ASSOCIATED WITH METABOLIC
DISORDERS IN ELDERLY
O.A.Poliakov, Y.Gavalko, M.Romanenko, L.Sineok, D.F. risk did not differ between non-Hispanic white and Hispanic/
Chebotarev State Institute of Gerontology, Kyiv, Ukraine
Last decade we observe a rising interest to circadian
cycle influence on metabolic disorders and weight control.
However, whether changes of sleep characteristics are associ-
ated with metabolic syndrome (MS) in the elderly remains
unclear.
We selected 88 elderly (6074years) patients: 68 with MS
and 20 without abdominal obesity and MS. MS was diag-
nosed according to IDF criteria (2005). Sleep characteristics
(bedtime, sleep duration, awakening time, exposure to bright
light) were studied by questioning. Data were compared with
one-tailed t-test, correlations were calculated using Pearson
coefficient.
Bedtime in the elderly significantly correlated with body
mass index (r=0,35) and waist circumference (r=0,34). Sleep
duration significantly correlated with body mass index
(r=0,32). Elderly people with MS went to the bed later (23:35
vs 22:36, p<0,05) and awoke later in the morning (07:53 vs
07:00, p<0,05) than people without abdominal obesity and
MS despite the same sleep duration. Moreover, elderly people
with MS showed significantly higher prevalence of light at
night exposure (71 % vs 25 %, p<0,05).
More late bedtime with stable sleep duration and expo-
sure to light at night are associated with increased body mass
and waist circumference, and, thus, may be the factors that
contribute to metabolic disorders in elderly.
SESSION 590 (POSTER)
OLDER ADULT MOBILITY AND REHABILITATIVE
CARE
FALL EVENTS AMONG OLDER, COMMUNITY-
DWELLING MEN: AN EXAMINATION OF RISK AND
PROTECTIVE FACTORS
E.J.Nicklett1, R.J.Thorpe2, 1. School of Social Work,
University of Michigan, Ann Arbor, Michigan, 2. Johns
Hopkins University, Baltimore, Maryland
IAGG 2017 World Congress
219
Falls are a leading cause of nursing home admission and
hospitalization among older adults; however, there is surpris-
ingly little research that examines risk and protective factors
for falls among community-dwelling older men. Our study
is the first to investigate fall events among older menand
to examine racial and ethnic differences in fall risk among
menusing a population-based sample.
We analyzed data from 4429 community-dwelling men
from the Health and Retirement Study aged 65 and older. We
used multinomial logistic regression analyses to examine risk
and protective factors for single and recurrent (1 or more)
self-reported fall profiles at baseline (2000) and longitudi-
nally (20002010). We examined self-reported fall events by
race/ethnicity (non-Hispanic white, African American, and
Hispanic/Latino), controlling health and socio-demographic
characteristics.
In baseline analyses, African American men were less
likely than non-Hispanic white men to experience multi-
ple fall events, compared to no falls (RRR: 0.63, p=0.005).
Racial/ethnic differences in single or recurrent fall events
were not statistically significant in longitudinal analyses. Fall
Latino older men.
Consistent with other population-based studies, certain
characteristics (e.g., older age, ADL limitations, greater
depressive symptoms) were associated with a higher relative
risk of single and/or recurrent fall events over follow-up.
This study identifies risk and protective factors of single
and recurrent falls among older men, which can inform clini-
cal practice and falls prevention programs for diverse com-
munity-residing older adult populations.
EXPERIENCES OF VIOLENCE ACROSS LIFE COURSE
AND ITS ASSOCIATION WITH MOBILITY DISABILITY
IN OLDER AGE
D.T.Guedes1, A.Vafaei2, B.Alvarado2, J.M.Guralnik3,
R.O.Guerra1, 1. FACISA, UFRN, Joao Pessoa, Paraiba,
Brazil, 2. Queens University, Kingston, Ontario, Canada, 3.
University of Maryland, Baltimore, Maryland
Background: Life course exposure to violence may lead to
disability in old age. We examined associations between life
course violence and mobility disability in older participants
of the International Mobility in Aging Study (IMIAS).
Methods: During the IMIAS 2012 baseline survey, men
and women aged 6574 years were recruited at five cit-
ies (n=1995): Kingston and Saint-Hyacinthe (Canada),
Tirana (Albania), Manizales (Colombia), and Natal (Brazil).
Mobility was assessed by the SPPB and by two questions on
difficulty in walking and climbing stairs. Childhood physical
abuse history and the HITS instrument were used to gather
information on childhood exposure to violence and violence
by intimate partners or family members. Multivariate logistic
regression analysis models were constructed to explore asso-
ciations between violence and mobility disability.
Results: Psychological violence either perpetrated by
partner or family was more frequent than physical violence.
Compared to men, women were more often victims of all
types of violence. Experiences of childhood physical abuse
and adult physical violence either by family or partner were
related to mobility disability (adjusted for age, sex, childhood
socioeconomic status, education and research site). Those
220
exposed to physical violence by a partner showed 40% to
63% greater odds of mobility disabilities. Those exposed to
childhood physical abuse showed 43% to 69% greater odds
of mobility disabilities. Gender was not an effect modifier for
the relationships between any form of violence and mobility.
Conclusion: Our results provide evidence for the detri-
mental effects of life course exposure to violence on mobility
in later life.
ALTERNATIVE COST MODELS FOR DELIVERING
IN-HOME BALANCE IMPROVEMENT AND FALLS
PREVENTION PROGRAMMING
L.W.Kaye1, A.Adoff1, J.Crittenden1, D.Wihry1, confidence. Two patients self-withdrew. Most importantly,
M.R.Gugliucci2, 1. UMaine Center on Aging, Bangor,
Maine, 2. University of New England, Biddeford, Maine
The risk of falling increases with age with one in three
older adults experiencing a significant fall each year. Falls are
the number one cause of fractures, hospital admissions for
trauma, loss of independence, and injury deaths among older
adults. Virtually all available falls prevention programs that
focus on older adult weight training and balance improve-
ment are exclusively group taught in congregate settings.
An NIH/NIA-funded research study assessed the efficacy of
a self-taught, in-home, balance improvement curriculum for
individuals who do not wish to take advantage of centralized,
group taught falls prevention programming. Three alternative
cost models were arrived at for Area Agencies on Aging (AAA)
wanting to implement the program in communities experienc-
ing varying levels of resource scarcity. Based on two focus
groups conducted with staff (N=23) at two northern New
England AAAs, the alternative cost models offered are par-
ticularly sensitive to potential budgetary limitations in small
towns and rural communities. Programmatic costs of the three
models vary based on decisions as to the utilization levels of
staff versus volunteers, the frequency of follow-up home vis-
its as compared to calls to clients, the length and intensity of
training, and the decision to utilize mobile technology for data
collection and documentation. Rural AAAs and other older
adult health promotion agencies in particular will benefit from
implementation options that are sensitive to the cost, time,
and physical challenges associated with both staff and clients
travel in geographically isolated regions.
PIONEERING AMEDICATION SELF-
ADMINISTRATION PROGRAM IN ATERTIARY
HOSPITAL REHABILITATION WARD
C.Humphries, S.Al Hashemi, Pharmacy, Mona Vale
Hospital, Sydney, New South Wales, Australia
Introduction: Assisting patients to regain independence in
medication management is an integral part of rehabilitation
pharmacist care. A structured self-administration of medi-
cation program (SAMP) is needed as an objective measure
of patients ability to self-manage medication and support
patient-centred care.
Aim: To assess and improve rehabilitation patients ability
to self-manage medications using SAMP and provide further
support for unsuccessful patients.
Method: An assessment tool was developed to identify eli-
gible patients. SAMP consisted of four stages: (1) initial phar-
macist counselling with use of medication list, (2) supervised
self-administration, (3) independent self-administration and
(4) patient-to-pharmacist teach-back assessment. A Drug
Innovation in Aging, 2017, Vol. 1, No. S1
Regimen Unassisted Grading Scale (DRUGS) was used to
assess patients understanding of medication. A validated
Medication Regimen Complexity Index (MRCI) was used to
assess change in complexity of medication regimen.
Results: The program had a high success rate with 14 out
of 20 participants successfully completing the SAMP. The
mean age of participants was 74.4 years. The participants
were self-administering a mean of 6.1 medications on admis-
sion and 10.4 on discharge, with a mean increase in MRCI
of 45%. Successful SAMP participants demonstrated a mean
change in DRUGS score from 90.6% to 98.4%. Seventy-
eight percent of successful participants reported increased
SAMP identified 4 patients as unable to safely self-adminis-
ter giving the pharmacist opportunity to arrange alternative
medication management.
Conclusion: SAMP improved patients understanding and
ability to self-manage medications. Furthermore, it enabled
objective assessment of patients capacity to manage their
medications aiding decision making for discharge planning.
PREVALENCE OF HEARING IMPAIRMENT AND
ASSOCIATED FACTORS AMONG OLDER U.S. ADULTS
K.Forrest, N.Campbell, Slippery Rock University, Slippery
Rock, Pennsylvania
Hearing impairment significantly impacts older peoples
communication and interaction with others, and their abil-
ity to understand and follow doctors advice. This study
evaluated the prevalence rate of hearing impairment and
associated factors among older U.S. adults. Data from the
20132014 National Health and Nutrition Examination
Survey (NHANES) were analyzed. Hearing impairment was
assessed through self-reporting of serious hearing difficul-
ties. To account for the complex multistage sample design in
NHANES, SAS survey procedures were utilized to analyze
the data. All analyses were based on the weighted data for
a better representation of the U.S. population. The current
analysis contained 1,264 individuals aged65, representing
12.4% of the NHANES sample, with 44.3% males. Age dis-
tribution was 34.0%, 26.3%, 16.0%, and 23.8% for 6569,
7074, 7579, and 80+, respectively. Race distribution was
80.0%, 8.6%, 7.2%, and 4.2% for White, Black, Hispanic,
and Asian, respectively. The prevalence of hearing impairment
was 16.5% overall, 20.1% for males, and 13.5% for females.
This rate increased significantly with age (27.0% among age
80+). Hispanic and White older adults had a significantly
higher prevalence of hearing impairment than Black and Asian
older adults. Those who lived alone, had an annual income
of $35,000 or less, and had poor health status were more
likely to experience hearing impairment (all p-values<.05).
Approximately one in every six older adults suffers from seri-
ous hearing impairment. Besides aging and some demographic
factors, older adults with lower socioeconomic status and poor
health status had a significantly higher risk for the condition.
LIFE SATISFACTION AMONG OLDER KOREAN
ADULTS WITH DISABILITIES: AN APPLICATION OF
THE PACID MODEL
S.Cho, Office for Policy Research Team 1, Korea Disabled
Peoples Development Institute, Seoul, Korea (the Republic
of)
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 221

This study aimed to examine whether the Psychosocial capacity, although it had no statistically significant associa-
Adaptation to Chronic Illness and Disability (PACID) model tion with participation frequency. Furthermore, the analysis
is a well-established framework for older Korean adults with showed that the better infrastructure the lower psychological
disabilities and to investigate the associated factors of life and emotional functions among older adults. Infrastructure
satisfaction (LS) among them. Asample of 384 older Korean had a moderating effect on the association between chronic
adults with disabilities obtained from the Korea Welfare illnesses and multidimensional disability. Based on these find-
Panel Study data (2014), a representative national survey ings, I argue that there is an urgent need to enhance older
funded and approved by Korean government, was used in Koreans health status. The findings furthermore suggest that
this study. Structural equation modeling was employed to an increase in the number of welfare facilities and accessibil-
examine the dynamics among the antecedents (i.e., causes of ity to these facilities can play an essential role in reducing
disability, age and income at disability onset, gender), pro- the level of multidimensional disability and alleviating the
cess factors (i.e., depression, self-esteem, disability severity, negative influence of chronic illnesses on multidimensional
functional ability, course of disability condition, discrimina- disability among Korean older adults.
tion experiences, use of services, social support, education,
income) and outcome (i.e., LS) based on the PACID model. SESSION 595 (POSTER)
The research model had good model fit, indicating that the
PACID model was well applied to older Korean adults with
PHYSICAL ACTIVITY AND EXERCISE I
disabilities. The findings showed that various factors had
direct and indirect influences on LS. Depression, self-esteem,
PROMOTE: TAILORING PHYSICAL ACTIVITY
functional ability, discrimination experiences and income
INTERVENTIONS TO PROMOTE HEALTHY AGEING
directly affected LS. Age at disability onset influenced LS
I.Bragina1, S.Lippke2, C.Pischke3, J.Meyer4,
through functional ability and discrimination experiences;
S.Muellmann3, E.Rost2, H.Zeeb3, C.Voelcker-Rehage1,
income at disability onset affected LS through depression,
1. Human Movement Science and Health, TU Chemnitz,
self-esteem and income; causes of disability affected LS
Chemnitz, Germany, 2. Jacobs University Bremen, Bremen,
through income. Findings suggest that programs and services
Germany, 3. Leibniz Institute for Prevention Research and
are required to improve the levels of depression, self-esteem
Epidemiology, Bremen, Germany, 4. OFFIS - Institute for
and functional ability of older Korean adults with disabili-
Information Technology, Oldenburg, Germany
ties in order to enhance their positive feelings toward life.
Physical activity (PA) and the reduction of sedentary
Findings also suggest policy makers should pay attention to
behavior positively influence healthy aging. PA results in
ways to reduce their discrimination experiences and increase
increases in aerobic capacity and strength and is associated
their income level for better LS among older Korean adults
with less age-related cognitive decline. Further, a pronounced
with disabilities.
sedentary behavior, i.e. prolonged periods of sitting or over-
all inactivity, increases mortality risk regardless of PA level
THE EFFECTS OF HEALTH ON MULTIDIMENSIONAL
[1]. The interaction between sedentary behavior, dedicated
DISABILITY AMONG OLDER ADULTS: AN
exercise and PA level, and their effects on physical and men-
APPLICATION OF THE ICF
tal fitness has not yet been fully elucidated.
S.Cho, Office for Policy Research Team 1, Korea Disabled
120 healthy older adults (OA) participated in a 10-week
Peoples Development Institute, Seoul, Korea (the Republic
exercise intervention within the PROMOTE project on tai-
of)
loring PA interventions to promote healthy ageing. The inter-
This presentation will report on findings from a study
vention was tailored to individuals age, gender, and previous
conducted among 10,451 Korean older adults (65+) sampled
PA behavior. Participants were randomized into two inter-
through the 2014 Survey of Living Conditions and Welfare
vention groups (IG) and a waiting-list control group. Both
Needs of Korean Older Persons. The study had three objec-
IGs received a web-based self-regulatory counseling aid,
tives. First, to investigate whether chronic illnesses influenced
which aims to support the participants in reaching a suf-
multidimensional disability among Korean older adults; sec-
ficient PA level. IG differed in the way of PA monitoring:
ondly, to analyze whether service-related environmental fac-
subjective self-report vs. subjective self-report and objective
tors affected the multidimensional disability and thirdly, to
measure of PA using an off-the-shelf activity tracker. (Non-)
test whether the service-related environmental factors mod-
activity behavior (assessed objectively via ActiGraph) as well
erated the association between chronic illnesses and multidi-
as physical and mental fitness were assessed at baseline and
mensional disability. Using the ICF as a conceptual model,
post intervention. Multiple regression and moderation analy-
the data was analyzed using structural equation modeling.
ses will be performed to analyze the interaction of dedicated
For the purpose of this study, the multidimensional disability
exercise, supportive-technology, PA level and sedentarism
was composed by the following three dimensions: psycho-
and their effect on physical and mental health.
logical/emotional functions, activity capacity and participa-
We expect sedentary behavior to moderate the association
tion frequency; and the service-related environmental factors
between PA and physical/mental fitness. Results will contrib-
were composed by the following two factors: accessibility
ute to optimized health promotion programs and recommen-
and infrastructure. Key findings showed that the higher the
dations for OA.
number of chronic illnesses the higher the level of multidi-
[1] Hagger-Johnson, etal. (2016). American J Prev Med
mensional disability. Better accessibility to welfare facilities
50(2), 154160.
had a positive effect on all three dimensions of disability, and
better infrastructure proved to increase the level of activity

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222
EFFECTS OF COMBINED EXERCISE ON
INFLAMMATORY FACTORS IN OLDER WOMEN
WITH SARCOPENIC OBESITY
J.Jang1, H.Park3, J.Park2, S.Lim4, Y.Kwon5, 1. Institute
of Convergence Bio-Health, Dong-A University, Busan,
Korea (the Republic of), 2. Institute of Taekwondo for
Health and Culture, Dong-A University, Busan, Korea
(the Republic of), 3. Department of Health Care Science,
Dong-A University, Busan, Korea (the Republic of), 4.
Research Foundation for Industry-Academy Cooperation,
Dong-A University, Busan, Korea (the Republic of), 5.
Department of Taekwondo, Dong-A University, Busan,
Korea (the Republic of)
This study aimed to evaluate the effectiveness of a com-
bined exercise program on physical performance related to
the risk of falling and inflammatory factor in community-
dwelling sarcopenic obese elderly women.
Twenty-four participants with Sarcopenic Obese elderly
women ( 70 years) were randomly assigned to ether the
intervention(n=12) or control(n=12) group, and the interven-
tion comprised an individually tailored combined exercise
program. The combined exercise program included resist-
ance and aerobic exercise for 12 weeks.
The ANOVA and deltas of change (%) were used for
data analysis. The level of significance was set at p<0.05.
The effects of greater statistical significance on body com-
position related the variables time, group and the inter-
action between the two (time group) were observed for
the percentage of body fat (F=42.750, p <.01), upper lean
mass (F =29.342, p <.01) and lower lean mass (F =45.333,
p <.01),arm curl(F =38.918, p <.01), functional reach(F
=9.651, p <.05), chair sit-and-down(F =57.894, p <.01),
preferred walking speed(F =16.154, p <.01), open-eyes one-
legged standing time(F =5.199, p <.05) were significantly
improved after the intervention. Moreover, the mean values
of serum lipids (triglyceride, HDL cholesterol, HOMA-IR)
and levels of high-sensitivity C-reactive protein, IL-1 and
TNF-) were significantly improved in exercise group as
compared in control group.
Combined exercise training is associated with reduced
inflammatory activity such as hs-CRP, IL-1 and TNF-
in this population, and improve the physical performance
related to the risk of falling in this population.
PREVENTION OF REHOSPITALIZATION OF FRAIL
GERIATRIC PATIENTS
P.Eccles, Azusa Pacific University, Azusa, California
A literature search was done to determine if rehospitali-
zation of frail geriatric patients could be prevented with the
use of specific personalized home exercise programs. Five
relevant studies had an exercise group and a control group.
Authors of two of the articles reported significant reductions
of rehospitalizations due to exercise program implementa-
tion. The results in the other articles pointed to exercise sig-
nificantly impacting physical activity, quality of life, frailty,
and overall health status. These results strongly indicated
implementation of exercise programs for frail older adults for
decreased rehospitalizations. To strengthen future research
in this area there is a need to standardize outcome meas-
ures to determine physical ability as well as the definition
of frailty. Rehospitalization of frail older patients could be
Innovation in Aging, 2017, Vol. 1, No. S1
prevented with utilization of prescribed exercise programs.
Therapists must be proactive to obtain referrals for home
health patients who may benefit from a personalized home
exercise program.
LEG CYCLING TRAINING ON CARDIORESPIRATORY
FITNESS, MUSCLE STRENGTH, AND WALKING
SPEED IN OLDER ADULT
S.Lin2, J.Lin1, M.Hsu1, 1. Department of Physical Therapy,
Kaohsiung Medical University, Kaohsiung, Taiwan, 2.
Department of Physical Medicine and Rehabilitation,
Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City,
Taiwan
Purposes: This study was to explore if cycling motion
training could improve cardiorespiratory endurance, lower
extremity muscle strength and walking speed in older and
young adults. Methods: Twenty-three healthy older adults
and twenty-three healthy young adults were recruited. Asta-
tionary cycling system was used to provide exercise train-
ing at moderate exercise intensity for 30 minutes/day, 5days
a week for a month. Acycling training session consisted of
15-minute forward cycling and 15-minute backward cycling,
at the pedaling rate of 60 revolutions per minute. Six-Minute
Walk Test, 10-Meter Walk Test and a dynamometer test were
used to assess cardiorespiratory fitness, lower extremity mus-
cle strength, and walking speed respectively, prior to the start
of the training, at the termination of the training, and at one-
month follow-up. Amixed-model ANOVA was used to ana-
lyze training effects on outcome measures, with Bonferroni
post-hoc test. Results: The ANOVA results showed no sig-
nificant group differences for the 6-Minute Walk test and
the 10-M Walk Test, while significant group differences on
lower extremity strength. For both groups, significant train-
ing effects on the 6-minute Walk Test, 10-Meter Walk Test,
and lower extremity strength were found at post-training
(p<0.01) and follow-up (p<0.05). Conclusion: The results
suggested that the cycling training protocol used in this study
can effectively improve cardiorespiratory endurance, lower
extremity muscle strength, and walking speed in both older
and young adults and appear to be a practical exercise.
SHORT PHYSICAL PERFORMANCE BATTERY
DIFFERENCES BETWEEN PHYSICALLY ACTIVE AND
SEDENTARY OLDER ADULTS
J.Rosa, M.M.Monteiro Bezerra, J.E.Uchida, S.M.Borges,
student, Universidade Santa Ceclia, Santos, So Paulo,
Brazil
The aim of this study was to compare the performance
in Short Physical Performance Battery (SPPB) between
physically active and sedentary older adults. A cross-sec-
tional study was conducted with 123 older adults (mean:
72,687,06years old), who were divided into two groups:
physically active (Study Group SG; n=75) and sedentary
older adults (Control Group CG; n=48). The SPPB eval-
uates lower limb performance using three tests: balance
(SPPBb), gait speed (SPPBg) and lower limb force (SPPBf).
The final score is the sum of the three tests, ranging from
0 to 12. Statistical analysis showed a significant difference
(Mann-Whitney test: p=0.004) between the groups in rela-
tion to total SPPB scores (SG: 8,731,88 and CG: 9.671.97
points). In the SPPB subtests, the SPPBb was significantly
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
different (p=0,018) between the SG (3.770.54) and the CG
(3.480.77). The SPPBf was significantly different (Mann-
Whitney test: p=0.017) between the SG (SG: 2.251.10)
and the CG (CG: 1.760.99 points). By analyzing the bal-
ance tests evaluated in the tandem position (heel of one foot
directly in front of and touching the other foot) there was a
significant difference (Mann-Whitney test: p=0,020) between
groups (CG:8.432.99 and SG:9.462.05 seconds). No dif- efficacy.
ferences were noted in the feet side by side position and the
semitandem position (heel of one foot along side the big
toe of the other foot). In conclusion, older adults who were
physically active had a better lower limb performance in the
lower limb strength and balance tandem positions compared
to older adults living a sedentary lifestyle.
LEAD LEG PREFERENCE OF THE 8-FOOT
UP-AND-GO
M.Henderson, T.Bodman, C.Patrick, M.Smith, A.Kiser, phase, the TUG improved by 32.1% (mean difference= -8.58,
S.Wickham, L.Boyd, M.D.Powers, Kinesiology and
Health Studies, University of Central Oklahoma, Edmond,
Oklahoma
The 8ft-up-and-go (UPGO) test is a commonly used tool
for assessing agility and dynamic balance in older adults. The
purpose of this study was to determine if lead leg impacts
UPGO performance. Participants were 31 adults (males=
7, females=24) over the age of 65years, with a mean age
of 82.03 years (SD = 6.93). Volunteers completed three
UPGO tests of two trials each with the fasted time recorded
for each test. In the initial test, participants performed the
UPGO with no instruction on lead leg. Researchers noted
the lead leg chosen (called preferred leg). In subsequent tests,
participants were instructed to use either the right or left
leg as the lead in random order. Results indicate no differ-
ence in performance between the three tests (p=.10). In the
initial test, twenty-four participants preferred the right leg,
while seven preferred the left leg. Although non-significant
(p=.19), participants who preferred the left leg had scores
0.74 seconds faster than those who preferred the right leg on
the initial UPGO test. When grouped by preferred leg, par-
ticipants who preferred the right leg performed significantly
better when instructed to use the right leg than during their
preferred leg test (p=.03) which could indicate a familiari-
zation effect. Those who preferred the left leg did not see a
similar improvement in subsequent tests perhaps due to the
high initial performance or the small sample size. While some
evidence indicates a difference in performance between lead
legs, further study is needed to draw definitive conclusions.
PERSON-CENTERED WALKING TO MAINTAIN THE
MOBILITY, ADL FUNCTION, AND QUALITY OF LIFE
OF LTC RESIDENTS
C.H.Chu1,2, M.Puts1, M.Parry1, D.Brooks2,
K.McGilton1,2, 1. University of Toronto, Toronto, Ontario,
Canada, 2. Toronto Rehabilitation Insitute - UHN,
Toronto, Ontario, Canada
Aim: To determine the efficacy of a person-centered mul-
tifaceted walking intervention (MWI) to maintain the mobil-
ity, ADL function, and QOL of LTC residents with dementia.
Method: An interrupted time-series design was used.
Measures of mobility (2-minute walk test[2MWT], Timed-
Up-and-Go[TUG], gait speed), ADL function (Functional
IAGG 2017 World Congress
223
Independence Measure[FIM]), and QOL (Alzheimers
Related Quality of Life Scale[ARQOL]) were collected before
and after the 2-month pre-MWI phase, and at the middle and
end of the 4-month MWI phase. The MWI consisted of a
one-to-one walking regime and an individualized communi-
cation care plan tailored to the resident provided up to 4x/
week for 4months. RM-ANOVA was used to evaluate MWI
Results: All eligible residents (n=26), PSW staff (n=21)
and power of attorneys (n=25) enrolled in the study. During
the pre-MWI phase, residents experienced a significant
decline in mobility: TUG increased by 4.4% (mean differ-
ence= 4.15sec., P=0.01), 2MWT decreased by 9.7% (mean
difference= -5.78 m., P=0.03), gait speed decreased by
11.3% (mean difference= -0.05 m/sec, P=0.022), decline in
ADL function (mean difference= -17.88, P=0.03), and a loss
of QOL (mean difference= -1.84, P=0.030). During the MWI
P=0.000), 2MWT improved by 51.2% (mean difference=
27.47, P= 0.000), gait speed improved by 55.1% (mean dif-
ference= 0.23, P=0.000), ADL function increased by 25%
(mean difference= 15.60, P=0.000), and QOL increased by
7.8% (mean difference= 2.44, P=0.063).
Conclusion: Findings provide preliminary evidence for a
future trial, and a greater understanding of the role of per-
son-centered care in delivering PA in LTC.
SUBJECTIVE AND OBJECTIVE PHYSICAL ACTIVITY
IN OLDER ADULTS WITH AND WITHOUT
ALZHEIMERS DISEASE
B.Rendzia, A.Breda, A.Bevan, A.Watts, University of
Kansas, Lawrence, Kansas
Physical activity has many health benefits, even among
older adults diagnosed with Alzheimers disease (AD), yet rel-
atively little research has characterized the typical daily activ-
ities of people with AD as compared to their non-impaired
counterparts. Modern technology allows us to objectively
measure the amount and intensity of physical activity, but
other methods are still needed to link objective amount and
intensity data to information about types of activities. Older
adults rarely engage in structured exercise or sports. Thus,
we evaluated the types of everyday activities in which older
adults with and without AD engage and the objectively meas-
ured activity counts generated by those activities. In older
adults with (n=38) and without (n=47) AD, we measured
physical activity for one week, objectively using a thigh-worn
postural monitor (ActivPalTM), and subjectively using activ-
ity diaries. Activity counts were averaged over 30 minute
intervals to match the diaries. Sedentary activities were the
most common self-reported activity type (38.4% of all wak-
ing self-reported activity, mean 83.1 counts/min), followed
by indoor chores (19.4%, 88.7 counts/min) and errands
away from home (14.0%, 89.1 counts/min). During leisure
walking, participants with AD had lower objective activity
counts/min than those without AD [F(1,55)=9.4, p<0.01],
suggesting they walk less vigorously. Objective activity
counts were lower in participants with AD [F(1,65)=5.7,
p<0.05] and women [F(1,65)=9.4, p<0.01] during outdoor
chores, suggesting less vigorous engagement. Understanding
differences by AD status and gender during common types
of unstructured physical activities may help to design more
224
effective and targeted physical activity interventions to pro-
mote health.
PHYSICAL ACTIVITY, COGNITIVE DECLINE,
PLATELET CHANGES IN ALZHEIMERS DISEASE AND
HEALTHY OLD ADULTS
N.V.Bento-Torres, J.Bento-Torres, A.Toms, V.Costa, (fat and lean body mass, DXA). Our preliminary results show
P.Correa, C.Costa, N.Jardim, C.Picano-Diniz, that 12 weeks of mixed exercise training alleviated CRF (EX:
Universidade Federal do Par, Belm, Par, Brazil -5 vs. CON: -15) and the deterioration of global QoL (EX:
We investigated potential associations between platelet
morphological changes, level of physical activity, and age-
related cognitive decline by analyzing blood samples of
volunteer healthy old elderly adults with different exercise
functional capacities. We also compared the morphology of
platelets from age-matched healthy adults and Alzheimers
disease (AD) patients. Physical activity was assessed by the
International Physical Activity Questionnaire (IPAQ, long
form), and functional exercise capacity was assessed by agil-
ity (8-foot up-and-go), lower body strength (chair stand),
and aerobic capacity (6-minute walk) tests. Cognitive func-
tion was assessed by the Mini Mental State Examination
(MMSE) and Cambridge Neuropsychological Automated
Battery (CANTAB). Compared to sedentary healthy adults,
active healthy adults had significantly better functional exer-
cise capacity in all physical fitness tests, better performance
in visual sustained attention and reaction time tests, smaller
platelet volumes, and larger platelet distribution width.
There were significant correlations between platelet morpho-
logical markers and neuropsychological performance on vis-
ual learning and memory, rapid visual processing, and visual
sustained attention tests. Compared to healthy elderly adults
matched by age and educational level, AD patients had lower
MMSE scores, which were associated with larger platelet
volumes. Physical exercise in the elderly is associated with
less cognitive decline, which may be correlated with reduced
platelet volumes. Mean platelet volume, which is usually dis-
regarded in standard blood sample analyses, may be used in
association with cognitive assessments to improve differen-
tiation between normal and pathological aging
AEROBIC AND RESISTANCE TRAINING TO
REDUCE CANCER-RELATED FATIGUE: EFFICACY IN
ONCOGERIATRIC PATIENTS
A.Fontvieille1,2, H.Parent-Roberge1,2, M.Langlois3,4,
T.Flp2,3, M.Pavic3,4, E.Riesco1,2, 1. Faculty of Physical post intervention and follow-up), revealed a significant time
Activity Sciences, University of Sherbrooke, Sherbrooke,
Quebec, Canada, 2. Research Centre on Aging, CIUSSS de
lEstrie CHUS, Sherbrooke, Quebec, Canada, 3. Faculty of
Medicine and Health Sciences, University of Sherbrooke,
Sherbrooke, Quebec, Canada, 4. Research Center of the
Centre Hospitalier Universitaire de Sherbrooke (CHUS),
Sherbrooke, Quebec, Canada
Despite the high prevalence of cancer in the elderly, there
is no strong evidence regarding the efficacy of exercise train-
ing for reducing debilitating effect of cancer-related fatigue
(CRF) and improving quality of life (QoL) in the oncogeri-
atric population. Hence, the objective of our study is to
determine the impact of combined aerobic and resistance
training on CRF and QoL in older adults undergoing can-
cer treatment. Atotal of 40 older adults (6580years) with employed.
an ongoing treatment for a curable cancer will be recruited
Innovation in Aging, 2017, Vol. 1, No. S1
and randomised in two groups: 1) combined training (EX,
n=20) and 2) control group (CON, n=20). All variables will
be measured before and after 12 weeks of intervention: CRF
(FACIT-Fatigue), QoL (European Organization for Research
and Treatment of Cancer Quality of Life Questionnaire),
physical capacity (Senior Fitness Test) and body composition
-16.7; CON: -41.7). Physical functioning remained stable
(EX: 0 vs. CON: -20) and cognitive functioning improved
(EX: 33.3 vs. CON: 0), both in EX group only. Finally, lean
body mass (EX: +0.5kg; CON: -3.0kg) and physical capacity
improved in EX while it declined in CON. To conclude, our
preliminary results show that combined training is feasible
and have a positive impact on CRF and physical capacity.
Furthermore, our intervention mitigated the reduction of
QoL in older adults undergoing cancer therapy.
THE EFFECTS OF PHYSICAL TRAINING CESSATION
ON EXECUTIVE FUNCTIONS IN OLDER ADULTS
L.Rodrigues1,2,3, T.Vrinceanu1,2,3, N.Berryman2,4,
L.Bosquet2,5, M.Kergoat2, T.Vu2,6, L.Bherer1,2,3, 1.
Concordia University, Montreal, Quebec, Canada, 2.
Centre de Recherche de lInstitut Universitaire de Griatrie
de Montral, Montral, Quebec, Canada, 3. PERFORM
Centre, Montreal, Quebec, Canada, 4. Bishops University,
Sherbrooke, Quebec, Canada, 5. Universit de Poitiers,
Poitiers, France, 6. Universit de Montral, Montreal,
Quebec, Canada
Combined strength and aerobic (S+A) and gross motor
skills programs (GMS) have shown promise in selectively
improving executive functions (EF) of older adults. However,
interruptions in training may occur resulting in losses of
training-induced physiological benefits. So far, little is known
about the effects of physical training cessation on EF.
Therefore, forty older adults (70.55.51 years; 67.5%
female) who had completed an 8-week S+A or GMS pro-
gram followed by an 8-week training cessation period were
included in this study. Performances in the Random Number
Generation (RNG) test (inhibition and working memory) in
a single task (ST) and a dual-task (DT, walking at 4 km.h-1)
were analyzed.
Two-way ANOVAs, with repeated measures for time (pre,
effect for inhibition scores. For example, Turning Point Index
(TPI - occurrence of sequence changes from ascending to
descending numbers) improved in ST for all time compari-
sons (pre to post intervention and post to follow-up) whereas
TPI performances in DT improved from pre intervention to
follow-up and from post intervention to follow up (p < 0.05).
However, participants exhibited worse performances (p <
0.05) from pre intervention to follow-up (ST and DT) and
from post intervention to follow-up (ST) for one working
memory score (redundancy index).
Our study demonstrates training cessation can selectively
impact EF. Interestingly, performances for inhibition in a sin-
gle and a dual-task can be improved after a period of physi-
cal training cessation, regardless of the exercise intervention
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
PROACTIVE REACH AND TELEHEALTH
MONITORING (GEROFIT) ENHANCE RESISTANCE
EXERCISE AT RURAL SETTINGS
W.Valencia Rodrigo1,2, D.Botros1,3, D.Pendlebury1,
H.Florez1,2, C.Lee4,5, K.Oursler6,8, L.I.Katzel7,8,
M.C.Morey9,10, 1. Miami VA Geriatrics Research,
Education and Clinical Center (GRECC), Miami, Florida,
2. University of Miami School of Medicine Department
of Public Health Sciences, Miami, Florida, 3. Jackson
Memorial Hospital, Miami, Florida, 4. Greater LA VA
Geriatrics Research, Education and Clinical Center
(GRECC), Los Angeles, California, 5. UCLA David
Geffen School of Medicine, Los Angeles, California, 6.
Salem VA Geriatrics Research and Education, Salem, New
York, 7. Baltimore VA Geriatrics Research, Education
and Clinical Center (GRECC), Baltimore, Maryland, 8.
University of Maryland School of Medicine - Department
of Medicine, Baltimore, Maryland, 9. Durham VA
Geriatrics Research, Education and Clinical Center
(GRECC), Durham, North Carolina, 10. Duke University
School of Medicine - Department of Medicine, Durham,
North Carolina
Gerofit, a health promotion exercise program for older
Veterans, is well-received and supported by Primary Care
(PC). However, we observed low referral numbers rela-
tive to the thousands of older veterans, limitations in
space, resources, and long driving distances for potential
participants.
We developed Proactive Reach: 1) partnership with
rural PC leadership and providers, 2) use electronic medi-
cal records (EMR) to identify individuals without any con-
traindication to Gerofit, and 3) telehealth assessment and
counseling (physical activity, aerobic, resistance, flexibility,
balance exercises), and mailed Gerofit instructions, National
Institute of Aging Go4Life book, pedometers and resistance
bands.
Then, we implemented Telehealth Monitoring (phone):
response, use, adherence and progress.
We identified 302 older subjects, and successfully com-
pleted Proactive Reach in 236 (78%). At baseline: aver-
age age 69.67.2, body mass index 29.35.9kg/m2; 21%
declined services, 60% admitted not doing any exercise, 38%
reported aerobic exercise, and only 2% reported resistance
exercise.
We contacted again 107 subjects for Telehealth
Monitoring. Fifty-one (48%) did not respond or declined
further participation, 22 (20%) reported not having received
materials, 34 (32%) confirmed receipt and satisfaction with
the program. Effective use: book (79%), pedometer (11%),
resistance bands (53%). Barriers: book (6%), pedometer
(0%), bands (6%), neither (58%), other (25%).
Overall, 58% reported improved physical activity, and
38% effectively incorporated resistance exercise.
Proactive reach using EMR effectively identifies and
delivers exercise interventions in rural PC, enhances physi-
cal activity, and increases awareness and implementation of
resistance exercise. Further studies on telehealth monitoring
are warranted, including cost-effectiveness and use of new
technologies.
IAGG 2017 World Congress
225
SEX-DEPENDENT EFFECT OF EXERCISE ON BRAIN
HEALTH IN OLDER ADULTS WITH VCI
C.Barha, E.Dao, J.Best, R.G.Hsiung, R.Tam, T.Liu-
Ambrose, Physical Therapy, University of British Columbia,
Burnaby, British Columbia, Canada
Aerobic training (AT) is a promising strategy for the pro-
motion of brain health. However, a large amount of variation
exists in its efficacy, and importantly, it is greatly underap-
preciated that biological sex may moderate the effect of
aerobic training on cognition. Few studies have directly or
comprehensively compared males and females to address
the question of sex differences in the magnitude of AT effi-
cacy. Therefore, we conducted a secondary analysis of data
acquired from a 6-month single-blind randomized controlled
trial of AT in older adults with mild subcortical vascular
cognitive impairment (sVCI), a population at high risk of
progression to dementia. Executive processes were measured
at baseline and trial completion using: 1)Trail Making Test
(TMT; set-shifting); 2)Digit Symbol Substitution Test (DSST;
sustained attention); 3) Stroop-Color Word Test (selective
attention & conflict resolution). Total WML load (mm3) was
quantified using a semi-automated analysis pipeline at base-
line and 6-months. We found that AT significantly enhanced
TMT performance in females compared with controls.
Notably, AT was ineffective in males. Groups did not differ
in DSST or Stroop performance. Our results underscore the
need for future studies to consider biological sex as a key
moderator of the positive effect of exercise on brain health.
SESSION 600 (POSTER)
REHABILITATIVE CARE
CHRONIC DYSFUNCTIONAL AND PAINFUL FOOT IN
ELDERLY
S.Nica, R.Nartea, M.Clantau, Rehabilitation Medicine,
UMF Carol Davila, Bucharest, Romania
Introduction
Older people frequently develop impaired balance and
functional ability [6]. One main cause of this affection is
represented by the foot and ankle problems. This condition
affects the quality of the life in elderly. One important role
in the disability of this patient is played by the painful foot.
Material and method
In this study we want to demonstrate the relationship
between the painful foot, the disability and the quality of
life in older people. We selected 30 patients (17 women
and 13 men), aged between 65- 80years old, who suffered
from severe foot pain associated with disability for the last
3months or more. We observed the walking speed, the endur-
ance and we correlated this with the analog visual scale. We
modulated this with gender, race, age, IMC, comorbidities,
smoking status and the number of other pain locations.
Results
We could observe that the incidence of foot pain is really
high, and also is increasing in the last years. This symptom is
directly proportional with the disability prevalence and also
with the limitation of the activities of the daily living. Hallux
deformaties, calluses or corns, edema, hammer toes and pes
planus are the main affections that cause this symptom. [1].
226
Conclusions
The two components of pain, the sensory and the emo-
tional, influence each other and correlated with the reduced
functional ability, the increased risks of falls and the reduced
physical and mental (depression) aspects influence the qual-
ity of life for older persons. These aspects are very important
ones especially when the treatment solution is in discus.
THE TIMED UP AND GO TEST WITH ADDITIONAL
MOTOR TASK FOR ASSESSING OLDER ADULTS WITH
CHRONIC STROKE
S.Ng, P.Chan, J.Si Tou, M.Tse, The Hong Kong
Polytechnic University, Hung Hom, Hong Kong
Many daily activities involve multiple motor functions
which have to be performed simultaneously. For example,
carrying objects while walking is frequently mentioned as
risky activitivers for falls in people with stroke.
The Timed Up and Go test (TUG) is an objective measure
for assessing functional mobility. Aversion of TUG with an
accompanying manual task (TUGmotor) has been developed to
investigate the effect of performing multiple motor tasks on
functional mobility in older adults. Participant is required to
stand up, walk 3 meters, turn, walk back and sit down while
holding a glass of water in one hand. The time to complete
the task was recorded.
Thirty-three chronic stroke survivors and 32 healthy con-
trols participated in this cross-sectional study. In additional
to the TUGmotor times, stroke-specific impairments including
Fugl-Meyer Assessment for the Lower Extremities (FMA-LE)
scores, paretic hip abductor and knee flexor muscle strength,
Berg Balance Scale (BBS) scores; the Timed Up and Go Test
(TUG) times were recorded.
The TUGmotor completion times demonstrated excellent
intra-rater, inter-rater and test-retest reliabilities, with intra-
class correlation coefficients ranging from 0.944 to 0.987.
The TUGmotor times correlated significantly with stroke-spe-
cific impairments. The MDC of TUGmotor times was 3.5 sec-
onds, and the TUGmotor cut-off time of 13.5 seconds could
discriminate participants with stroke from healthy older
adults.
The TUGmotor is a reliable and easy-to-administer clini-
cal tool for assessing advanced functional mobility in older
adults with chronic stroke.
A CITIZENS JURY TO INFORM POLICY ON
REHABILITATION FOR PEOPLE IN RESIDENTIAL
CARE WITH HIP FRACTURE
K.Laver1,2, E.Gnanamanickam1,2, J.Ratcliffe1, W.Shulver1,2,
I.Cameron3, M.Agar2, M.Crotty1,2, 1. Department
of Rehabilitation, Aged and Extended Care, Flinders
University, Adelaide, South Australia, Australia, 2. NHMRC
Cognitive Decline Partnership Centre, Sydney, New South
Wales, Australia, 3. University of Sydney, Sydney, New
South Wales, Australia
It has long been recognised that eliciting the views and
preferences of members of the public can improve health care
decision making. One way of engaging members of the pub-
lic in decision making is via Citizens Juries. Citizens Juries
bring together a small group of people (jurors) who represent
members of the public and ask them to consider a particu-
lar aspect of health care that is often complex (a wicked
Innovation in Aging, 2017, Vol. 1, No. S1
problem). The aim of this jury was to consider (1) should
there be an investment in physical rehabilitation services in
residential care for older people following hip fracture? and
(2) If so, what are some options for providing this service
(considering funding, models of service delivery and equity)?
A group of 13 jurors in Australia listened to presentations
from expert witnesses including rehabilitation and palliative
care specialists, a residential care provider, a health econo-
mist and three consumers. Following deliberation, all mem-
bers of the jury agreed that there needs be a greater focus
on promoting independence and rehabilitation in residential
care and that upskilling of care staff is required. Twelve of
the thirteen jurors agreed that in-reach rehabilitation services
should be provided for this population with certain param-
eters. The remaining juror had reservations. The jurors felt
that rehabilitation should not focus on physical recovery
exclusively but should be flexible to meet the needs of the
person; for some people this may include a greater focus on
pain management or psychosocial rehabilitation. All jurors
agreed that rehabilitation should take place in the residential
care setting.
THE GERIATRIC DEPRESSION SCALE (GDS) IN
GERIATRIC REHABILITATION
K.Hager1,2, M.Brecht1, O.Krause1,2, 1. Center for Medicine
for the Elderly, Diakovere Henriettenstift, Hannover, Lower
Saxony, Germany, 2. Medical School Hannover, Hannover,
Germany
Background: The geriatric depression scale (GDS) is a
widely used test the mood of patients in German geriatric
clinics.
Aim: It should be investigated whether a depressive mood
on admission was associated with a reduced amelioration in
independence in the course of geriatric rehabilitation.
Methods: In a retrospective study 1453 patients in the
years 20062009 in the center for medicine in old age were
investigated. Beside the GDS several assessment tests were
included like the Functional Independence Measure (FIM),
and the Mini Mental State Examination (MMSE).
Results: 1315 (90.5%) of the patients showed a GDS-
Score of 5 points or lower and were, according to the test,
not depressive. Only 138 (9.5%) had 6 points or more
and had to be classified at least as slightly depressive. The
mean age of those with a GDS of 05 points was 81.77.4
but 79.08,3 years for those with 615 points (p<0.001).
There was no difference with the MMSE (24.64.8 versus
25.04.6 points, n.s.). The FIM on admission was 86.921.5
for those not classified as depressive versus 82.821.3 points
for those with a GDS over 5 points (p<0.05). The FIM on dis-
charge was 101.920.0 versus 96.420.5 points (p<0.05).
The improvement in the independence in the FIM there-
fore not different in the two patient groups (15.012.7 vs.
13.612.8 points, n.s.).
Conclusion: Over 90% of the geriatric patients admitted
to a clinic for geriatric rehabilitation were not in a depres-
sive mood. Adepressive mood was associated with a younger
age as well as with a slightly lower FIM on admission and
on discharge, but there was no significant difference for
the improvement of the FIM. A depressive mood should
therefore not be an obstacle for the admission to geriatric
rehabilitation.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
BEYOND THE ISOLATED SWALLOW: DYSPHAGIA
IN THE CONTEXT OF PERFORMANCE DURING
AMEAL
T.Hansen, Metropolitan University College, Copenhagen,
Denmark
Dysphagia (difficulty in swallowing) makes the socially
and culturally important meal situation problematic in
elderly people, and may lead to decreased health, well-being
and quality of life. Since eating, drinking and swallowing
are complex and integrated neuromuscular processes, it is
proposed that assessment of dysphagia should be based on
a multi-stage process of ingestion: pre-oral (anticipatory),
oral, pharyngeal, and esophageal. However, there is limited
literature regarding the influences of the individual ingestion
stages on the swallowing safety in dysphagic elders during
a meal. As a part of a comprehensive needs assessment for
developing and enhance dysphagia rehabilitation, this study
aimed to provide insights into which specific ingestive skill
impairments influences unsafe swallowing in elderly (65+)
people with dysphagia. A cross-sectional study with 328
Danish elderly people (mean age: 77.711.6years) referred also improves the outcomes and reduces the medical utiliza-
to occupational therapy for swallowing evaluation was car-
ried out, and data on mealtime performance was collected
using the McGill Ingestive Skills Assessment. Multiple logis-
tic regression models showed that unsafe swallowing dur-
ing a meal was significantly associated with: 1)inability to
maintain a seating position, 2)inability to self-feed, impaired
judgment and energy and 3)reduced labial seal, inability to
bite and chew food items, piecemeal deglutition, inability to
coordinate respiratory pattern during ingestion and inability
to clear the airway in case of aspiration. Since impairments
in all stages of ingestion tend to occur concurrently in elders
with dysphagia, the goal of rehabilitation should not only
address the swallowing impairment, but also eating as an
activity of daily living.
GENDER IN GERIATRIC REHABILITATIONARE
THERE ANY DIFFERENCES?
K.Hager1,2, M.Brecht1, O.Krause1,2, 1. Center for Medicine
for the Elderly, Diakovere Henriettenstift, Hannover, Lower
Saxony, Germany, 2. Medical School Hannover, Hannover,
Germany
Background: Gender may have an influence on the results
of geriatric therapy and rehabilitation. The aim of this study
was to analyze the activities of daily living (ADL), evaluated
by the Functional Independence Measure (FIM) on admis-
sion and on discharge made by women and men.
Patients and Methods: Data of 2496 patients with a wide
variety of diseases from the years 20062009 were analyzed.
The patients were treated in the Center for Medicine in the
Elderly in Hannover (Germany), a clinic with both acute and
rehabilitative geriatric care.
Results: 1802 (72.2%) of the patients were women
and 695 (27.8%) men. The mean age of the patients was
81.67.7 years (women: 82.57.3; men: 79.28.3). R.Kenny1, A.B.Dey3, 1. Trinity College Dublin, Dublin,
Cognition was not different between women and men
(women: 23.65.6; men 24.15.3 points; n.s.). India
The FIM on admission for women and men was alike
(women: 84.021.9; men: 83.3 23.9 points, n.s.). The mean
improvement of the FIM was 14.313.4 points (women:
14.713.2; men: 12.9 13.6; n.s.). No differences were emphasize specific domains, such as physical, functional and
IAGG 2017 World Congress
227
found neither for the motor nor the cognitive FIM. No dif-
ferences were found for the FIM items.
Conclusion: Although women were slightly older than
men, there was no gender difference of the whole FIM or
FIM domains on admission as well as on discharge. This was
also true for functions where men might have an advantage
like climbing stairs or where women might have more inter-
est in like hygiene.
MEDICAL OUTCOME AND UTILIZATION FOR
HIP FRACTURE PATIENTS WITH OR WITHOUT
OUTPATIENT REHABILITATION
P.Lin1, P.Pan3, T.Lan4, 1. Kuang Tien General Hospital,
Taichung, Taiwan, 3. National Yang-Ming University
Hospital, I-Lan, Taiwan, 4. National Yang-Ming University,
Taipei, Taiwan
The National Health Insurance (NHI) in Taiwan has not
yet covered the post-acute care and only provides outpatient
rehabilitation after discharge for hip fracture. This provides
an opportunity to examine whether outpatient rehabilitation
tion. The purpose of this study was to compare the medical
outcomes and utilization in hip fracture patients receiving or
no receiving outpatient rehabilitation.
The data of this retrospective cohort study were from the
NHI Research Database. Propensity score matching by gen-
der, age, Charlson Comorbidity Index, and Adjusted Clinical
Groups with the 1:4 matching ratio was employed. Atotal
of 3585 patients aged 65 and over admitted for hip frac-
ture between 2005 and 2012 were further divided into two
groups, 717 receiving and 2868 not receiving outpatient
physical therapy during the first three months after hospital
discharge. Each hip fracture patient was followed for one
year. The outcomes included death, emergency use, and re-
hospitalization. Medical utilization included outpatient,
emergency, and inpatient costs. Cox proportional hazards
regression and generalized linear models were used.
Patients receiving outpatient rehabilitation demonstrated
significantly lower mortality rate than those without reha-
bilitation (12.7 % vs. 16.7 %, p<0.05). Rehabilitation group
had statistically significant lower risk of death (HR=0.74,
95% CI=0.590.94). However, patients receiving rehabili-
tation were at higher risk of emergency (HR=1.15, 95%
CI=1.021.30) and re-hospitalization (HR=1.37, 95%
CI=1.221.55). Rehabilitation group also had higher medi-
cal utilization (p<0.05).
Patients receiving outpatient rehabilitation have lower
risk of death, but higher risk of emergency, re-hospitaliza-
tion, and medical utilization.
RANDOMIZED CONTROLLED TRIAL OF
OCCUPATIONAL THERAPY IN ELDERLY WITH MILD
AND MODERATE DEMENTIA
P.Kumar1, M.OConnell1, S.C.Tiwari2, R.K.Tripathi2,
Ireland, 2. KGMU, Lucknow, India, 3. AIIMS, New Delhi,
Non-pharmacological intervention has been reported to
reduce the symptoms of dementia. However, the few stud-
ies to have examined the effects of occupational therapy,
228
quality of life. This study aimed to investigate the effects of
occupational therapy on multiple key functional domains in
patients with mild to moderate dementia. An open label ran-
domized control trial was conducted among patients attend-
ing 2 memory clinics in India. Of 319 attendees screened,
100 had dementia (DSM-IV criteria) and were randomized
to a novel occupational therapy programme of 2 sessions per
week including relaxation, physical and cognitive exercises,
and personal and recreational activities or standard medi-
cal treatment (control). Participants were reassessed after 5
weeks. The mean age of participants was 69.4years with 78%
male, 18 participants were lost to follow-up. Experimental
and control participants were matched for demographic fac-
tors and severity of dementia. Using an intention to treat
analysis the intervention group showed improvement in the
primary outcomes. Geriatric Depression Scale (14.84.4
to 13.34.1; 95% CI (0.9, 2.0), Bristol Activities of Daily
Living scale (23.16.1 to 17.54.7; 95% CI (3.8, 7.2), lution of an acute illness/injury to restore independence.
Modified Physical Performance Test (17.03.1 to 19.63.7; Limited mobility has been identified as an important predic-
95% CI (3.8, 7.2). Significant improvements were also noted
in MMSE, BEHAVE-AD and the physical, psychological and
environmental domain of WHOQOL-BREF (p<0.01).This
novel occupational therapy programme can improve physi-
cal performance, functionality, mood, cognition, behavioural
status, and quality of life in mild to moderate dementia
patients at short-term. Future studies are required to assess
long term effects
REDEFINING DINING PRACTICES IN CARE
FACILITIES THROUGH COMMUNITY-BASED
PARTICIPATORY RESEARCH
S.Shune1, D.Linville2, 1. Communication Disorders and
Sciences, University of Oregon, Eugene, Oregon, 2. Couples
and Family Therapy, University of Oregon, Eugene, Oregon
As related to eating, older adults, especially those with
swallowing problems (dysphagia), experience increased risk
of mortality and malnutrition, and a loss of socialization,
autonomy, and identity. Given required dependencies and
adaptations, these eating-related negative outcomes may be
further magnified among nursing home residents. Thus, one
goal of person-directed care in these facilities is to enhance
the dining process by understanding how to best support
dining-related quality of life while balancing safety/risks,
resident preferences, and quality of care goals (e.g., quan-
tity of intake, decreased dysphagia-related sequelae such as
pneumonia). The purpose of this study was to conduct a
needs assessment in skilled nursing facilities using commu-
nity-based participatory research (CBPR) methods in order
to understand the dining-related needs, goals, and barriers
of various stakeholders. In-depth interviews were conducted
with 21 individuals across seven groups: residents with
dysphagia, nurses, nursing assistants, dietary staff, speech-
language pathologists, occupational therapists/assistants,
and residents family members. Interviews and data analysis
were guided by grounded theory and CBPR methodology.
Multiple process/procedural-based themes emerged across
groups including how communication, transparency and
education promote positive dining experiences, while lack of
routine normalization, food presentation, and environment
contribute to negative experiences. Attitude/relational-based
themes centered around the meanings of autonomy and
Innovation in Aging, 2017, Vol. 1, No. S1
identity, the quality of staff-resident relationships, the level
of staff investment, and the stigmas associated with altered
eating. These findings suggest the importance of taking an
interdisciplinary approach to dining and highlight poten-
tial relevant and malleable intervention targets toward the
design of new dining program models.
ACTIVITY PATTERNS AND MOBILITY BARRIERS IN
AREHABILITATION SETTING
A.M.Mudge1,3, P.McRae1, P.Bew2, J.Ylarde2, S.Smith3,
1. Internal Medicine and Aged Care, Royal Brisbane and
Womens Hospital, Brisbane, Queensland, Australia, 2.
Brighton Health Campus, Brisbane, Queensland, Australia,
3. University of Queensland, Brisbane, Queensland,
Australia
Functional decline in common in older inpatients and
often necessitates inpatient rehabilitation following reso-
tor of functional outcomes in older acute care inpatients, but
few studies have examined mobility in inpatient rehabilita-
tion settings. This prospective observational study conducted
in a purpose-built urban rehabilitation facility in Brisbane
Australia used mixed methods to identify current mobility
levels and barriers and enablers to mobility. Mobility levels
were measured using activity mapping across two wards (a
rehabilitation ward n=37 and restorative care ward n=42).
A trained observer cyclically observed all ward inpatients
over an 8 hour period (8am-5pm). On average, patients spent
about 8% of day time upright or mobile (standing, walking
or actively wheeling), and spent less than one third of day-
time out of their bedrooms. Barriers and enablers were iden-
tified by a validated staff survey (n=84: 52 nursing, 25 allied
health professionals, 7 other) and semi-structured patient
interviews (n=30). Staff agreed that mobilisation benefited
patients, and had knowledge, skills and physical resources to
mobilise patients. Staff barriers included insufficient nurse-
patient ratios, uncertainty about workload implications,
concern about risk of staff injuries, patient contraindications
to mobilising, resistance from patients and lack of interest
from families. Patients rated the importance of mobilising
very highly, but reported little mobilising outside of therapy
sessions. Patient-reported barriers included lack of nursing
assistance, lack of family and visitors, and pain. Findings will
inform quality improvement strategies to enhance mobility
in rehabilitation inpatients.
REHABILITATION OUTCOMES OF THE OLDEST-
OLD PATIENTS AFTER HIP FRACTURE SURGERY:
APROSPECTIVE STUDY
P.Mazzola1,2, P.Floris1,3, F.De Filippi3, 1. School of
Medicine and Surgery, University of Milano-Bicocca,
Monza, MB, Italy, 2. NeuroMI - Milan Center for
Neuroscience, Milano, MI, Italy, 3. Regional Hospital of
Valtellina and Valchiavenna, Department of Medicine,
Geriatric Rehabilitation and Sub-acute Care Unit, Sondrio,
SO, Italy
Hip fracture (HF) incidence is growing progressively
with an age-related trend. In recent years, the average age
of elderly patients admitted to acute care units and reha-
bilitation facilities has increased steadily, but research about
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
clinical and functional rehabilitation outcomes in this age
group is still limited. In order to contribute to fill this gap,
the aim of this study was to investigate the functional and
clinical outcomes of the oldest-old HF patients in compari-
son with younger subjects.
We prospectively enrolled 328 patients (80.5% females,
mean age 85.2years) admitted to the Geriatric Rehabilitation
Unit of Regional Hospital of Valtellina and Valchiavenna
(Sondrio, Italy) in the period 20122015. We divided them
according to age: Group1 (age <85, N=152) and Group2
(age 85, N=176). All subjects underwent a comprehensive
assessment according to a well-established orthogeriatric
protocol and were compared. Outcome measures included
the Barthel Index (BI) at discharge, the occurrence of medical
complications, and death during the 30-day rehabilitation
period.
The groups had similar baseline characteristics, and
showed a similar incidence of complications. The baseline BI
score was higher in Group1 than in Group2, but the recov-
ery in terms of mean BI gain was significant in both cases
(+36.2, p<0.001, and +24.8, p<0.001, respectively).
If carefully managed, the oldest-old have a good potential
of recovery after HF surgery. The dissemination of compre-
hensive orthogeriatric protocols should be promoted because
it allows to optimize the individuals rehabilitation course,
and to invest resources in patients irrespectively from their
chronological age.
COGNITION, NOT LENGTH OF STAY,
PREDICTS REHABILITATIVE IMPROVEMENT IN
TRANSITIONAL CARE
E.Fauth1, J.Sullivan1, S.Y.Schaefer2, 1. Utah State
University, Logan, Utah, 2. Arizona State University, Tempe,
Arizona
Activities of daily living disability for older adults is
likely an outcome of physical limitations, environmental
constraints, cognitive impairment, and psychosocial factors.
During medical rehabilitation, physical therapy emphasizes
physical improvements, but does not systematically con-
sider cognitive ability or mood as part of treatment. The
current study assesses the extent to which cognitive and
psychosocial status at admission (intake) predicts patients
physical therapy progression (walking improvement) in a
transitional care facility. Environmental conditions were
considered constant for all patients. In a sample of adults
(n=93; 65.6% female) aged 3898 (M=75.17; SD=9.72) PEOPLE
receiving physical rehabilitation, we used data from the St.
Louis University Mental Status (SLUMS) exam, Resident
Mood Interview (PHQ-9 from the Minimum Data Set), and
2-Minute Walk Test (2MWT). Mean intake 2MWT=106.76
feet (SD = 95.44), or 32.54 meters (SD = 29.09), suggest-
ing significant physical impairment. Intake SLUMS scores
indicated 38.7% Dementia, and 28% Mild Neurocognitive
Disorder. Mean number of weeks in rehabilitation was 4.09
(SD=1.87; range 212). Linear regression models indicated
that cognitive ability at intake (SLUMS score B=.420; p <.01)
predicted improvement in walking ability (change in feet on
the 2MWT from intake to discharge), even after account-
ing for gender (B=-.318; p <.05), age (B=-.078; p=n.s.) and
number of weeks in rehabilitation (B=0.159; p=n.s.). Model
R-squared=0.22, with mood excluded from the model due
IAGG 2017 World Congress
229
to bivariate insignificance with 2MWT. Intake cognitive
function may be a useful predictor of rehabilitation success,
rather than length of stay.
UNMET MEDICAL AND REHABILITATION NEEDS
IN COMMUNITY: LIVING OLDER ADULTS WITH
STROKE IN MEXICO
A.Kumar1, B.Downer2, R.Wong2, 1. Department of Health
Services, Policy & Practice, Center for Gerontology and
Healthcare Research, Brown University, School of Public
Health, Providence, Rhode Island, 2. University of Texas
Medical Branch Galveston, Galveston, Texas
Stroke patients often need intensive medical care and
rehabilitation to regain functional independence to live inde-
pendently in the community. However, stroke patients often
times do not receive sufficient medical care and rehabilita-
tion, especially in lower and middle-income countries such as
Mexico. The aim of this study was to explore the health char-
acteristics of Mexican older adults who have experienced a
stroke and determine if this population is receiving sufficient
care and rehabilitation. We examined 15,354 participants
from the Mexican Health and Aging Study-2012 wave.
Atotal of 365 participants reported having been told by a
physician that he/she had experienced a stroke in the past
two years. The mean age of participants with self-reported
stroke was 69.9 years and 58% were residing in an urban
area. The majority had falls (55%), fracture (12%), upper
limb disability (69%), and lower limb disability (86%).
Comorbid conditions including hypertension (72%), diabe-
tes (37%), and obesity (25%) were highly prevalent. Nearly
half of stroke patients reported limitation in daily activi-
ties (53%), vision impairment (48%), difficulty in speaking
(38%), and difficulty in expressing him- or herself (35%) due
to stroke. Approximately 53% of stroke patients reported
having received stroke-related medical treatment and only
18% reported having received physical therapy. These results
indicate stroke patients in Mexico often experience comor-
bid health conditions and patients may have unmet medi-
cal care and physical therapy needs. These unmet needs may
ultimately lead to long-term disability, which increases the
burden on the patients, their caregiver, and the health care
system in Mexico.
DEVELOPMENT OF ASSESSMENT METHOD FOR
PHYSICAL PERFORMANCE BY Z-SCORE IN OLDER
N.Kamide1, Y.Inaba2, Y.Shiba1, H.Sato1, 1. School of
Allied Health Sciences, Kitasato University, Sagamihara,
Kanagawa, Japan, 2. School of Nursing and Rehabilitation
Sciences, Showa University, Yokohama, Kanagawa, Japan
We have previously reported development of the physi-
cal performance score by z-score (PPSz) for assessing instru-
mental activities of daily living (IADL) disability risk among
older individuals. The aim of this study was to investigate
the validity of PPSz for community-dwelling older individu-
als. Atotal of 117 participants aged 65years or older were
recruited from the community (mean age, 72.46.4 years;
23 male). The following physical performance tests were
measured for the PPSz: 5-m walking times at comfortable
pace and at maximum effort; timed up-and-go test; 5-repeti-
tion chair stand test; and grip strength. Measurement values
230
from those tests were transformed into z-scores, and summed
to calculate PPSz in the present study. Z-scores for each test
were calculated according to methods described in a previous
study (Kamide etal., in print). As an assessment of IADL, the
subscale of the Tokyo Metropolitan Institute of Gerontology
Index of Competence (TMIG-IC) was used. Statistical anal-
ysis after adjusting for age and sex showed that PPSz was
significantly lower for individuals with IADL disability than
for those without IADL disability. Furthermore, the receiver
operating characteristic curve was used to assess the ability
of PPSz to discriminate IADL disability risk. The area under
curve was 0.81 (95% confidence interval, 0.680.94), with
91.2% sensitivity and 66.7% specificity. The PPSz developed
in this study could thus detect the presence of IADL disabil-
ity among community-dwelling older individuals and may
be useful for assessing IADL disability risk in older people.
NEW CONCEPT FOR SUPPORTING THE ELDERS
HAVING GARBAGE TROUBLES
K.Noda1, J.Sagara2, R.Tanemura1, T.Nagao1, J.Hoshii1, setting the percentage of elderly patients, who show declining
T.Uchida1, O.Nakata1, K.Sunagawa1, 1. Kobe University,
Kobe, Hyogo, Japan, 2. Kobe Design University, Kobe,
Hyogo, Japan
Introduction: The garbage gathering system in Japan is
complex. People have to separate their garbage according to
several different categories, which is difficult for many elders.
Many elders in Japan are having problems of separating their
garbage. We have developed a new way for supporting the
elders having garbage troubles.
Method: This new concept has three characteristics. The
first is the technology done automatically, specially designed
for the elders who are poor at using modern technologies.
The second is to stimulate and urge the elders to be able to
separate and throw the garbage by themselves without direct
support from the others. The third is that we have chosen the
bed ridden and person with disability who are able to use
IT devices for supporting the elders. We have experimentally
tried this new method of separating the garbage to support
the elders having garbage troubles and recorded the results.
Result: The participants in our experiment were six elders
and five persons with disability. The elders were able to solve
their garbage problems and the persons with disability were
able to feel self-efficacy.
Discussion: We were able to seek some possibilities for
supporting the elders with garbage troubles through this
new method. However, there are some points we have to
reconsider.
Conclusion: We believe that these three characteristics
of our new garbage separating method will help the elders
with garbage problems and lead the persons with disability
to have their fair occupational rights in the society.
FUNCTIONAL DETERIORATION IN AGERIATRIC
UNITHOW OFTEN DOES THIS HAPPEN?
K.Hager1,2, M.Brecht1, O.Krause1,2, 1. Center for Medicine
for the Elderly, Diakovere Henriettenstift, Hannover, Lower
Saxony, Germany, 2. Medical School Hannover, Hannover,
Germany
Background: Most patients in a geriatric unit show an
improvement of their functional abilities. But unfortunately
this is not always true. Additionally due to changing financial
Innovation in Aging, 2017, Vol. 1, No. S1
resources the treatment results may have deteriorated over
the past years.
Methods: In the Center for Medicine in the Elderly in
Hannover, an in-patient geriatric clinic in Germany 756
patients in 2004 and 2527 in the years 2008 to 2009 were ana-
lyzed. The measure for the activities of daily living (ADL) was
the Functional Independence Measure (FIM). Moreover data
from 1602 patients from 2014 were included, but here the
Barthel-Index (BI) was used as ADL measure. Improvement
resp. deterioration was defined as more or less than 0 points
on the ADL scale between admission and discharge.
Results: As shown by the FIM 5.26.0% of the patients
deteriorated, 3.06.2% remained unchanged and 88.9
90.9% improved. As judged by the BI 6.2% deteriorated,
12.6% remained unchanged and 81.2% improved.
Conclusion: Over ten years and with two instruments
to measure activities of daily living, deterioration was only
seen in about 56 % of the patients. About 95% remained
unchanged or improved in their independence. In a usual care
ADL abilities may be much higher (e.g. Sager etal., 1996).
THE EFFECT OF EXPIRATORY MUSCLE STRENGTH
TRAINING ON THE SWALLOWING FUNCTIONS OF
THE ELDERLY
N.Ito1,2, S.Watanabe2, K.Morita3, K.Morita1,2,
Y.Okuyama1, T.Takizawa1, K.Suzuki1, Y.Iida1, 1. Nihon
Institute of Medical Science, Saitama, Japan, 2. Graduate
School of Gerontology J.F. Oberlin University, Tokyo,
Japan, 3. Mizuho-no-Sato Geriatric Health Services Facility,
Saitama, Japan
The Effect of Expiratory Muscle Strength Training/EMST
is reported not only to strengthen the respiratory muscle,
but also improve the ability to swallow, and activate super-
ficial muscles of the suprahyoid muscle group. Effects on the
improvement in aspiration have not been fully determined yet.
Objective: To determine the effects of EMST on the swal-
lowing functions of the community elderly residents using
day-care centers, based on the accumulative time spent for
the thrice saliva- swallowing. To expect that EMST would
improve respiratory function, phonation and the ability to
swallow in the elderly.
Methods: 31 community elderly residents using day-care
centers were asked to participate in the 4-week intervention
program for the study. The Threshold Trainor was used to
undergo 5-set, 5-times-per-day EMST trainings at 75% load
of maximum expiratory pressure/MEP, for 4 weeks. The par-
ticipants underwent home training independently, monitored
their compliance with study protocols, and reported on the
log sheet. Swallowing functions were evaluated by accumula-
tive time for thrice saliva-swallowing; respiratory functions,
by MEP, and maximum inspiratory pressure/MIP; while
phonation functions, by maximum phonation time/MPT.
Comparative analyses between baseline time and that after
4 weeks intervention were done using t-test.
Results: Accumulative time for thrice saliva-swallowing
was significantly reduced from 26.40 at baseline to 18.58
seconds 4 weeks after the intervention. Effects of intervention
were also significant in: MPT-9.79 at baseline, prolonged to
11.62 seconds after 4 weeks; MEP-22.47, to 26.86cmH2O;
MIP-19.06 to 21.02cmH2O after 4 weeks.
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Innovation in Aging, 2017, Vol. 1, No. S1
Conclusion: The study findings suggest that EMST could
improve the swallowing functions in the elderly patients. The
repeated EMST training leads to the shortened time neces-
sary for swallowing. This may be explained by the fact that
the pathway for swallowing is partially shared with that of
phonation. The prolonged expiration time seems to have led
to the improved phonation.
COGNITIVE FUNCTION DURING REHABILITATION
AFTER HIP FRACTURE
K.Shibasaki1,2, S.Ogawa1, K.Mizobuchi2, T.Asahi2,
M.Akishita1, 1. The University of Tokyo, Tokyo, Japan, 2.
Asahi Neurology and Rehabilitation Hospital, Chiba, Japan
Aim; Both hip fracture and dementia are major reason
for elderly to be with long-term care. Hip fracture has been
reported to deteriorate cognitive function. However, we lit-
tle experience deterioration of cognitive function after hip
fracture during rehabilitation. The aim of this study is that
whether rehabilitation could prevent elderly with hip frac-
ture from deterioration of cognitive function.
Method; We analyzed elderly with hip fracture by using
Japanese rehabilitation database. Inclusion criteria are aged
65 or older, evaluated physical and cognitive function before
and after rehabilitation and elderly with hip fracture. Elderly
who were suffered from psychological symptoms which
effect on cognitive function was excluded. Physical function
and cognitive function were evaluated by using functional
independence measure (FIM) and mini-mental state exami-
nation (MMSE) respectively. The data were compared before
and after physical and cognitive function by paired-t test.
Moreover, we divided into 3 group according to cognitive
function (MMSE24, 23MMSE14, 13MMSE) the same health screen who engaged in athletic competition
and same analysis was done.
Result: The number of subjects were 475. The mean
age was 83.4 7.4. The length of hospital stay was
44.027.4days. FIM was significantly improved compared
before with after rehabilitation. Positive correlation was
shown between the length of hospital stay and MMSE gain
(after MMSE before MMSE). Similar result was seen in
analysis which divided into three groups.
Conclusion: Although hip fracture has been reported that
alter cognitive function in the elderly, cognitive functional
deterioration was not seen during rehabilitation period.
BENEFITS OF PHYSICAL THERAPY MANAGEMENT
OF SPINAL STENOSIS IN THE GERIATRIC
POPULATION:A CASE REPORT
M.Schooley1,2, G.Mandel1,2, 1. University of St. Augustine,
Saint Augustine, Florida, 2. First Coast Rehabilitation, Saint
Augustine, Florida
Spinal Stenosis is a common diagnosis among the geri-
atric population and is often associated with significant
pain, loss of function and high medical costs. The patient
in this case was referred with a diagnosis of lumbar spinal
stenosis. He was experiencing severe pain and functional
deficits. Additionally, he was scheduled to receive steroid
injections. The patient was examined and treated by two
physical therapists in an outpatient orthopedic setting.
Interventions included patient education for aquatic home
exercise program, manual therapy, functional strengthening
and spine stabilization. Following one month of physical
IAGG 2017 World Congress
231
therapy, patient demonstrated a meaningful change in spine
active range of motion, neural tension, functional strength,
manual muscle testing and Revised Oswestry Low Back
Pain Questionnaire. Patients improvement allowed him to
function at his desired level and avoid costly injections. The
results of this case demonstrate that a patient with a diag-
nosis of spinal stenosis can achieve meaningful changes in
short term outcomes and self-management of spinal stenosis
with physical therapy and compliance with home program.
The duration and cost of physical therapy over 9 visits was
equal to or less than the cost of a single steroid injection.
Many patients with similar diagnoses go without treatment
or undergo expensive medical interventions without prior
utilization of physical therapy services. The purpose of this
case report is to highlight the benefits of physical therapy in
the management of spinal stenosis.
PHYSICAL PERFORMANCE MEASURES IN
COMPETITIVE SENIOR ARCHERS
B.Jordre, W.Schweinle, M.Johnson, A.OKief, I.Pohlman,
The University of South Dakota, Vermillion, South Dakota
Older adults are showing greater participation in sports
competition and have been found to demonstrate physical per-
formance superior to their community-dwelling counterparts.
However, very little is known about the impact of competitive
archery on the physical health of older adults. Eighteen com-
petitive archers over the age of 50 completed a short health
and exercise history and participated in a physical screen of
waist circumference, wait-to-hip ratio, BMI, grip strength,
chair stands, balance, and gait speed. Outcomes were com-
pared to the results of 1,628 senior athletes participating in
unrelated to archery. Archers reported spending a significantly
greater amount of time in strength training (F=3.89,p=.048)
than other senior athletes but reported slightly less time spent
on cardiovascular training. They showed significantly higher
rates of diabetes (2=12.28, p<.001) but a lower incidence of
cancer (2=5.18, p=.023). No other differences in health or
training history were seen. Archers demonstrated performance
superior to other senior athletes on measures of grip strength
(F=10.59, p=.001), usual gait speed (F=9.44,p=.002), fast
gait speed (F=10.46,p=.001) and single leg balance on foam
(F=6.32,p=.01). All other comparisons were non-significant.
Senior archers unexpectedly excelled in physical performance
measures already associated with longevity, health and fall
prevention. These benefits may be related to the sport-specific
tasks of pulling a bow, maintaining a steady stance and walk-
ing to retrieve arrows. Longitudinal analysis with larger num-
bers of senior archers should be conducted to confirm any
health benefits associated with archery.
SESSION 605 (POSTER)
RESEARCH METHODS: QUALITATIVE AND
QUANTITATIVE APPROACHES
SYSTEMATIC MEASUREMENT OF NON-RESPONSE
IN TRIALS WITH NURSING HOME RESIDENTS
A.Budnick1, R.Kreutz2, D.Draeger1, 1. Charit -
Universittsmedizin Berlin, Institute of Medical Sociology
and Rehabilitation Science, Berlin, Germany, 2. Charit
232
- Universittsmedizin Berlin, Institute of Clinical
Pharmacology and Toxicology, Berlin, Germany
Non-response in trials can cause bias, potentially impair-
ing the reliability and validity of research results. Few
systematic analyses have examined the reasons for non-
response in surveys of nursing home residents (NHR).
However, standardized assessment of these reasons may
guide efforts to obtain higher response rates in this target
group. We performed a cluster-randomized controlled trial
in NHR from twelve nursing homes who were 65years of
age and without moderate or severe cognitive impairment.
The aim was to improve pain management, and analysis
was performed before (T0, n=239) and after an interven-
tion (T1, n=206; T2, n=177). We additionally recorded
open-ended comments throughout the trial to investigate
the reasons for unit non-response by questioning NHR,
legal representatives, nursing staff, and/or trained interview-
ers. The non-response rate was 60.8% at baseline, with a
25.9% attrition rate from T0 to T2. We performed content
analysis following the step model of inductive category
development, using all open-ended comments (n=522) to
develop a system of categories representing the reasons for
non-response in nursing homes. Overall, we identified four
major categories of refusalgeneral refusal, health reasons,
accessibility, and excessive demandswhich further com-
prised 17 subcategories. In view of the insufficient number
of trials that include very old people, we will discuss options
for increasing response rates in future studies. Notably, as
NHR commonly have legal representatives (e.g. a lawyer)
due to cognitive impairment, non-response is often based
on third-party decisions. Accordingly, it is necessary to
discuss ethical issues in non-response analyses with NHR.
CULTURAL CONSIDERATIONS IN FOCUS GROUP
RESEARCH WITH AMERICAN INDIAN FAMILY
CAREGIVERS
C.H.Hennessy1, R.John2, 1. Bournemouth University,
Plymouth, United Kingdom, 2. University of Oklahoma
Health Sciences Center, Oklahoma City, Oklahoma
The use of focus groups in gerontology to capture infor-
mation on experiences, perceptions and attitudes related to
aging and older people has burgeoned over the past 20years.
While researchers have given attention to procedural issues
in conducting focus groups, there has been little examination
of the effects of cultural factors in the use of this method.
This presentation analyzes experiences from focus groups
conducted with American Indian tribes in the U.S. Southwest
and Oklahoma as part of research on the long-term care
needs of elders and their family caregivers. Focus groups
were used to establish content validity of a caregiver bur-
den scale for a survey of family caregivers, and to explore
the experience of caregiving to frail elders within reservation
and other rural settings. This method was selected as being
culturally compatible for use with tribal groups that have a
strong oral tradition including storytelling and talking cir-
cles, an indigenous process that involves active listening and
the opportunity for all participants to contribute their views
on subjects under discussion. Issues that emerged in conduct-
ing these focus groups including the influence of cultural
orientation to confrontation, cultural role definition that
affected who identified themselves as caregivers, the decorum
Innovation in Aging, 2017, Vol. 1, No. S1
accorded to older focus group members, the latitude of com-
munity and tribal concerns, and the public idealization of
elder care, are discussed in terms of their effects on the focus
group process. The implications of these influences are con-
sidered from a cultural framework for focus groups and in
recommendations for research practice.
EXPLORING ENGAGEMENT IN DEMENTIA:
EMERGING THEORETICAL AND
METHODOLOGICAL APPROACHES
S.E.Canning, 1. University of British Columbia, Vancouver,
British Columbia, Canada, 2. University of the Fraser
Valley, Chilliwack, British Columbia, Canada
Ensuring quality of life for residents in long-term care
homes poses complex challenges, especially for individuals
with advanced dementia who often spend long periods alone
in passive activity. While arts-based and creative program-
ming have been shown to provide opportunities for mean-
ingful engagement, there is limited understanding of the
experiences of the residents participating, especially those
with advanced dementia. My doctoral research seeks to bet-
ter understand the social and emotional engagement of older
adults with advanced dementia living in care, drawing par-
ticular attention to their experiences of participating in an
innovative inter-generational dance programme.
Given the challenges of including older adults with severe
cognitive impairment as research participants, in this pres-
entation Iaddress the need for conceptual and methodologi-
cal development aimed at identifying and refining research
approaches that look beyond the confines of language and
memory. The theoretical framing of this study examines
opportunities to understand persons with dementia in terms
of phenomenological concepts of embodiment, personhood,
and meaningful engagement. These conceptual underpin-
nings in turn support a methodological framing that draws
on visual ethnographic approaches designed to analyse expe-
riences of people with advanced dementia through observ-
ing their interactions, gestures, movements, and expressions.
Preliminary findings illustrate the potential of this approach
utilizing visual data as a vehicle to hear the voices of people
with advanced dementia who are no longer able to commu-
nicate and participate in usual ways. Emerging theoretical
and methodological approaches that provide more nuanced
understandings of the experience of dementia are critical -
because everyone is someone.
CARE MANAGERS PERCEPTIONS OF ACP BARRIERS
AND BENEFITS: NUANCES FROM AMIXED
METHODS ANALYSIS
J.Aultman1, K.Baughman1, R.Ludwick2, J.Heffner2, 1.
Family and Community Medicine, Northeast Ohio Medical
University, Rootstown, Ohio, 2. Kent State University, Kent,
Ohio
Barriers and benefits of advance care planning (ACP)
experienced by Area Agency on Aging (AAA) care manag-
ers (CMs) were analyzed from a mixed methods approach.
This methodology is used to acquire a deeper understanding
of perspectives and practices related to ACP, and to identify
nuances between quantitative and qualitative data. A two-
part study was conducted with CMs; 458 participated in a
survey, and 62 also participated in one of 8 focus groups.
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Innovation in Aging, 2017, Vol. 1, No. S1
Results from both surveys and focus groups showed
that CMs felt knowledgeable about ACP. CMs were gener-
ally comfortable (67%) and confident (67%) when discuss-
ing ACP, and qualitative data confirmed that comfort levels
tended to rise with experience and personal history with
consumers. While ACP was not always easy, and there were
some who were uncomfortable due to cultural factors, CMs
recognized that consumers were generally comfortable with
dying and found value in ACP. While surveys indicated 78%
disagreed that ACP takes too much time, qualitative data
revealed a more moderate position: some reported time was
a big barrier, and when others placed ACP as a priority,
there was not enough time for other obligations. Finally, CMs
recognized their important role in a team-based approach
to ACP (64%), despite the fact that they wished physicians
would take a more active role.
Mixed methods analysis helps unravel complex nuances
of CMs perceptions about ACP. In this study, CMs reported
their attitudes about ACP, which were confirmed through a
rigorous grounded theory qualitative analysis of focus group
discussions.
RACIAL DIFFERENCES IN MISCLASSIFICATION OF
HEALTHY EATING BASED ON FFQ AND 24-HOUR
DIETARY RECALLS
B.Olendzki1, E.Procter-Gray1, M.Magee2, G.Youssef2,
K.Kane1, W.Li1, 1. Preventive and Behavioral Medicine,
University of Massachusetts Medical School, Worcester,
Massachusetts, 2. MedStar Diabetes and Research
Institutes, Washington, District of Columbia
Accurate measurement of dietary intake is an important
component in the assessment of racial disparities in healthy
eating among older adults. We examined the agreement in
alternative healthy eating indices (AHEI) based upon Womens
Health Initiative food frequency questionnaire (FFQ) and
24-hour dietary recalls (24HR) by race among urban older
women. In 2014 and 2015, 49 White and 44 Black women
65 years and older living in Washington, DC, were queried
about diet using both FFQ and 24HR. The correlation coef-
ficients (rho) of 56 nutrient intake measures and agreements
in AHEI based on FFQ and 24HR were compared by race.
The median rho was 0.50 for Whites and 0.21 for Blacks. For
48 measures, rho was lower for Blacks. Whites had a strong
correlation of >0.5 for 25 items, while Blacks had strong cor-
relations for only 3 items. Based on FFQ, the mean (SD) of
AHEI was 54.0 (10.3) for Whites and 45.9 (8.8) for Blacks
(p<0.001). Based on 24HR, the mean (SD) was 43.9 (10.8)
for Whites and 33.2 (9.6) for Blacks (p<0.001). Using 32 as
the cutoff (40% of maximum AHEI score), diet quality of
50% of Blacks and 14% of Whites was classified as unhealthy
based on 24HR versus 2.6% and 0% based on FFQ. These
results suggest that the FFQ had limited ability to accurately
assess nutrient intake and healthy eating among Blacks, and
underestimated racial differences in healthy eating. Further
improvement in FFQ is needed for assessing racial disparities
in healthy eating among older adults.
DEVELOPMENT OF THE HELP-SEEKING
PREFERENCE SCALE FOR ELDERLY
T.Takahashi1, T.Koike2, T.Ando3, 1. Graduate School spouse, admitted to a long-term care facility) and psychiat-
of Environment and Information Sciences, Yokohama
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233
National Unversity, Yokohama, Japan, 2. Kyushu Sangyo
University, Fukuoka, Japan, 3. Yokohama National
University, Yokohama, Japan
The purpose of this study was to develop the Help-
seeking Preference Scale for elderly and to investigate the
factors correlated with help-seeking preference among the
elderly. A self-administered questionnaire survey was con-
ducted by mail (N=1680). A Questionnaire consisted of a
draft of the Help-seeking Preference Scale for elderly (12
items), demographic variables, social variables, physical con-
dition, and others. 602 responses (302 men and 300 women)
were analyzed.
Factor analysis (maximum likelihood method and pro-
max rotation) was conducted with the 12 items. The results
indicated 2 factors consisting of 10 items: (1) desire to
receive supports, 6 items (=.83), and (2) reluctance to
receive supports, 4 items (=.70). The testretest reliability
and the criterion-related validity of two factors were enough
to use. Multiple regression analysis indicated that the desire
to receive support was positively correlated with financial
difficulty and decline in physical performances. Also, the
reluctance to receive support was correlated with the sub-
jects financial difficulty, social variables (neighborhood
association, participating groups etc.), and demographic
variables (sex, spouse).
The result suggests that the Help-seeking Preference
Scale was both reliable and valid. And the results of multiple
regression analysis suggests that the subjects financial cir-
cumstance influences the attitude toward receiving support
from others. Moreover, while the willingness to receive sup-
port was positively correlated with the decline in physical
ability, the reluctance to receive support was positively cor-
related with weak social ties.
APPLYING QUALITATIVE METHODS TO BIG DATA:
INVESTIGATING LATE-LIFE OF SUICIDE
B.Mezuk1,2, V.Kalesnikava1, 1. Family Medicine &
Population Health, Virginia Commonwealth University,
Richmond, Virginia, 2. University of Michigan, Institute for
Social Research, Ann Arbor, Michigan
Efforts to prevent suicide in later life are hampered by a
lack of empirically-informed theoretical models. Most empir-
ical research relies either on population mortality statistics,
which are representative of all suicides but lack context,
or on psychological autopsy studies of decedents which
include detailed information but rely on small, non-repre-
sentative samples. We sought to overcome these limitations
by applying an interdisciplinary framework and qualita-
tive analytic approach to Restricted-Access data from the
National Violent Death Reporting System, a US population-
based suicide registry that includes narrative text descrip-
tions of the circumstances surrounding each death. We used
a data mining approach to analyze 28,200 qualitative narra-
tives of suicide deaths among adults age 55 and older from
20032012. We identified textual themes using clustering
analysis and modeled the relationships across themes using
association analysis. Preliminary themes extracted included
those related to health (e.g., chronic pain, cancer), means of
self-harm (e.g., overdose, fall), recent events (e.g., death of a
ric history. While qualitative analysis of big data addresses
234
many limitations of existing methods of investigating sui-
cide, it presents new challenges for both quantitative and
qualitative researchers. It presents a conceptual challenge to
consider how the subjective nature of lived experience for
decedents (especially when it is constructed by others as in
these case narratives) obscures our understanding of the
causes of self-harm in later life. It also presents an analytic
challenge through the need to engage in machine learning
methodologies to handle these large datasets.
REVIEW OF DATA VISUALIZATION PRACTICE IN
GERONTOLOGY
H.Mathews2, T.Yamashita1, S.R.Kunkel2, A.J.Bailer2, so as to reduce ones own stress as well as burden on others.
1. Sociology, University of Nevada, Las Vegas, Las Vegas,
Nevada, 2. Miami University, Oxford, Ohio
Data visualization is an effective strategy to achieve clear
scientific data communications. Gerontology has produced
a tremendous amount of cross-disciplinary data based on
surveys, experiments, and qualitative methods. Types of data
and analytical techniques have become more diverse than
ever before. However, little is known about how gerontolo-
gists use data visualization to communicate their research.
The purposes of this study are to document data visualiza-
tion practice in the premier gerontology journal and to pro-
vide basic guidelines for more effective data communication.
To capture historical trends, all data graphics published in
1984, 1994, 2004 and 2014 issues in Journal of Gerontology
Series B (JGSS) were examined and classified into common
types. Results showed that the numbers of articles with data
graphics increased from 29 data graphics in 16 (out of a
total of 63)articles in 1984 to 163 graphic elements in 67
(out of 109)articles in 2014 in JGSS. Interestingly, the most
frequently used data graphics were fairly simplistic: dyna-
mite plots --- a modified bar-chart that displays means and
standard deviations --- (45% of articles with data graphics),
line-graph (18%) and box-plot (9%). Based on the review of
data graphics and current literature in data visualization, it
is recommended that data graphics should be diversified and
tailored for target audiences, better able to stand alone, and
more informative than simple summary statistics. Finally,
the advantages and disadvantages of commonly used data
graphics for displaying data distributions are illustrated with
data from different simulated distributions (e.g., normal,
skewed, bimodal).
A MIXED METHODS STUDY OF HOW NURSING
HOME RESIDENTS VIEW THEIR SOCIAL
RELATIONSHIPS AND INTERACTIONS
A.M.Washburn, S.Williams, National University, La Jolla,
California
As part of a larger study of social cognition and social func-
tioning in nursing home residents (N=40) with and without
cognitive impairment, participants responded to open-ended
questions about their day-to-day interactions with staff and
other residents, as well as their ongoing relationships with
family and friends. Beginning with a content analysis of ver-
batim transcripts, themes were constructed inductively first
within and then across participants responses to the inter-
view questions. Next, data from measures of social cognition
and cognitive status, as well as nursing staffs ratings of their
social behavior, were used in within-participant analyses to
Innovation in Aging, 2017, Vol. 1, No. S1
identify possible cognitive and behavioral correlates of resi-
dents self-assessments of interpersonal relationships and
interactions. Finally, patterns of perceived change in the resi-
dents social functioning were characterized in cross-partic-
ipant comparisons of these combined individual qualitative
and quantitative results.
Participants social experiences appeared to be determined
not only by long-established habits and preferences and
length of time at the nursing home, but also by their cognitive
status and social cognition competencies. Acommon theme
though, regardless of cognitive status, was the importance of
managing ongoing relationships and day-to-day interactions
For those with little or no cognitive impairment, maintaining
a sense of self was also a priority, especially as they became
frailer and as they witnessed cognitive decline in their peers.
Examples will be given of how participants with moderate
cognitive impairment but intact social cognition assess their
relationships and interactions with others.
COMPARING DAILY DAIRY METHODOLOGIES:
MTURK VS. TRADITIONAL APPROACHES
J.A.Bellingtier, S.D.Neupert, North Carolina State
University, Raleigh, North Carolina
To our knowledge, only one study has used mTurk
(Amazons crowdsourcing platform) to collect daily dairy
data and it excluded older adults. We compare benefits and
challenges associated with conducting a 9-day daily dairy
study of older adults on mTurk vs. traditional approaches
(i.e., in-person recruitment with paper-and-pencil data col-
lection). The speed of recruitment (hours in mTurk vs. weeks
in traditional methods) was balanced by a higher rate of par-
ticipant drop-off in the mTurk sample. Of 167 individuals in
the mTurk sample who agreed to participate only 139 met
study criterion; 116 continued to day 2, and only 71 made it
to day 9 (43% retention vs. 78% in our traditional sample).
In comparison to our traditional sample, mTurk participants
were more likely to be white, younger, male, and not retired.
Methodologically, collecting data via mTurk allowed for
more precise timing of cognitive measures, as well as veri-
fication of survey completion timing. However, recruitment
via mTurk meant we were unable to personally explain the
process to participants. Although detailed procedures were
sent to participants, mTurk participants generated more
emailed questions than traditional participants. MTurk pre-
sented additional challenges specific to daily dairy designs
as the mTurk system is best designed to accommodate one-
time cross-sectional research. We present problems and solu-
tions related to designing a daily dairy study of older adults
compatible with mTurk, paying participants, recruiting par-
ticipants, validating participants ages, and managing mTurk
fees. Overall, we present mTurk as a viable option for daily
dairy collection with older adults.
INFORMATIVE METHODS TO WORK ON FOOD
FREQUENCY QUESTIONNAIRES DATA
M.Colpo1,2, V.Del Panta1, G.Sini1, B.Stefania1, 1.
Laboratorio di Epidemiologia InCHIANTI, Azienda Usl
Toscana Centro, Firenze, Italy, 2. University of Florence,
Florence, Italy
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Purpose and methods: Interest on studying the rela-
tionship between food intake (FI) and diseases status is
increasing. FI data are usually collected by food frequency
questionnaires (FFQ) leading to a large number of variables
to be considered in statistical models.
Two approaches have been adopted in order to deal with
FI data: a priori, by taking into account of clinical exper-
tise aimed to build scores like Mediterranean Diet Score
for example, or a posteriori, by adopting classical statistical
methods to shrink information in a few number of covariates
such as factorial analysis or principal components analysis.
Unfortunately a posteriori methods are not enough reliable
depending on their poor power in explaining complex cor-
relation structures.
We are going to propose the Differential Networks
method to overcome both arisen problems, in order to iden-
tify differences in the correlation structure between different
groups.
An application of this method was aimed to study the link
between FI and the occurrence of depressive symptoms in the
InCHIANTI Study. CES-D score assessed depressive symp-
toms while FI data were collected by the EPIC-FFQ. Aset of
confounders was taken into account by modeling residuals
derived from multivariate regression.
Results: Data on 665 participants (age=72.65.9, 334F)
with MMSE24 were considered. Preliminary results showed
that not-depressed participants seemed characterized by a
complex pattern while depressed participants showed an
easier one leading to a more random behavior in FI.
Conclusion: Properly modelling of FI data could be cru-
cial to increase informative power to determine the role of
food in diseases.
THE NORWEGIAN LONGITUDINAL STUDY ON LIFE
COURSE, AGEING, AND GENERATION (NORLAG)
M.Veenstra, K.Herlofson, T.Hansen, B.Slagsvold,
T.Hellevik, G.Kvamme Lset, P.Solem, M.Aartsen, Oslo 0.68). We then used the 2012 sample and performed a
and Akershus University College, NOVA, Oslo, Norway
The objectives of the Norwegian panel study on life
course, ageing and generation (NorLAG) are to: explore
conditions for active ageing and wellbeing in later life;
examine how different social contexts respond to long lives
and ageing populations; and provide knowledge needed for
the development of sustainable policies and practices in the
field.
NorLAG is framed in a life course perspective and builds
on the assumptions that ageing and old age are embedded in
life pathways, that pathways are interdependent, and that the
shape of life reflects the historical context. The longitudinal
design gives the opportunity to examine different life phases,
as well as to explore ageing as a process. The study includes
four main domains: 1.Work and retirement, 2.Family and
intergenerational relationships, 3. Quality of life and mas-
tery, 4.Health and care.
NorLAG includes survey data from three waves (2002
03; 200708 and 201617) and annual registry updates on
income, social benefits and civil status. NorLAG1 comprises
of 5,559 respondents aged 40+ yrs (67%). Of these, 3,774
also participated in the second wave. NorLAG2 includes
persons aged 1879years (N=15,156) and was merged with
IAGG 2017 World Congress
235
the international Generation and Gender Survey. NorLAG3
includes persons 50+ yrs who have responded to one of the
previous waves (N=9,300).
NorLAGs strengths are the combination of longitudinal
survey and register data, large samples, possibilities to ana-
lyze role change and life events over time, extensive data on
close family members, and a rich set of validated psychologi-
cal and sociological scales.
LEVERAGING LARGE DATA: ASSESSING SOCIAL
PARTICIPATION IN THE HEALTH AND RETIREMENT
STUDY
B.T.Howrey1, C.Hand2, 1. Family Medicine, University of
Texas Medical Branch at Galveston, Galveston, Texas, 2.
University of Western Ontario, London, Ontario, Canada
Continued participation in social activities is associated
with positive health outcomes and higher quality of life
among community dwelling older adults. Large datasets
have the potential to reveal useful information regarding
social participation and the factors that impact it; how-
ever, most datasets measure social participation via indi-
vidual items. We use data from the Health and Retirement
Study (HRS) to assess whether the five items from the
psychosocial questionnaire pertaining to social partici-
pation (volunteer with youth, charity work, education,
social clubs, non-religious organizations) form a reliable,
cohesive scale. The psychosocial questionnaire is adminis-
tered to an alternating subsample in each wave of the HRS
since 2008. We included respondents 65 and older who
returned the psychosocial questionnaire in 2010 and 2012
with responses to the social participation items (n=4,317
and n=3,978). In order to test whether the social partici-
pation items formed a reliable and cohesive scale, we first
used the data from the 2010 wave and performed explora-
tory factor analysis (EFA) of the social participation items.
All five items loaded onto a single factor (i.e., Eigen value
>1.0) and had borderline reliability (Cronbachs alpha=
confirmatory factor analysis (CFA) on the five items using
a structural equation model. The CFA showed reasonable
fit (RMSEA = 0.04, CFI = 0.99). Results suggest that a
scale derived from the social participation items in the
HRS may be useful in characterizing general social par-
ticipation levels and identifying factors that can promote
social participation in older populations.
SESSION LB610 (POSTER)
LATE BREAKER POSTER SESSION 1
ASSOCIATIONS OF CHILDHOOD SOCIOECONOMIC
POSITION WITH FRAILTY TRAJECTORIES AT OLDER
AGE
B.W.van der Linden1,6, B.Cheval1, S.Sieber1,
I.Guessous2,3,4, M.Kliegel1,6, D.Courvoisier1,2, S.Cullati1,5,
1. Swiss NCCR LIVES - Overcoming Vulnerability:
Life Course Perspectives, Geneva, Switzerland, 2. Unit
of Population Epidemiology, Department of Community
Medicine, Primary Care and Emergency Medicine,
University of Geneva, Geneva, Switzerland, 3. Department
236
of Epidemiology, Emory University, Atlanta, Georgia, 4.
Institute of Social and Preventive Medicine, Lausanne
University Hospital, Lausanne, Switzerland, 5. Department
of General Internal Medicine, Rehabilitation and Geriatrics,
University of Geneva, Geneva, Switzerland, 6. Center
for the Interdisciplinary Study of Gerontology and
Vulnerability, University of Geneva, Geneva, Switzerland
Poor socioeconomic circumstances during childhood have
been shown to be associated with negative health outcomes
at older age. Frailty is an important outcome associated with
ageing, but research on risk factors of frailty is lacking. We
aimed to assess associations of childhood socioeconomic
position (CSP) with frailty trajectories at older age. Data on
well-being, health, socioeconomic situation, and retrospec-
tive life course from 17,916 individuals aged 50 years and
over included in the longitudinal Survey of Health, Ageing,
and Retirement in Europe study was used. Frailty, includ-
ing pre-frailty, was operationalized as presenting either
weakness, shrinking, exhaustion, slowness, or low activity.
Confounder-adjusted multilevel logistic regression models
were used to analyze associations of CSP with frailty trajecto-
ries. Results showed that disadvantaged CSP was associated
with higher risk of (pre)frailty and that this association was
mediated by education for both men and women (OR=1.45,
p<0.01; OR=1.43, p<0.01, respectively). A lower level of
education was associated with a lower risk of (pre)frailty
(OR=0.97, p<0.001, both men and women). Also lower skill
main occupation class was associated with an increased risk
of (pre)frailty in both men and women (OR=1.20, p<0.01;
OR=1.28, p<0.001, respectively). Moreover, health behav-
iors and demographics seemed to increase the risk of being
(pre)frail. The findings suggest that CSP is associated with
frailty trajectories at older age, which can be explained by
adult socioeconomic position, in particular by education.
The results can help in improving frailty trajectories by
stimulating educational achievement and associated conse-
quences across the life course.
INCIDENCE OF DEMENTIA IN PREDOMINANTLY
MALE U.S. VETERAN CENTENARIANS
R.Kheirbek1,2,3, A.Fokar1, M.Balish1,2, M.Llorente1,2, 1. leisure activities, higher education, having no spouse, lower
Washington DC VA Medical Center, Washington, District of
Columbia, 2. Georgetown University, Washington, District
of Columbia, 3. George Wahington University Medical
Center, Washington, District of Columbia
Background: Centenarians are the fastest growing age
group globally, yet little is known about US Veteran cente-
narians incidence of dementia and its impact on survival.
Methods and Results: retrospective longitudinal cohort
study of elderly U.S. Veterans. Subjects are community
dwelling Veterans living in rural areas, born between 1904
and 1914 who survived to at least age 80. The study included
47936 octogenarians, 27176 nonagenarians, and 1378 cen-
tenarians. KaplanMeier method was used to estimate
the cumulative incidence of dementia within age groups.
Incidence rates were compared using log-rank test.
Cox proportional-hazards model used to estimate unad-
justed hazard ratios. Veteran centenarians were 92.5% male,
85.9% white, 38.3% widowed, 90.5% served in World War
II and 72.1% had no service related disability. Significant
Innovation in Aging, 2017, Vol. 1, No. S1
differences in dementia incidence rate were observed. By age
89years, the estimated risk for dementia was 0.21% in the
centenarian group, 3.1% in the nonagenarian group and
9.1% in the octogenarian group. Whereas by age 99years,
the risk of dementia increased to 8.3% for the centenarian
group and 20.4% for the nonagenarian group. The differ-
ence in incidence rate remained between the statistically sig-
nificant across age group (P =<.0001). The Hazard Ratio for
dementia incidence among octogenarians and nonagenarians
compared with centenarians is 8.9 CI 95% (7.2- 10.8) and
2.7 CI 95% (2.3- 3.3), respectively.
Conclusion: While dementia is generally under-recog-
nized in the elderly, the study found that being a centenar-
ian remained significantly associated with a reduced risk of
dementia compared to both octogenarians and nonagenarians.
THE RELATIONSHIP BETWEEN BABY-BOOMERS
CONSUMPTION PATTERN AND DEPRESSION
AMONG KOREAN RETIREES
S.Hong1, S.Park2, 1. Dongguk University in Korea, Seoul,
Korea (the Republic of), 2. Shingu College, Seoul, Korea
(the Republic of)
The purpose of this study is to examine the characteristics
of baby boomers consumption patterns among retirees and
the effect of their consumption patterns on depression.
This study used the 5th data of Korea Retirement and
Income Study(KReIS) of Korea National Pension Research
Institute. Of those who were born in Korea from 1955 to
1963, total 2,034 retirees were included in this study. The
Latent Profile Analysis(LPA) structured the empirical pat-
terns of consumption and then multiple regressions ana-
lyzed the relationship between consumption patterns and
depression.
In general, retirees spent more on private households
and health care expenses. Overall the five consumption pat-
terns were classified: (1) Basic life-oriented type(26.9%), (2)
Balanced consumption life style(29.3%), (3) Social life-ori-
ented type(18.3%), (4) Leisure-oriented type(18.5%), and
(5) Education-oriented type(7.0%). The level of retirees
depression was associated with higher dissatisfaction with
subjective health, higher limitations in physical functions,
having any diagnosed disability, having fewer children, and
more negative self-perceived economic status. Regarding
their consumption patterns, the education-oriented type
showed significantly lower depression than the basic life-
oriented type.
These results suggest meaningful implications for better
understanding of the baby-boomers economic burden and
life styles. In light of a key generation of silver industry and
market, gerontological research on baby-boomers should
expand its scope towards more inclusive measures of con-
sumption in later life.
BIG DATA FOR RESEARCH ON AGING
R.Rosen, D.Hochfellner, Center for Urban Science +
Progress, New York University, Brooklyn, New York
The interdisciplinary field of aging research is poised to
benefit from the confluence of new data sources, new types
of researchers, and new security and storage technologies.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Electronic health records can be linked with novel built
environment data, in order to reduce reliance on surveys
for health surveillance and to facilitate new studies on envi-
ronmental determinants of wellbeing. Computer scientists,
social scientists, and biomedical scientists bring comple-
mentary analytic and contextual knowledge to the field.
Advances in sensor technology, cloud storage services,
and cryptography can ensure that real-time data is both
usable and secure. This confluence can be best leveraged
by a shared research infrastructure for trusted informa-
tion on effective aging research and healthcare interven-
tions. The Center for Urban Science and Progress at New
York University (CUSP) has built such an infrastructure.
Users can remotely access microdata and novel data on the
built environment, collaborate across fields and organiza-
tions, and responsibly disseminate urban policy research
results to data providers and their stakeholders. We report
here how the technical design must be directly informed
by user expectations and must incorporate a training
program, in order to incentivize a diverse community of
active researchers and data providers. We demonstrate
that it is indeed possible to balance usability with data
security. We will introduce conference attendees to new
urban informatics data for the aging research community.
Further, conference attendees will learn how a pilot Aging
Research Data Facility can operate as a secure research
infrastructure for researchers, computer scientists, and
practitioners to develop and disseminate evidence-based
best practices in gerontology.
FRAILTY PREVENTION IN AT-RISK OLDER ADULTS
IN THE PRIMARY CARE AND COMMUNITY
SETTING
A.Garm, Fraser Health, Surrey, British Columbia, Canada
Research demonstrates it is possible to prevent and/or
delay frailty. Comprehensive geriatric assessment (CGA),
patient directed chronic disease management planning and
health coaching have been identified as effective frailty
prevention interventions for older adults. The CARES
(Community Action and Resources Empowering Seniors)
Project combines all three interventions in a collaborative
inter-disciplinary model that introduces the CGA and FI
calculation capacity into primary care physicians electronic
medical record (EMR)
Methods: Seniors aged 65 to 85 with an estimated clini-
cal frailty score between 3 and 5 receive personalized health
coaching for up to six months from Self-Management BC
at no charge in weekly telephone contacts. Before and post
coaching, primary care physicians conduct a CGA, which
is embedded in the electronic health record and able to
calculate a Frailty Index (FI). The effect of the combined
intervention on frailty is evaluated by comparing the
baseline and follow-up FI-CGA scores and quality of life
assessments.
Results: Pilot studies CGA-FI scores of the participants
were statistically significantly (0.032) decreased post inter-
vention, which is equivalent to 2 less health problems at fol-
low up. Meanwhile, 59% of participants reported an increase
in their health attitude and 67% reported an increase in exer-
cise frequency.
IAGG 2017 World Congress
237
Discussion: CARES involves physicians, health coaches
and patients in the prevention of frailty. The electronic CGA,
FI and free health coaching provide both a measurement and
management strategy to address frailty in the primary care
and community setting.
Conclusion: Preliminary results suggest CARES is effec-
tive in delaying frailty. CARES empowers seniors to engage
in self-management of their health in partnership with
their physician. Together they are able to track and address
frailty development through the use of the electronic CGA
and FI results. Fraser Health in British Columbia, Canada
has adopted CARES as part of a senior care strategy. More
research is pending.
HEALTH AND SELF-PERCEPTION OF HEALTHDO
WELFARE REGIME AND SOCIOECONOMIC STATUS
HAVE GENDER EFFECT?
A.Paz1, I.Doron1, A.Tur-Sinai2, 1. Gerontology, Haifa
University, Tel Aviv, Israel, 2. The Max Stern Yezreel Valley
College, Yezreel Valley, Israel
Health is measured by subjective or self- perceived health
as well as by objective parameters as the number of chronic
illnesses or physical limitations. There is a well-established
relationship between socioeconomic status and health indi-
cating that individuals with lower income are likely to be less
healthy than those with high income. Factors such as edu-
cation, material status, social position, and work situation
shown to be important determinants also in the perception
of health. The study applies a cross sectional and a longitu-
dinal study based on SHARE (Survey of Health, Ageing and
Retirement in Europe) in its first, second and fifth waves. The
cross-sectional model is based on data from 16 European
countries, divided to 5 different types of welfare regimes, of
132,845 responders (mean age 65.810.5) 55.8% of whom
are women, to investigate the influence of welfare regime
and socioeconomic status on health and self-perceived
health. A second longitudinal model explores changes over
time between the first, second and the fifth wave (a period
of about 10 years) in health parameters and self-perceived
health in correlation to changes in sociodemographic and
socioeconomic factors. The study found significant gender
differences in self-perceived health and that welfare regimes
have an effect both on health perception and on health indi-
cators that in some regimes (e.g. the Mediterranean coun-
tries) differ for men and women. Abetter understanding of
the differences in socioeconomic abilities of men and women
on their health is needed for framing social policies in differ-
ent countries and regimes.
THE ROLE OF COMMUNITY OBLIGATION IN
DEPRESSION DIAGNOSIS
S.Songco2, D.Liao2, S.S.Merkin2, L.A.Jennings1, 1.
Reynolds Department of Geriatrics Medicine, Univeristy
of Oklahoma Health Sciences Center, Oklahoma City,
Oklahoma, 2. Division of Geriatrics, David Geffen School
of Medicine at UCLA, Los Angeles, California
By 2030, depression is projected to be the foremost con-
tributor to global disease burden. In cross-sectional studies,
religious involvement and volunteerism are protective against
depression. Connectedness to the welfare of a community
238
(community obligation) may also have long-term protective
effects on depression.
Participants included 1,928 adults ages 4576 without
depressive symptoms who participated in the 1995 Midlife
in the US (MIDUS)I survey and 10years later in MIDUSII.
Using logistic regression, we determined the effect of self-
rated contribution to others (5-point scale), altruism, civic
obligation, and volunteerism at MIDUSI on depression at
MIDUSII. We also examined the effect of change in contri-
bution to others and change in volunteerism on depression.
Excellent self-rated contribution to others (vs. good)
at MIDUSI and a decrease in contribution to others from
MIDUSI to MIDUSII were associated with greater odds of
depression at MIDUSII (OR2.37, 95%CI 1.23, 4.57 and
OR2.27, 95%CI 1.43, 3.60, respectively), after adjusting for
age, gender, marital status, employment, health insurance,
socioeconomic status, social contacts, and chronic condi-
tions. Altruism, civic obligation, volunteerism, and change in
volunteerism were not associated with depression. Multiple
conditions, female gender, and partner loss were predictive
of depression, while employment at MIDUSII and older age
were protective.
Excellent self-rated contribution and a decrease in con-
tribution to others over 10 years were associated with
depression; the paradoxical relationship between excellent
self-rated contribution and depression was unexpected. No
other components of community obligation were predictive
of depression. Additional studies examining the longitudinal
relationship between community obligation and depression
are warranted.
TO WHAT EXTENT CAN APURPOSE-BUILT
RETIREMENT VILLAGE BE DESCRIBED AS AN AGE-
FRIENDLY COMMUNITY?
J.Proctor, Social Sciences, Keele University, Newcastle
Under Lyme, United Kingdom
Background: In 2003, a research team from Keele
University completed a three-year Lottery-funded project
examining health, identity and well-being amongst residents
in the then newly built Berryhill Retirement Village. More
than 10years on, this unique follow-up study explores the
ways in which the village has evolved and responded to resi-
dents changing needs over time. An overarching aim was to
investigate the extent to which Berryhill may be defined and
experienced as an age-friendly community.
Method: In Phase One of the current project, 25 in-depth
interviews were carried out with long-term residents (includ-
ing six who took part in the original study). In Phase Two,
a survey questionnaire was distributed to the whole resident
population (149). The survey explored age friendliness in
more depth across each of the eight domains identified by
the World Health Organisation (2007) as being: Built envi-
ronment, Transport, Housing, Social participation, Respect
and Social inclusion, Civic Participation and employment,
Communication and Information, Community support and
Health services.
Results: Residents predominantly reported positive expe-
riences in terms of opportunities to increase social partici-
pation and to be enabled to maintain independence in each
phase of the research. However, the losses experienced by
some residents in terms of changes in health, bereavement,
Innovation in Aging, 2017, Vol. 1, No. S1
and changing roles and responsibilities created barriers to
activities and wider community engagement.
Conclusion: The findings demonstrate the benefits of a
longitudinal research in highlighting the different challenges
staff and residents face in dealing with change across time.
The relationship between loss and wellbeing in a communal
environment has implications for regular reviews of policy
and practice.
SLOW PROCESSING SPEED PREDICTS FALLS IN
OLDER ADULTS WITH AFALLS HISTORY: 1-YEAR
PROSPECTIVE COHORT
J.Davis1, J.Best1, K.Khan1, L.Dian1, S.Lord2, K.Delbaere2,
C.Hsu1, T.Liu-Ambrose1, 1. University of British
Columbia, Vancouver, British Columbia, Canada, 2. Falls,
Balance and Injury Research Centre, Sydney, New South
Wales, Australia
Background/Objective: Recent epidemiologic data sug-
gest that deficits in processing speed predict future injurious
falls. Our primary objective was to determine a parsimoni-
ous predictive model of future falls among older adults who
experienced 1 fall in the past 12months based on the fol-
lowing categories: counts of 1)total, 2)indoor, 3)outdoor or
4)non-injurious falls; 5)one mild or severe injury fall (yes
versus no); 6)an injurious instead of a non-injurious fall; and
7)an outdoor instead of an indoor fall.
Design: 12-month prospective cohort study.
Setting: Vancouver Falls Prevention Clinic, Canada (www.
fallsclinic.ca)
Participants: 288 community-dwelling older adults aged
70years with a history of 1 fall resulting in medical atten-
tion in the previous 12months.
Measurements: We employed principal component anal-
ysis (PCA) to reduce the baseline predictor variables to a
smaller set of 5 factors (i.e., processing speed, working mem-
ory, emotional functioning, physical functioning and body
composition/fall risk profile). These 5 factors were used as
predictors in regression models predicting the incidence of
falls over a 12-month prospective observation period.
Results: Among older adults with a falls history, process-
ing speed was the most consistent predictor of future falls;
poorer processing speed predicted a greater number of total,
indoor, outdoor, and non-injurious falls, and a greater likeli-
hood of experiencing at least one mild or severe injurious fall
(all p values < .01).
Conclusion: Poorer performance on the processing speed
factor, a trainable factor, was independently associated with
the most costly type of falls injurious falls.
THE IMPACT OF PEER MENTORING IN
RESIDENTIAL CARE ON THOSE VISITED
K.Theurer1, B.Mortenson1, R.I.Stone2, S.Brown4,
M.Suto1, V.Timonen3, 1. University of British Columbia,
Vancouver, British Columbia, Canada, 2. LeadingAge
Center for Applied Research, Washington, District of
Columbia, 3. Trinity College Dublin, Dublin, Leinster,
Ireland, 4. Schlegel-UW Research Institute for Aging,
Waterloo, Ontario, Canada
Depression and loneliness are biopsychosocial deter-
minants of health, which contribute to functional decline
and mortality among older adults living in residential care.
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Innovation in Aging, 2017, Vol. 1, No. S1
Research in other settings indicates peer support may be
effective at reducing depression and loneliness and enhanc-
ing social identity. Therefore, an innovative peer mentor-
ing intervention was developed based on the social identity
theory in which volunteers and residents (mentors) form a
supportive team. Mentors meet weekly, receive education
and then external volunteers pair up with resident volunteers
to visit socially isolated residents (visitees). This pilot study
was conducted to explore visitees experiences with the inter-
vention and perceived outcomes. Data were collected for 74
visitees in 10 homes in Ontario, Canada. The effectiveness
of the program was assessed over a 6-month period using
qualitative interviews and quantitative outcome measures
including standardized measures of depressive symptoms
and loneliness. Attendance at other programs was also
monitored. During their interviews visitees described strong
emotional connections with their peers, which contributed
to feelings of empowerment and an interest in becoming
mentors themselves. Visitees reported reduced symptoms of
depression (p=0.02) and loneliness (p=0.02), and a 60%
increase in the number of other monthly programs attended
was observed (p= 0.01). The findings of this pilot suggest
that peer mentorship may be a promising means of reducing
symptoms of depression and loneliness, which are extremely
prevalent in these settings. These findings will inform revi-
sions to the program that will be evaluated in future research
examining the efficacy of this intervention.
SKILLED NURSING FACILITIES ADMISSIONS AND
HOSPITAL READMISSIONS IN PATIENTS WITH HIP
FRACTURES
A.Karmarkar, D.Adhikari, C.Li, K.J.Ottenbacher,
A.Kumar, Y.Kuo, University of Texas Medical Branch at
Galveston, Galveston, Texas
Compare risk of 30-day and 90-day hospital readmis-
sion associated with post-acute services between skilled
nursing facilities (SNF) and inpatient rehabilitation facilities
(IRF), for patients with hip fractures. Secondary analysis of
Medicare claims data (20122014), linking inpatient claims,
enrollment indicators, patient-level assessment data from
SNF and IRF settings, and the provider of services files. We
identified index stays for patients with hip fractures using
medical severity diagnosis related groups and ICD-9 codes
in acute hospitals, and who were discharged to SNF or IRF.
We only selected cases age 66 or older and on Medicare
fee-for-service who survive 90-day follow-up (n=60,347).
Selection bias associated with post-acute discharge desti-
nations was handled using propensity score as the inverse
probability of treatment weights in the outcomes models,
along with adjusting for unbalanced patient-level covari-
ates (socio-demographic characteristics, condition severity,
acute length of stay, intensive care unit use, previous admis-
sion status, Elixhauser comorbidity index, and Hierarchical
Condition Category composite score), and hospital-level
covariates (profit status, size, urban/rural, presence of IRF
as an unit). Risk for 30-day readmission was significantly
lower for those discharged to IRF 0.93 (95% CI=0.870.99)
as compared with SNF. The likelihood of 90-day readmission
was also significantly lower for IRF discharges 0.91 (95%
CI=0.870.96) compared with SNF. The risk of 30-day and
90-day hospital readmission was significantly higher for
IAGG 2017 World Congress
239
those discharged to SNF. With the proposed episode-based
payment model for hip and femur fractures, it is important
to determine and compare quality of post-acute services, for
selection of effective and efficient discharge setting.
EFFECT OF DAY SERVICE USAGE FREQUENCY ON
THE CONTINUATION DURATION OF HOME LIVING
Y.Miyahara1, M.Niikura2, Y.Shimoda3, Y.Kitayama4,
K.Teranishi4, Y.Naruse5, 1. Course of Nursing, Graduate
School of Medicine and Pharmaceutical Sciences for
Education, University of Toyama, Toyama, Japan, 2.
Department of Nursing, Graduate School of Medicine
and Pharmaceutical Sciences for Research, University of
Toyama, Toyama, Japan, 3. Department of Nursing, Kinjo
University, Hakusan, Japan, 4. Faculty of Nursing, Toyama
College of Welfare Science, Imizu, Japan, 5. Faculty of
Social Work, Toyama College of Welfare Science, Imizu,
Japan
Purpose: The purpose of this study was to clarify the
relationship between day service usage frequency and the
subsequent continuation duration of home living based on
long-term care insurance certification information on elderly
people who had received their start care need certification.
Methods: The subjects were 4,674 elderly people (1,646
men, 3,028 women) aged 65years or older in X Region of
Japan who had received an initial certification in the long-
term care insurance system between 2000 and 2013. The
continuation duration of home living was calculated as the
number of months from the effective first date of certification
in the examination taken at home until the home living end
date or the observation end date. The relationship between
day service usage frequency and continuation duration of
home living was analyzed using the Cox proportional haz-
ards model.
Results: Hazard ratios that showed a significant trend
for continuation of home living in users of outpatient
services compared with the non-use group were 1.33
(95%Confidence interval[CI]:1.141.54) in the twice weekly
group aged 7584years and 1.17 (95%CI:0.991.39) in the
twice weekly group aged 8594years.
Conclusion: The results suggest that use of day services up
to two times a week is a factor in the continuation of home
living. That trend was seen to be relatively higher with age,
and was not seen in people who used these services three
times a week or more.
FORESHADOWING ALZHEIMERS: VARIABILITY
AND COUPLING OF OLFACTION AND COGNITION
J.Knight, A.M.Piccinin, University of Victoria, Victoria,
British Columbia, Canada
The earliest stage of Alzheimers disease (AD) pathol-
ogy begins in one of the main components of the olfactory
pathway, the entorhinal cortex, making deficits in smell a
potential prospective biomarker for the early detection of
AD. A bivariate longitudinal coupling model was used to
determine whether assessment-to-assessment variation in
olfaction mirrors variation in cognition over time. The model
included terms for age, sex, education, ApoE e4 allele, and
autopsy diagnosed AD pathology.
Using a sub-sample of 573 individuals: the between-per-
son variation in odour identification had a robust positive
240
association to episodic memory (b=0.129, SE=0.0135, P
< 001; conditional R-squared = 0.86). Higher AD pathol-
ogy was related to both lower episodic memory at baseline
(b=-0.236, SE=0.0685, P < 001), and faster declines in epi-
sodic memory (b=-0.059, SE=0.017, P < 001). Additionally,
more rapid declines in olfactory identification were robustly
associated with more rapid declines in episodic memory
scores (b=0.011, SE=0.0039, P < 0.001). The within-person
coupling between olfaction and episodic memory was robust
and positive (b=0.07, SE=0.016, P < 001), indicating that
odour identification and episodic memory scores fluctuated
together over time.
This research indicates that at a given occasion, individu-
als with higher olfactory scores also have higher episodic
memory scores. This coupled relationship indicates that
olfactory testing can be a useful tool for assessing cognitive
decline and possibly an inexpensive screener for pathological
brain changes.
INCIDENCE OF HEART FAILURE IN
PREDOMINANTLY MALE U.S VETERAN
CENTENARIANS
R.Kheirbek1,2,4, A.Fokar1,4, M.Llorente1,4, R.Fletcher1,4,
H.Moore1,3,4, 1. Washington DC VA Medical Center,
Washington, District of Columbia, 2. George Washington
School of Medicine and Health Sciences, Washington,
District of Columbia, 3. Uniformed Services University,
Bethesda, MD, Washington, District of Columbia, 4.
Georgetown University Medical School, Washington,
District of Columbia
Background: Male centenarians are generally under-rep-
resented in centenarian studies. The United States Veteran
cohort has the largest known male centenarians of any
nation. Here we study Veteran centenarians incidence of
Heart Failure and its impact on survival.
Methods and Results: retrospective longitudinal cohort
study of elderly U.S. Veterans. Subjects are community
dwelling, born between 1910 and 1915, who survived to
at least age 80. The study included 31,109 octogenarians,
52,419 nonagenarians, and 3,351 centenarians. Kaplan
Meier method was used to estimate the cumulative incidence
of heart failure within age groups. Incidence rates were com-
pared using log-rank test. Cox proportional-hazards model
was used to estimate unadjusted hazard ratios. Veteran cen-
tenarians were 97.0% male, 88.0% white, and 31.8% wid-
owed. 87.5% served in World War II, 63.9% had no service
related disability. Significant differences in HF incidence rates
were observed. By age 89, incidence of HF for octogenar-
ians was 19.3%, v. 3.3% for nonagenarians and 0.4% for
centenarians By age 99 incidence of HF for nonagenarians
increased to 15.8% and 3.3% for centenarians. Differences
in incidence rate remained significant across age groups
(P =<.0001). The Hazard Ratio for heart failure incidence
among octogenarians and nonagenarians compared with
centenarians is HR 36.54 CI 95% (29.90- 44.66) and 5.37
CI 95% (4.42- 6.52), respectively.
Conclusion: In a large cohort of predominantly male U.S.
Veterans, compared with octogenarians and nonagenarians,
centenarians had the lowest incidence of heart failure after
age 80, demonstrating compression of morbidity and exten-
sion of health- span in this unique group of survivors.
Innovation in Aging, 2017, Vol. 1, No. S1
USING TRANSCRANIAL DIRECT CURRENT
STIMULATION TO REDUCE CHRONIC PAIN IN
ELDERLY INDIVIDUALS
M.Harvey2,1, M.Martel2,1, F.Houde2,1, I.Daguet3,
M.Sguin1,4, G.Leonard2,1, 1. University of Sherbrooke -
Facult de Mdecine et des Sciences de la Sant, Sherbrooke,
Quebec, Canada, 2. Research Centre on Aging, Sherbrooke,
Quebec, Canada, 3. Universit Claude Bernard Lyon 1,
Lyon, France, 4. Sherbrooke University Hospital Centre -
Department of Neurosurgery, Sherbrooke, Quebec, Canada
The prevalence of chronic pain drastically increases with
age. The objective of this study was to determine if tran-
scranial direct current stimulation (tDCS) could be a valid
treatment option to relieve chronic musculoskeletal pain in
elderly individuals. Twenty-four chronic pain patients were
randomized to receive either anodal tDCS over the contralat-
eral motor cortex (2 mA, 20 minutes; n=12) or sham tDCS
(n=12) for 5 consecutive days. Pain logbooks were used to
measure pain intensity on the days before, during and after
treatment sessions, and the Margolis pain drawing and scor-
ing system was used to assess the number of painful areas.
Analysis of the pain logbooks revealed that real tDCS led
to a reduction in pain (p 0.04), while sham tDCS did not
produce any change. Patients from the real tDCS group also
reported a decrease in the number of painful areas, while the
patients in the sham tDCS group reported no change. Every
patient who received real tDCS reported an alleviation of
pain. These results suggest that anodal tDCS applied over the
motor cortex can decrease pain, and that this effect persists
for several days following treatment. To our knowledge, this
study is the first to investigate the analgesic effect of tDCS
with a randomized, controlled trial in elderly individuals.
The results can support the use of this technique in chronic
pain patients aged 60years and older. Future studies are nec-
essary to determine whether these results can be replicated
using a larger population.
THE MOLECULAR BIOLOGIC STUDY ABOUT
THE CIRCADIAN RHYTHMIC CONTROL OF
MICTURITION FUNCTION
K.Chung1,2, S.Cho3, K.Kim1,2, 1. Gachon University,
Incheon, Korea (the Republic of), 2. Gil hospital, Incheon,
Korea (the Republic of), 3. Kyung Hee University, Seoul,
Korea (the Republic of)
Circadian rhythmic(CR) disruption shows adverse effects
like fatigue, nocturia, sleep-disturbance, and mood disorder
which are common in elderly. We investigate the relation-
ship between CR and water metabolism(WM) and expres-
sion of circadian-clock-gene(CCG) in peripheral bladder and
central-micturition-centers(CMC).
In 8-week-old male(C57BL/6J male; WT) and CCG knock-
out mouse(per1-/-per2-/-; PDK), metabolic cage was used to
know WM according to CR in 12:12 LD-photoperiodic(LD
cycle) and constant-dark(DD cycle). To know CCG expres-
sion, activation of Per2 promotor was checked after har-
vesting the bladder of adult/neonate mouse. We checked
the expression of CCG; Bmal1, Rev-erb by extraction of
RNA after reverse transcription and the check the rhythmic
expression of CCG in micturition related tissues (detrusor,
sphincter and uroepithelium, MRT) in WT and PDK to know
the existence of peripheral clock in bladder. To know CCG
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
expression in CMC, real-time-RT-PCR was used in every 3
hours for 24-hour in DD cycle in WT and PDK.
WM was increased in DD cycle of WT, however, this was
disappeared in PDK. CR is not related with environment but
related with endogenous CR. We observe the activation of
Per2 promotor CR, and characteristic circadian expression
pattern of CCG in MRT of WT, but not observed in PDK,
which means bladder peripheral clock is well functioned.
In spinal level, unlike PDK, CCG expression rhythm was
observed in WT. But there was no rhythmicity in upper CMC.
Endogenous CR in WM exist. Bladder peripheral CCG
exists in MRT. But in terms of CMC, we can find CCG
expression only in lower CMC.
GLYCAEMIA BUT NOT THE METABOLIC
SYNDROME IS ASSOCIATED WITH COGNITIVE
DECLINE IN AGEING MEN
J.Tournoy1, M.Overman1, N.Pendleton2, T.ONeill2,3,
F.Wu2, D.Vanderschueren1, EMASStudy Group1,2, 1.
University of Leuven, Leuven, Belgium, 2. University of
Manchester, Manchester, United Kingdom, 3. Manchester
Academic Health Science Centre, Manchester, United
Kingdom
Objectives: Previous research has indicated that com-
ponents of the metabolic syndrome (MetS), such as hyper-
glycaemia and hypertension, are negatively associated with
cognition. However, evidence that MetS itself is related to
cognitive performance has been inconsistent. In this lon-
gitudinal study, we aimed to investigate whether MetS or
its components affect cognitive decline in ageing men and
whether any interaction with inflammation existed.
Design: Longitudinal study over a mean of 4.4 (SD 0.3)
years.
Setting: Multi-centre European male Ageing Study
(EMAS).
Participants: Men aged 4079years.
Measurements: Cognitive functioning was assessed using
the Rey-Osterrieth Complex Figure (ROCF), the Camden
Topographical Recognition Memory (CTRM) task, and
the Digit Symbol Substitution Test (DSST). High-sensitivity
C-reactive protein (hs-CRP) levels were measured using a
chemiluminescent immunometric assay.
Results: Overall, 1,913 participants contributed data to
the ROCF analyses and 1,965 subjects contributed to the
CTRM and DSST analyses. In multiple regression models,
the presence of baseline MetS was not associated with cog-
nitive decline over time (p>0.05). However, logistic ordinal
regressions indicated that high glucose levels were related
to a greater risk of decline on the ROCF Copy (=-0.42,
p<0.05) and the DSST (=-0.39, p<0.001). There was neither
a main effect of hs-CRP levels nor an interaction effect of hs-
CRP and MetS at baseline on cognitive decline.
Conclusions: We found no evidence for a relationship
between MetS or inflammation and cognitive decline in this
sample of ageing men. However, glycaemia was negatively
associated with visuo-constructional abilities and processing
speed.
A SYSTEMATIC REVIEW OF CHANGE POINT
STUDIES ON COGNITIVE AND NEUROLOGIC
OUTCOMES PRECEDING DEMENTIA
IAGG 2017 World Congress
241
R.Graham1, J.E.Karr1, G.Muniz2, S.M.Hofer1, 1.
University of Victoria, Victoria, British Columbia, Canada,
2. University of Edinburgh, Edinburgh, United Kingdom
Older adults who ultimately develop dementia experi-
ence accelerated cognitive decline long before diagnosis. The
current systematic review aimed to summarize the litera-
ture on preclinical change points (CPs) in relation to mild
cognitive impairment (MCI) and dementia, identifying the
order in which cognitive and neurological outcomes decline
and factors that modify the onset of decline. Eligible stud-
ies included preclinical MCI/dementia CP models for cog-
nitive/neurological outcomes from longitudinal cohorts free
of early-onset dementia or concurrent neurological disor-
ders associated with cognitive decline. The search protocol
yielded 16 eligible studies describing 9 cohorts (1 pre-MCI, 8
pre-dementia). Only the MCI cohort involved neuroimaging
and motor outcomes, identifying CPs for increased ventricu-
lar cerebrospinal fluid volume (CP=3.66years before onset
[95% CI: 0.755.58]) and white matter (WM) hyperintensi-
ties (10.58years [5.15-Unknown]). Gait resulted in the earli-
est CP at 12.10years (8.10-Unknown), while finger tapping
declined after diagnosis. Across domains, cognitive abili-
ties declined roughly 34 years prior to MCI. The earliest
observed CP for dementia was perceptual speed (10.90years
[7.5014.40]). Verbal memory was most commonly meas-
ured, with CPs ranging from 1.008.60years pre-diagnosis.
The latest cognitive ability to decline was reading ability
(0.40years [-0.100.11]). Greater education, female gender,
and involvement in cognitively-stimulating activities signifi-
cantly delayed CP onset. CPs preceding Alzheimers disease
occurred earlier than CPs preceding vascular dementia. The
findings from this systematic review suggest that neurologi-
cal and cognitive changes occur long before MCI/dementia
diagnoses. Lifestyle, dementia type, and gender influence the
onset of decline, but few studies evaluated CP moderators.
STATE QUALITY OF CARE LAWS AND NURSING
HOME OUTCOMES IN THE UNITED STATES
W.Lin, University of Illinois at Chicago, Chicago, Illinois
Introduction: Low quality of care in nursing homes has
presented long-standing policy challenges for consumers,
researchers and policy-makers. However, the impact of regu-
lation on quality has only recently been addressed and cur-
rent studies focus on enforcement stringency. Although all
nursing homes are subject to federal standards, some states
have adopted additional regulations in different areas of care.
Using this natural experiment, this study is the first to ana-
lyze the contents of quality of care state regulations, compare
them to federal regulations, tease apart specific components
and link them to a corresponding quality outcome.
Methods: State laws for all 50 states and D.C.were com-
piled using primary legal research methods and secondary
sources. Next, quality of care laws were analyzed and linked
quantitatively to quality indicators developed and publicly
reported by CMS.
Results: Using data from 2011 and coding laws as dichot-
omous variables, adjusted regression results on outcome var-
iables showed that compared to states that were only subject
to federal standards, states that went above federal regula-
tions had better outcomes such as less high-risk residents
with pressure ulcers, less residents who self-report moderate
242
to severe pain and less residents experiencing one or more
falls with major injury.
Discussion: There is some evidence to support that more
stringent state regulations have a positive relationship with
quality of care in nursing homes. This study is well posi-
tioned to inform policy-makers on existing regulations and
whether and how regulation is associated with better quality
in the nursing home setting.
ORGANIZATIONAL FACTORS OF RESIDENT
WEIGHT LOSS IN GERMAN NURSING HOMES
J.Zimmermann1, H.Pfaff1,2, 1. Graduate School GROW,
University of Cologne, Cologne, Germany, 2. Institute
for Medical Sociology, Health Services Research, and
Rehabilitation Science (IMVR) at the Faculty of Human
Sciences and the Faculty of Medicine of the University of
Cologne, Cologne, Germany
Background: Nursing care in Germany is faced with a
radical change in quality report standards. Until now nurs-
ing home quality has been measured mostly on the basis of
structural and care process criteria. By the year 2018, new
quality indicators will be implemented by law that include
measures of resident outcomes. The results of this doctoral
project should contribute to scientific discourse on quality
reporting standards for German nursing homes. Theoretical
Orientation: Using Donabedians structure-process-outcome
framework (1988), we assumed that structural indicators of
quality are associated with outcome indicators. Methods:
The data for this study came from the internal quality man-
agement of the Caritas Association and form the EQisA-
project, within which the indicators of nursing home
outcomes were developed and validated. The sample con-
sisted of 221 German nursing homes which included data of
over 22 thousand residents. For the investigation of relation-
ship between organizational characteristics and weight loss a
logistic regression analysis was used. Findings: The analysis
showed that resident-to-staff ratios and mortality rate were
associated with weight loss of residents with low cognitive
impairment. Conclusion: The findings indicated that resident
weight loss is more probably to occur in facilities with lower
staffing levels of registered nurses and additional care staff
and in facilities with higher mortality rates. However, there
are only a few studies in Germany that examine this kind of
relationships. More research using a broader national sample
of nursing facilities would be needed in this field.
SUPERVISORY LEADERS IN AGING: PRACTICE
CHANGE TO STRENGTHEN SOCIAL SERVICE
DELIVERY TO OLDER ADULTS
D.Kaplan1,2, B.M.Silverstone2, 1. Adelphi University,
Garden City, New York, 2. Hartford/NASW Supervisory
Leaders in Aging Program, Washington, District of
Columbia
Social services for older adults are instrumental in
addressing vulnerabilities associated with aging. Yet, prac-
titioners report needing expanded geriatric knowledge and
better supervision. This poster reports outcomes of the first
full year of implementation of a social work supervisor con-
tinuing education program. The program provides advanced
training that enhances gerontological knowledge as well
as supervisory skills in teaching and leadership. Positive
Innovation in Aging, 2017, Vol. 1, No. S1
outcomes from three pilot programs led to a 2015 expan-
sion, funded by the John A.Hartford Foundation under the
auspices of the National Association of Social Workers. Now
called Supervisory Leaders in Aging, the program is being
adopted and tested in four states (IL, FL, MD, and NY), with
plans for subsequent national implementation. NASW antic-
ipates training nearly 160 MSW supervisors between 2015
and 2017. These supervisors will, in turn, provide support to
more than 1,200 direct practitioners, potentially enhancing
the health and well-being of more than 100,000 older clients
annually. Trainees self-rated frequency of supervisory prac-
tices during the prior month, related to workshop content,
were measured with the Practice Inventory for Supervisors in
Aging Services. This novel measure was administered prior
to the first session and three months after the final session.
Statistically significant findings demonstrate that 18 previ-
ously used best practices were maintained by participants and
12 underutilized best practices were adopted as a result of
education received during workshops, with variability across
training sites. The program is shown to enhance supervisory
practice overall. Implications of this tested model for enhanc-
ing workforce capacity will be discussed.
PREVALENCE AND CORRELATES OF FRAILTY IN
CHINESE OLDER ADULTS: CHINA HEALTH AND
RETIREMENT STUDY
C.Wu1, E.Smit1, Q.Xue2, M.Odden1, 1. Oregon State
University, Corvallis, Oregon, 2. Johns Hopkins University,
Baltimore, Maryland
Frailty is an age-related medical syndrome of decreased
resilience to stressors and is associated with numerous
adverse outcomes. Although there is preponderance of lit-
erature on frailty in developed countries, limited investiga-
tions have been conducted in developing countries including
China, which has the worlds largest aging population. We
examined the prevalence of frailty in China by socio-demo-
graphics and geographic region, and investigated health and
functional correlates of frailty. Data are from the 2011 base-
line survey of the China Health and Retirement Longitudinal
Study on 5,301 adults aged 60years (mean=67.9, SD=6.9).
Frailty was assessed using 5 criteria: weakness, slowness,
exhaustion, inactivity, and shrinking. We classified individu-
als with 0, 12, and 35 criteria as robust, prefrail, and
frail, respectively. The prevalence of frail and prefrail were
7.0% and 51.2%, respectively. Higher frailty prevalence was
observed in persons who were older, women, and had lower
education level. Frailty prevalence ranged from 3.3% in the
Southeast to 9.1% in the Northwest, and was >1.5 times
higher in rural vs. urban areas. Frail vs. nonfrail individu-
als had higher prevalence of chronic conditions including
cardiovascular disease, lung disease, kidney disease, stomach
disease, and arthritis. Frail persons also had higher preva-
lence of falls, depression, disability, and functional limitation.
In summary, the frailty prevalence among Chinese elders was
similar to that in Western populations and we found sub-
stantial socio-demographic and regional disparities in frailty
prevalence. This standardized frailty assessment may be
incorporated into geriatric practice in China to identify the
most vulnerable elders to reduce morbidity and disability.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE CONNECTION BETWEEN SOCIAL SUPPORT
AND COGNITIVE FUNCTION AMONG ELDERS IN
RURAL EAST CHINA
J.Liang, J.Xue, X.Tao, W.Weng, B.Cui, J.Wang, Y.Jiang,
S.Chen, Zhejiang University, Hangzhou, Zhejiang, China
This study aims to investigate the cognitive function of
elders who live in rural areas of East China and studied the
relationship between different subtypes of social support and
cognitive function.
Two hundred and twenty-two elders aged 60years or more
were randomly selected from 9 villages of Jiande County.
The assessment package included: General Characteristics
Questionnaire, PHQ-9 (9-item Patient Health Questionnaire),
DSSI (Duke Social Support Index), and MMSE (Mini-mental
State Examination). The analysis methods included descrip-
tive statistics and logistic regression.
The final sample included 218 participants, and 57 of
them may have potential cognitive problems. Results showed
that the education level, residential arrangement, and daily
activities frequency may have positive relationships with
cognitive function(p0.05). Age, the depressive symptoms
presence, and overall scores of social support were negatively
associated with cognitive function(p0.05). In the logistic
regression, the best fit model indicated that elders reported
more perceived social support were more likely to maintain
good cognitive function.
This study found the social supports positive effect on
buffering the decline of cognitive function in elders of rural
East China, especially perceived social support. The positive
connection between perceived social support and cognitive
function indicates the importance of social support interven-
tion approach in rural China. Further study will explore the
protective effect of perceived social support in other areas,
such as Midwest China, and the methods to prevent the
abnormal cognitive decline in the regards of psychosocial
factors for promoting healthy aging in rural China.
NEW IMPLICATIONS FOR DIABETES EDUCATION:
PHYSICAL ACTIVITY BARRIERS AMONG DIABETIC
OLDER ADULTS
S.Chard1, L.Girling1, E.Roth1, B.Harris-Wallace1,
L.Henderson1, C.C.Quinn2, J.K.Eckert1, 1. UMBC,
Baltimore, Maryland, 2. School of Medicine, University of
Maryland, Baltimore, Baltimore, Maryland
An estimated 33% of U.S.adults 65 have type 2 diabe-
tes (T2D). Physical activity is a key component of successful
T2D self-management. Yet, only 25% of older adults with
T2D meet American Diabetes Association physical activ-
ity guidelines. Newly available findings from a NIA-funded
ethnographic study of T2D among African-American and
non-Hispanic Whites (n=83) provide insights into partici-
pants questions and concerns that impede their physical
activity. Systematic, thematic analyses using Atlas.ti, reveal
first, considerable confusion regarding the appropriateness
of physical activity in the context of changing comorbidities.
Second, concerns regarding insulin levels and fears about
exercising alone undermine the perceived safety of physical
activity. Finally, participants struggle to find specific types of
physical activity that match their fitness level, lifestyle prefer-
ences, and economic constraints. Faced with these barriers,
participants report not being physically active, even as they
IAGG 2017 World Congress
243
acknowledge the importance of physical activity for their
T2D control. These findings are of immediate relevance to
diabetes education. Personalized, ongoing diabetes educa-
tion that is tailored to address physical activity in the context
of T2D and participants comorbidities is critically needed.
Furthermore, detailed information on the range of commu-
nity physical activity opportunities, their accessibility, and
safety for participants may play a critical role in increasing
levels of physical activity among the diverse older adults with
T2D.
ERRORLESS TRAINING CHANGES VISUOMOTOR
CONTROL IN REACHING UNDER VISUAL
DEFICIENCY AMONG OLD ADULTS
M.Fan, T.Wong, School of Public Health, Li Ka Shing
Faculty of Medicine, The University of Hong Kong, Hong
Kong, China
Aging problems influence older adults on motor learn-
ing and control, such as coordination difficulties. Errorless
training, aiming to prevent the accumulation of explicit
knowledge in movement execution, is regarded as a poten-
tial training method to obtain motor benefit through visuo-
motor adaptation.Twenty-two right-handed healthy older
adults (Mean age= 70.07 years, SD =2.37) with normal or
corrected-to-normal vision participated in the study and
were trained to do a reaching task in the scenarios of chang-
ing the target size that minimized or promoted movement
errors (i.e., errorless or errorful groups, respectively). The
simulated vision deficiency was conducted by blocking parts
of visual feedback of the hand controlled mouse cursor.
Gaze behaviors and motor performance data was recorded
by the EyeLink (SR Research, Canada).Both errorless and
errorful training groups improved participants motor per-
formance in reaching under simulated vision deficiency.
However, only errorless training but not errorful training
could decrease reaching movement time with improvement
in reaching accuracy. Additionally, different training methods
affected gaze behaviors differently. Errorless training group
demonstrated a significant decrease in first fixation duration
on the target (p<.001) while errorful and normal training
groups increased the duration. Participants in the errorless
training group conducted more tracking actions to enter
or leave the target area (p=.011), implying that perceptive
dependence might be transformed from vision to proprio-
ception.Errorless training affects gaze behaviors and motor
performance positively during simple reaching task in older
adults and might change the visuomotor control in reaching
under the limited visual information situation by inducing a
decrease in the dependence on vision with compensation by
the proprioception.
SPIRITUALITY AND INTRINSIC RELIGIOSITY:
MODERATORS OF WISDOM AND PSYCHOLOGICAL
WELL-BEING RELATION
N.Borhan, O.Bozo, Psychology, Middle East Technical
University, Ankara, Turkey
General opinion suggests that wisdom, intrinsic religiosity,
and spirituality are linked to favorable outcomes. Research
done so far about this topic verify this belief. Yet, to the best of
our knowledge, there is not any study investigating the poten-
tial effects of intrinsic religiosity and spiritual well-being on
244
the relation between wisdom and psychological well-being
(PWB) among elderly. Hence, the present study proposes and
tests this moderation model.Three-Dimensional Wisdom
Scale (3D-WS), Religious Orientation Scale (ROS), Spiritual
Well-being Subscale of Mental, Physical, Spiritual Well-being
Scale (MPSW), and Psychological Well-being Scale (PWS)
were administered to 165 Turkish elderly people whose age
ranged from 65 to 88. Wisdom and spiritual well-being had
significant positive correlations with each other and they
seem to contribute to PWB. In addition, a significant moder-
ating effect of spirituality on wisdom-PWB association was
found. Yet, intrinsic religiosity was unrelated to wisdom and
PWB, and it did not have a moderating role in this relation.
Findings regarding spirituality and wisdom are consistent
with the literature while findings about intrinsic religiosity
are contrary to expectations. This study emphasizes that wis-
dom and spiritual well-being should be taken into consid-
eration when dealing with elderly in mental health or health
settings.
A PROFILE OF AFRICAN AMERICAN CAREGIVERS
FOR FAMILY MEMBERS WITH MEMORY PROBLEMS
IN THE DEEP SOUTH
O.J.Clay, D.Ejem, M.M.Waters, The University of
Alabama at Birmingham, Birmingham, Alabama
Interventions formulated to help caregivers have gener-
ally not included enough African Americans (AAs) to deter-
mine if they are effective within this population. The current
investigation provides information on AA caregiving issues
and needs. Participants were recruited from the Birmingham,
AL metro area and received a $25 gift card for completing
a telephone interview. Caregivers provided information on
demographics, social support, problems encountered as car-
egivers, and interest in services if they were made available.
Of the 29 caregivers enrolled, 21 were female (72%) and 8
male (28%). The average age of caregivers was 53.76years
(range = 22 77) and they reported caring for individuals
with average scores on the AD8 Dementia Screening Scale
of 7.3 out of 8 and 10.8 out of 18 on the Clinical Dementia
Scale Sum of Boxes (above the cutoffs for probable demen-
tia). Caregivers reported between 1 and 20 members in
their social support networks and 14 (48%) caregivers
were employed. Caregivers reported problems dealing with
the family member not remembering who they were, tak-
ing care of the family members financial affairs, and other
comorbid conditions such as high blood pressure and dia-
betes. Additionally, 23 caregivers (79%) reported being
interested in at least 1 of the services listed. These data will
be utilized to provide initial evidence of if the New York
University Caregiver Intervention, an efficacious counseling
and support intervention, can be pilot tested as constructed
to address issues of AA caregivers in the Deep South or if
cultural modifications need to be made.
OBJECTIVE PHYSICAL ACTIVITY, SEDENTARY TIME,
AND INCIDENT DISABILITY IN OLDER ADULTS
T.Chen1, Y.Haeuchi1, T.Honda1,2, S.Chen1,4, K.Narazaki3, individuals low in social participation. Social support, how-
S.Nagayoshi1, S.Kuamagai1, 1. Kyushu University, Kasuga,
Japan, 2. Research Fellow of the Japan Society for the
Promotion of Science, Tokyo, Japan, 3. Fukuoka Institute
Innovation in Aging, 2017, Vol. 1, No. S1
of Technology, Fukuoka, Japan, 4. Central South University,
Changsha, China
Substantial evidence shows that higher levels of moder-
ate-to-vigorous physical activity (MVPA) are associated with
lower risk of disability, and an emerging body of literature
suggests a higher level of sedentary time (ST) is related to
a higher risk of disability. However, most studies assessed
MVPA and ST using questionnaires. This prospective study
investigated the associations of accelerometer-assessed PA
and ST with risk of disability among 1,603 participants from
the prospective population-based Sasaguri Genkimon Study,
who were aged 65years and without disability at baseline
in 2011. MVPA and ST were assessed by a tri-axial acceler-
ometer in 2011. During follow-up, incidence of disability was
defined as first certification for personal support or care by
the national long-term care insurance system of Japan. Cox
proportional hazards models were used to estimate adjusted
hazard ratios (HR) and 95% confidence intervals (CI) for
the onset of disability. Over a median follow-up of 3.8years,
incident disability was identified in 149 participants (9.2%).
After adjusting for sex, age, education, living status, cogni-
tive impairment, multi-morbidity, smoking and drinking sta-
tus, higher level of MVPA was associated with lower risk of
disability. After additional adjustment for ST, those in the
two higher tertiles of MVPA showed lower risk of disabil-
ity compared to the lowest tertile group, with adjusted HR
(95% CI) of 0.51 (0.320.81) and 0.52 (0.300.91), respec-
tively. No association was observed for ST. These data dem-
onstrated clear benefits of MVPA for prevention of disability.
THE DIFFERENTIAL IMPACT OF SOCIAL
PARTICIPATION AND SOCIAL SUPPORT ON
PSYCHOLOGICAL WELL-BEING
N.Sharifian, D.Gruhn, North Carolina State University,
Raleigh, North Carolina
Being socially involved is theorized to diminish age-related
declines in cognitive and emotional functioning. However,
different facets of being socially involved may differentially
impact functioning in older adulthood. In the present study,
we aimed to expand on it by investigating the impact of two
distinct aspects of social engagement - social support and
social participation - to assess their impact on change in psy-
chological well-being in two samples from the three-wave
Wisconsin Longitudinal Study spanning 19 years (1992
2011): the original high school graduate respondents and
their siblings. The goal of the present study was to examine
(a) age-related trajectory of psychological well-being (PWB)
and (b) whether interindividual differences in social partici-
pation and social support influenced intraindividual change
in psychological well-being. Using latent growth curve mod-
els, we found general declines in psychological well-being
from middle to old adulthood. Social participation predicted
the slope of psychological well-being, that is, individuals high
in social participation demonstrated a less steep decline in
psychological well-being across the three time points than
ever, did not demonstrate a buffer effect on declines in psy-
chological well-being. Developmental implications of the
age-related trajectory of psychological well-being and the
relationship with social participation are discussed.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE HEALTHY AGING INSTRUMENT (HAI):
DEVELOPMENT AND PSYCHOMETRIC EVALUATION
L.Thiamwong1, W.Maneesriwongul2, P.Malathum2,
S.Jitapunkul3, T.Vorapongsathorn2, A.L.Stewart4, 1.
College of Nursing, University of Central Florida, Orlando,
Florida, 2. Mahidol University, Bangkok, Thailand, 3.
Chulalongkorn University, Bangkok, Thailand, 4. UCSF,
San Francisco, California
The purpose of this study was to develop, refine, and
evaluate the psychometric properties of the Healthy Aging
Instrument (HAI). The HAI is a multidimensional instrument
that attempts to measure the process of healthy aging in a
Thai context. Themes emerged from focus groups and in-
depth interviews, which were used to develop an item pool.
The HAI was reviewed for content format by five experts and
for clarity and readability by 10 older adults. The content
validity index among the experts was high. After the pretest,
the HAI consisted of 46 items. To test construct validity and
internal consistency, the HAI was completed by 403 older
adults in Southern Thailand. Evaluation of construct validity
through principal component factor analysis with varimax
rotation and using factor loading greater than 0.40 yielded
nine factors: 1) Being Self-Sufficient and Living Simply,
2) Managing Stress, 3) Having Social Relationships and
Support, 4) Making Merit and Good Deeds, 5) Practicing
Self-Care and Self-Awareness, 6) Staying Physically Active,
7)Staying Cognitively Active, 8)Having Social Participation,
and 9)Accepting Aging, which explained 62% of the vari-
ance in the process of healthy aging. Cronbachs alpha for
each of the subscales ranged from 0.69 to 0.80 with an over-
all alpha of 0.88. The HAI demonstrated adequate internal
consistency reliability and showed evidence of content and
construct validity. It requires less than 15 minutes on average
to administer and had no item-level missing data rates.
GENDERED INTERGENERATIONAL SUPPORT AND
FUNCTIONAL LIMITATIONS OVER TIME AMONG
RURAL OLDER CHINESE
W.Mao1, I.Chi2, 1. School of Social Work, University of
Nevada, Reno, Reno, Nevada, 2. University of Southern
California, Los Angeles, California
Objectives: There is much unknown regarding how
familial and cultural factors contribute to the relationship
between social support and physical functioning over time
in later life. This study examined the dynamic relationship
between intergenerational support and functional limita-
tions over time among rural-dwelling older Chinese adults,
as informed by the gendered filial norms and expectations
within the Chinese context.
Methods: Data came from a regional representative lon-
gitudinal study The Well-Being of Older People in Anhui
Province in 2001, 2003, 2006, and 2009. There were 1,322
respondents aged 60 or older having at least one son and at
least one daughter at baseline, 1,080 respondents in 2003,
834 respondents in 2006, and 631 respondents in 2009.
Functional limitations were measured as the sum of 11 items
reflecting difficulty in performing personal and instrumental
activities of daily living on a 3-point scale. Gendered inter-
generational support was measured by instrumental sup-
port and emotional support from caregivers including sons,
daughters, daughters-in-law, and sons-in-law. Cross-lagged
IAGG 2017 World Congress
245
panel analysis with maximum likelihood estimation was
conducted.
Results: Good model fit was demonstrated
(2(457)=1390.088, p < .001; CFI=.900; RMSEA=.039;
SRMR = .063). Receiving more instrumental support from
sons was significantly correlated with more functional limi-
tations at a later time, whereas receiving more instrumental
support from daughters-in-law was significantly correlated
with fewer functional limitations at a later time.
Conclusion: Caregiver support programs and policies
should take into consideration of the gendered nature of
intergenerational support and its relationship with physical
functioning in later life.
LONGITUDINAL EFFECTS OF AN
INTERGENERATIONAL MOBILE TECHNOLOGY
PROGRAM ON OLDER DIABETES PATIENTS
K.Yu, S.Wu, I.Chi, H.Hsiao, P.Lee, University of
Southern California, Los Angeles, California
Mobile technology and tablet computing devices are
gaining its popularity among older adults but the potential
to improve their health is underutilized. Given the over-
whelming prevalence of chronic disease in this population,
Intergenerational Mobile Technology Opportunities Program
(IMTOP) tested using the technology for older adult diabetes
self-care. In a wait-listed comparison trial, 237 adults aged 55
and above with Type 2 diabetes participated in eight weekly
intervention sessions at a general hospital in Taiwan. The
intervention incorporated Chronic Disease Self-Management
Program (CDSMP) to empower participants with diabetes
self-management knowledge and skills. Each participant
was given a tablet installed with the IMTOP App that was
designed to encourage diabetes patients to regularly record
their blood glucose, blood pressure, and self-care activities.
College students (N=111) were recruited as volunteers to
support seniors learning technology. Patients were linked via
a communication app to form a social support network. All
participants completed the baseline assessment, 233 and 226
completed 4-month and 8-month follow-up, respectively. The
longitudinal effects were evaluated using linear mixed-effects
models including contrasts compared mean estimates at each
follow-up to the baseline. The results indicate a stable over-
time improvement in overall diabetes self-care (p<.0001).
Specifically, patients reported more blood-glucose testing,
foot-care, and risk reduction (all with p<.0001), specific diet
(p=.04), and reduced the frequency of smoking (p=.03). Both
the WHOQOL physical health (p=.03) and self-rated general
health (p=.001) were enhanced. Moreover, financial barriers
to healthcare (p<.0001) and depression (p=.001) decreased
over follow-ups. The findings support the effectiveness of
IMTOP intervention over time.
RELATIONSHIP BETWEEN HAND GRIP STRENGTH
AND FUNCTIONAL classIN ELDERLY PATIENTS
WITH HEART FAILURE
M.Cadena-Sanabria1,2,3, C.Velandia-Carrillo1,3, 1.
Santander, Universidad Autonoma de Bucaramanga,
Floridablanca, Santander, Colombia, 2. Universidad
Industrial de Santander, Bucaramanga, Santander,
Colombia, 3. Clinica FOSCAL, Bucaramanga, Santander,
Colombia
246
Methods: We performed a cross-sectional analysis of the
study population, which comprised 120 adults with chronic
stable cardiac failure and an EF 50%. Participants were
from urban and rural households attending the Geriatric out-
patient unit of the FOSCAL Clnic, in Santander (Colombia),
who were enrolled in the FORCE study. Anthropometric and
physical measurments were taken and EF and HF assessed
using echocardiogram. Peak handgrip strength (the highest
value achieved from three trials in each hand) was measured
using a Jamar dynamometer, and calf circumference assessed.
We evaluated associations between hand grip strength and
functional class by New York Heart Association (NYHA)
classification using Wilcoxons Rank Sum Test. Patients gave
written informed consent to participate, and the study was
approved by the ethics comittee of the FOSCAL clinic.
Results: The median age of the patients was 64.5 years
with an age range between 2988years. The percentages for
stages of cardiac failure were for NYHA Iof 35%, NYHA
II of 44%, and for NYHA III / IV of 21%; Finding a force
average of 32kg, 26.3kg, 20.9kg respectively. Statistical sig-
nificant differences in the analysis of variance of all groups
according to the NYHA classification (p<0.0001) were
described.
Conclusions: Patients with heart failure have a gradual
decrease in hand grip strength in different stages accord-
ing to NYHA functional class. We propose the realization
of dynamometry as a useful, easy and economical measure,
with a potential impact to evaluate the progression of heart
failure.
LONGITUDINAL PATTERNS OF CHANGE IN SENSE
OF PURPOSE IN LIFE FOLLOWING STROKE ONSET
N.Lewis1, H.Brazeau1, P.Hill2, 1. Carleton University,
Ottawa, Ontario, Canada, 2. Washington University in St.
Louis, St. Louis, Missouri
A considerable body of research has linked having a sense
of purpose in life with positive health outcomes in later life.
However, it is less clear how the onset of a major health
condition may impact ones sense of purpose long-term. In
particular, stroke represents the leading cause of acquired
adult disability worldwide and is commonly associated with
significant physical and psychological symptoms capable
of impairing ones ability to pursue major life goals. Using
data from the Health and Retirement Study, the present
study explored changes in purpose scores in a total of 90
participants suffering from stroke between 2006 and 2010.
Purpose, demographic, social, and personality characteristics
were assessed prior to stroke onset in 2006, and again four
and eight years later. Overall, participants exhibited mean-
level decline in purpose in life following stroke, though
there was significant variability in purpose change within
the sample. Cluster analyses revealed 4 distinct patterns of
purpose change across the eight years of the study, suggest-
ing both adaptive and maladaptive change patterns in pur-
pose following stroke. These findings mirror past work from
the post-traumatic growth literature demonstrating similar
patterns of adaptation following potentially traumatic life
events. Discussion will focus on demographic and psychoso-
cial factors distinguishing these groups including personality
and close relationship support.
Innovation in Aging, 2017, Vol. 1, No. S1
A LONGITUDINAL STUDY OF THE NAVIGATION
PATTERNS OF DEMENTIA PATIENTS AND THEIR
RELATIONSHIP TO MMSE
A.Kumar1,2, C.Lau3, S.Chan4, M.Ma5, W.Kearns6, 1. Joint
NTU-UBC Research Centre of Excellence in Active Living
for the Elderly, Singapore, Singapore, 2. IGS, Nanyang
Technological University, Singapore, Singapore, 3. SCSE,
Nanyang Technological University, Singapore, Singapore,
4. College of Professional and Continuing Education,
Singapore, Singapore, 5. EEE, Nanyang Technological
University, Singapore, Singapore, 6. University of South
Florida, Tampa, Florida
Studies of the navigational patterns of assisted living facil-
ity residents with dementia have resulted in many insights
into the progression of dementia e.g. more tortuous naviga-
tion has been associated with declining mental capability. In
this pilot investigation, we found minute changes in naviga-
tional features such as speed, path-efficiency, angle-turn and,
ambulation-fraction were predictive of cognitive function.
In this study, navigational data of 10 subjects living in an
assisted living facility were collected daily over a period of
one year using an Ultra-wideband real-time location system
with an accuracy of 20cm at 1Hz using a method described
by Kearns etal. (2012), and compared with their cognitive
status as measured by the Mini Mental State Exam. Six sub-
jects had received clinical diagnoses of dementia with MMSE
scores averaging 13.33 (SD=7.6) while the four control sub-
jects MMSE averaged 18 (SD=9). We hypothesized that
linear trends in the aforementioned features over a lengthy
period might provide useful information concerning demen-
tias progression. We employed linear contrast analysis to
identify increasing and decreasing trends in the features and
evaluated the change using one-way ANOVA to compare the
trends within the two diagnostic groups. Two patients evi-
denced significant linear trends in angle-turn and path-effi-
ciency with the maximum variability captured by angle-turn
(14.7% and 11.7%). Both subjects were later found to have
very low MMSE value (6 and 9 respectively). In four other
residents angle-turn consistently increased over the 1-year
monitoring interval suggesting that their cognitive abilities
may have correspondingly deteriorated over this interval.
DEVELOPING AND VALIDATING THE LIFESTYLE
COGNITIVE DEVELOPMENT QUESTIONNAIRE
S.Leanos1, J.Coons1, G.Rebok2, D.Ozer1, R.Wu1, 1.
University of California, Riverside, Riverside, California, 2.
Johns Hopkins University, Baltimore, Maryland
Prior research has suggested that intellectual engagement
may have a positive impact on the aging brain. While intellec-
tual engagement has been employed in different ways in pre-
vious cognitive interventions, it has not been clearly defined.
This issue may be one reason why experimental studies test-
ing the causal relationship between intellectual engagement
and cognitive functioning have produced mixed results. Wu,
Rebok, and Lin (in press) propose that six factors define opti-
mal intellectual engagement: 1) open-minded input-driven
learning, 2) individualized scaffolding, 3) growth mindset,
4) forgiving environment, 5) serious commitment to learn-
ing, and 6)learning multiple skills simultaneously. Currently,
there are no extant measures that accurately assess levels
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of intellectual engagement. The current study reports the
development of a new measure of intellectual engagement,
the Lifespan Cognitive Development Questionnaire, which
includes six scales designed to measure different aspects of
intellectual engagement. Across two studies, we found that
the scale reliabilities ranged from =.493 (learning multiple
skills simultaneously scale) to =.744 (forgiving environ-
ment scale). The results of an exploratory item factor analy-
sis were not fully in accord with theoretical expectations.
The questionnaire serves as an initial effort to assess intel-
lectual engagement and future work will focus on developing
additional items that better represent the theoretical factor
structure.
MICROCIRCULATION, MUSCLE STRENGTH AND
BODY COMPOSITION IN OLDER ADULTS WITH AND
WITHOUT SARCOPENIA
K.G.Lopes, P.Farinatti, R.A.Loureno, E.Bouskela, for themselves. Weighted multivariable logistic regression
R.B.Oliveira, D.Bottino, State University of Rio de Janeiro,
Rio de Janeiro, Rio de Janeiro, Brazil
The number of older people is rapidly growing world-
wide. Sarcopenia is the age-related loss of muscle mass and
function that evolves to adverse health outcomes such as dis-
ability and loss of independence. Purpose: to compare body
composition, muscle strength and microvascular function in
older adults with and without sarcopenia. Methods: thirty-
eight eutrophic inactive elderly, aged 726 years, weight CI=1.226.23), and those with less than a high school
6510kg, mini mental state examination 254 points, were education vs beyond high school (7.9% vs 2.10%, OR=
classified as sarcopenic (n=12) and no sarcopenic (n=26),
assessed by dual energy x-ray absorptiometry (DXA). All
volunteers underwent assessments of body composition
(DXA), handgrip strength, vascular reactivity [venous occlu-
sion plethysmography (VOP)] and microvascular evaluation
[nailfold videocapillaroscopy (NVC)]. Independent samples
Student t-tests were used to compare variables between
groups and Spearman correlations to compare microcircula-
tion to body composition and handgrip strength. Significance
was set at p<0.05. Results: Handgrip strength, muscle mass,
L2-L4 bone mineral density and femoral neck were higher in
no sarcopenic group. Likewise, baseline forearm blood flow
and cappillary diameters were also higher in no sarcopenic
group (p<0.05 for all comparisons). The results demon-
strated reductions in muscle strength, bone mineral density
and basal forearm blood flow in sarcopenia. Although no
diferences were found in vascular reactivity and func-
tional capillary density between groups, there were positive
Spearman correlation coefficients between vascular reactivity
and Handgrip strength or appendicular skeletal muscle mass
or lean muscle mass as 0.34, 0.35 and 0.39, respectively.
Conclusion: Independently of having Sarcopenia or not, bet-
ter muscle strength and increased muscle mass were found
with increasing vascular reactivity.
SEVERE SOCIAL ISOLATION AMONG THE
UNMARRIED LIVING ALONE: NATIONAL HEALTH &
AGING TRENDS STUDY-NHATS
T.K.Cudjoe1, C.Boyd1, R.J.Thorpe2, J.L.Wolff2, ferentially integrated throughout articles. While theoretical
D.L.Roth1, 1. Division of Geriatric Medicine and
Gerontology, Johns Hopkins University School of Medicine,
IAGG 2017 World Congress
247
Baltimore, Maryland, 2. Johns Hopkins University,
Baltimore, Maryland
Background: Social Isolation is a complex issue that
affects the mental and physical well-being of older adults.
It is often characterized as the absence of social integration.
We examined severe social isolation in community-dwelling
adults older than 65years in the United States.
Methods: This is a cross-sectional study of community
dwelling participants in Round 1 of National Health &
Aging Trends Study who were unmarried and living alone.
Participants were characterized as having severe social iso-
lation if they a) had 0 or 1 person to talk about important
things in the last month, and b) responded that they did
not participate in any of the following activities in the last
month: visiting family or friends; attending religious services;
participating in club, classes, or other organized activities;
volunteering; and giving care to a person who could not care
analyses were performed to identify demographic predictors
of severe social isolation.
Results: Of the 2379 study participants, 105 (4.0%)
were characterized as having severe social isolation.
Weighted multivariable logistic regressions (predictors:
age, race, gender, education, and income) found that male
gender (7.5% vs 2.7%; OR= 3.44, 95% CI=2.125.57),
Hispanic vs white race (10.7% vs 3.5%; OR= 2.8, 95%
2.3, 95%CI=1.105.14) were significantly more likely to
have severe social isolation.
Conclusion: Among unmarried older adults living alone,
male, Hispanic, and lower education are associated with
severe social isolation.
SEXUALITY OF MIDLIFE AND OLDER WOMEN: USES
OF THEORY IN RESEARCH
S.Jen, School of Social Work, University of Washington,
Seattle, Washington
Gerontology is described as rich in data, but poor in
theory, a lack which weakens the link between research and
applied social gerontology. Reviews of theory in social ger-
ontology at large have been completed in the recent past.
However, little work examines theory use pertaining to spe-
cific older adult populations or narrower aspects of their
lives. This literature review examines how theory is used
in literature on the sexuality of midlife and older women.
The review includes 21 articles published in English between
20002016. Search criteria included theoretical and empiri-
cal articles that focused on the sexual lives of mid-life and
older women (age 45+). Returned articles were reviewed for
substantive theory or methodology and integration of the-
ory. All articles described the dominant narrative of asexu-
ality or sexual decline. However, each positioned their own
work as a counter-narrative, representing various theoretical
reactions. The majority were framed from a social construc-
tionist or interpretivist orientation. Theories were also dif-
work is inconsistently integrated into empirical research, its
uses have implications for the development of an overall nar-
rative shaped by a body of literature. In research examining
248
the sexuality of midlife and older women, substantive theo-
ries and methodologies react to the culturally dominant, but
empirically unsupported narrative of sexual decline, sup-
porting the role of health care and social service providers
to acknowledge and affirm the diverse sexual narratives of
older women and the ways that socially constructed notions
impact sexual experiences in later life.
EXPLORING USERS SATISFACTION GAP TO LONG-
TERM CARE SERVICE STATIONS IN THE REMOTE
AREA OF TAIWAN
L.Liu, Y.Lee, National Cheng Kung University, Tainan,
Taiwan, Taiwan
Aims: To achieve the goals of ageing in place and the
universal accessibility of long-term care (LTC), the Project
of Implementing LTC System in Remote Area has been
in operation since 2009 in Taiwan. The government con-
tracts out the program and sets up LTC service stations in
remote area to deliver LTC services. By using PZB model
(Parasuraman, Zeithaml, Berry, 1988), the study aimed to
examine the service gap from the customers perspectives in
order to synergize local resources and deliver appropriate
services.
Material and Methods: By convenience sampling at least
10 users from each LTC service station, participants were
206 older adults used one kind or more of LTC services from
23 LTC service stations in remote area. Data was collected
by interviews and analyzed by using Multilevel modeling
method in SAS 9.4.
Results: Users were mostly women (58.3%), with the age
of 6574years old (37.4%). The overall satisfactions mean
score was 4.366. The results of hierarchical generalized lin-
ear models revealed that 1) Users who know the function
of service stations and service stations which run by pub-
lic health centers had higher scores of users satisfaction;
2)users who had been to and know the function of service
stations; also the care managers who had longer LTC work-
ing experience got the significant higher satisfaction scores in
tangible services.
Conclusion: It is suggested that promoting recognition
and accessibility and hire experienced care managers can be
helpful to improve users satisfaction of LTC service stations
in remote area.
I CANT GET NO SATISFACTION: CHRONIC DISEASE
AND SEXUAL SATISFACTION AMONG OLDER
COUPLES
S.Shen, Michigan State University, East Lansing, Michigan
Chronic diseases are especially widespread among older
adults, and they can have harmful effects on their sexual-
ity. To examine how an individuals cumulative number
of chronic diseases is linked to their sexual frequency
and their sexual satisfaction, Idraw upon partner-specific
learning theory and utilize a gendered sexuality approach.
Data from the second wave of the National Social Life,
Health, and Aging Project (N=929 dyads) are analyzed
using Actor-Partner Interdependence Models to reveal
gendered findings. The results show that a husband with
fewer chronic conditions has a higher sexual frequency
which is in turn related to his own and his partners sexual
Innovation in Aging, 2017, Vol. 1, No. S1
satisfaction, such that having sex more frequently is asso-
ciated with higher sexual satisfaction for both a husband
and his wife. Further, a decrease in a husbands chronic
disease burden is also linked to an increase in his wifes
sexual frequency, which is thus positively related to her
own sexual satisfaction. A wifes sexual frequency, how-
ever, is not related to her husbands sexual satisfaction,
nor does her own chronic disease burden have any effect
on her or her spouses sexual frequency. The results speak
to healthcare providers treating older patients who are
concerned about how their health impacts their sexuality
and to policy makers working to ensure that adults can
have satisfying sex in later life.
LIFE COURSE STAGE AND SOCIAL SUPPORT FOR
END-OF-LIFE CAREGIVERS
S.LaValley, University at Buffalo, Buffalo, New York
Caregivers of terminally ill patients are at risk for anxiety,
depression, and social isolation. Social support from friends,
family members, neighbors, and healthcare professionals can
potentially prevent or mitigate caregiver strain. However,
little is known about how social support experiences differ
among caregivers at different life course stages. This study
uses thematic analysis of data from in-depth interviews with
50 caregivers of patients enrolled in hospice services to com-
pare experiences mobilizing social support among caregivers
at two life course stages: midlife caregivers caring for par-
ents and older adult caregivers caring for spouses/partners.
Both groups experienced long-term relationships and close
social network ties as facilitators of support. For older adult
caregivers, physical proximity to sources of social support
also facilitated support mobilization. Older adult caregivers
identified barriers to accepting social support as including: a
preference to autonomously adhere to personal habits and
routines, a sense of obligation to fulfill their role as spouses,
and a perception that potential sources of support had their
own families or other patients to take care of. Midlife car-
egivers barriers to accepting social support included domes-
tic conflict arising from multiple, overlapping caregiving
roles, and disagreements among multiple siblings providing
care for one parent. Findings enhance the understanding of
how caregivers life course stage affects their mobilization of
social support resources.
OSTEOSARCOPENIC OBESITY: FREQUENCY AND
ITS RELATION WITH FRAILTY AND PHYSICAL
PERFORMANCE
C.Szlejf, L.Parra-Rodrguez, O.Rosas-Carrasco, National
Institute of Geriatrics, Mexico City, Mexico
Design: Cross-sectional analysis of a prospective cohort.
Setting: The FraDysMex study, a two-round evaluation
of community-dwelling adults from two municipalities in
Mexico City.
Participants: Participants were 543 men and women older
than 50years, living in the designated area in Mexico City.
Measurements: Body composition was measured with
dual-energy X-ray absorptiometry and OSO was defined by
the coexistence of sarcopenia, osteopenia or osteoporosis
and obesity. Information regarding demographic character-
istics, comorbidities, mental status, nutritional status, history
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of falls, fractures and hospitalization was obtained from
questionnaires. Objective measurements of muscle strength
and function were grip strength using a hand dynamometer,
6-meter gait speed using a GAIT Rite instrumented walk-
way, and lower extremity functioning measured by the Short
Physical Performance Battery (SPPB). Frailty was assessed
using the Frailty Phenotype (Fried criteria) and the FRAIL
scale.
Results: The frequency of OSO was 16.6% (n=87). Frailty
and poor physical performance measured by the SPPB were
independently associated to OSO. In a logistic regression
model assessing frailty with the Frailty Phenotype the odds
ratio (95% confidence interval) for frailty was 5.04 (2.57
9.88), and for poor physical performance it was 2.41 (1.34
4.36). In the model assessing frailty with the FRAIL scale it
was 2.12 (1.104.11), and for poor physical performance it
was 2.53 (1.424.51).
Conclusion: OSO is a frequent condition in middle-aged
and older adults, and it is independently associated to frailty
and poor physical performance.
OLDER ADULTS WITH ALZHEIMERS DISEASE &
OTHER DEMENTIA FIND THEIR VOICE THROUGH
DIGITAL PHOTOGRAPHY
C.Takeda1,2, S.Dimond2, 1. University of California,
Berkeley School of Public Health, Berkeley, California, 2.
The Plaza Assisted Living, Honolulu, Hawaii
Older adults afflicted by Alzheimers disease and other
dementias can greatly benefit from therapeutic activities that
are dignifying and that can provide both physical and men-
tal stimulation. In an effort to integrate technology and art
therapy to support individuals with memory loss, residents
at various memory care communities in Hawaii were taught
how to use digital cameras and guided through the photo-
voice process. This well-documented process involves tak-
ing photographs and then using these photographs to explore
the unique thoughts and perspectives of the photographers,
which in this case are older adults living in communities
specializing in dementia care. Against a common misconcep-
tion that older adults with dementia cannot learn new skills,
the participants in this program found great success evident
by their beautiful photographs and vivid reflections, which
included reminiscence. Photographs will soon be displayed in
public exhibitions to feature the creativity and voice of the
older adult photographers and challenge perceptions about
dementia. Overall, this community program capitalized on
current technologies to achieve its program goalsthe par-
ticipants found a therapeutic opportunity to express them-
selves and the general public increased their awareness about
the talents and skills maintained by those with Alzheimers
disease and other dementias.
A COMMUNITY-BASED VIRTUAL REALITY
PROGRAM IMPROVES PHYSICAL ACTIVITIES IN
PARKINSONS DISEASE
Y.Liao, Department of Gerontological Health Care,
National Taipei University of Nusing and Health Science,
Taipei, Taiwan
Background: Virtual reality (VR) systems are proved to
increase motor performance in stroke and elderly. However,
the effects have not been established in patients with
IAGG 2017 World Congress
249
Parkinsons disease (PD). Purpose: To examine the effects
of VR based training in improving muscle strength, sensory
integration ability and walking abilities in patients with PD
by a randomized controlled trial. Method: Thirty six par-
ticipants with diagnosis of PD were randomly assigned to
one of the three groups (n=12 for each group). Participants
received VR-based Wii Fit exercise (VRWii group) or tra-
ditional exercise (TE group) for 45 minutes, followed by
treadmill training for another 15 minutes for 12 sessions
in 6 weeks. Participants in the control group received no
structured exercise program but fall-prevention education.
Outcomes included lower extremity muscle strength, sensory
integration ability, walking velocity, stride length, and func-
tional gait assessment (FGA). All outcomes were assessed at
baseline, after training and at 1-month follow-up. Results:
Both VRWii and TE groups showed more improvement in
level walking velocity, stride length, FGA, muscle strength
and vestibular system integration than control group after
training and at 1-month follow-up. The VRWii training, but
not the TE training, resulted in more improvement in visual
system integration than the control. Conclusions: VRWii
training is as beneficial as traditional exercise in improv-
ing walking abilities, sensory integration ability and muscle
strength in patients with PD, and such improvements per-
sisted at least for 1month. The VRWii training is then sug-
gested to be implemented in patients with PD.
SELF-REPORTED PHYSICAL FUNCTION AS
APREDICTOR OF HOSPITALIZATION IN THE LIFE
STUDY
K.Callahan1, L.Lovato2, M.E.Miller2, A.P.Marsh5,
T.M.Gill3, J.M.Guralnik4, S.B.Kritchevsky1, W.Rejeski5, 1.
Wake Forest University School of Medicine, Winston-Salem,
North Carolina, 2. Wake Forest University Health Sciences,
Winston-Salem, North Carolina, 3. Yale University School
of Medicine, New Haven, Connecticut, 4. University of
Maryland, Baltimore, Maryland, 5. Wake Forest University,
Winston-Salem, North Carolina
Background: For older adults, hospitalization confers
functional loss, which in turn increases hospitalizations.
Physical function screening may identify an at-risk popula-
tion for early intervention. The Mobility Assessment Tool
short form (MAT-sf) is a brief, innovative, avatar-based
self-report tool that predicts mobility disability. This study
explored whether baseline MAT-sf score is associated with
number of hospitalizations and time to first hospitalization.
Design: Post-hoc analysis of prospectively-gathered data
from the Lifestyle Interventions and Independence for Elders
(LIFE) Study, a randomized clinical trial of lifestyle interven-
tions to preserve mobility in older adults, conducted in eight
U.S.academic medical centers.
Participants: Among 1635 sedentary community-dwelling
older adults enrolled in LIFE, 1574 completed baseline phys-
ical function screening including MAT-sf, with scores rang-
ing from 30.2 (low function) to 69.8 (high function).
Measurements: Number of hospitalizations and time to
first hospitalization, adjusted for age, gender, race, living
alone, clinical site, and baseline comorbid conditions, # pre-
scription medications, and cognition.
Results: Of the 1557 participants with hospitalization
data, 726 (47%) experienced at least one hospitalization,
250
with the majority (78%) of these experiencing 12 hospitali-
zations. For every 10-point increase in MAT-sf defined mobil-
ity, there was a 16% decreased rate of all hospitalizations
(adjusted rate ratio 0.84, 95% CI: 0.76 to 0.93, p< 0.001).
Higher baseline MAT-sf scores were also associated with a
decreased risk of first hospitalization (adjusted Hazard Ratio
0.83, 95% CI: 0.76 to 0.92, p< 0.001, per 10-point increase
in MAT-sf).
Conclusion: MAT-sf may identify older adults at
increased risk for hospitalizations, who may benefit from
care coordination.
USING VIDEO REFLEXIVE GROUPS TO DEVELOP
DEMENTIA PRACTICE
L.Hung, University of British Columbia, Vancouver, British
Columbia, Canada
Hospital environments have been criticized as inade-
quate for meeting needs of patients with dementia. There is
a need to explore innovative ways to involve frontline staff
to make practical changes. Using videos to show compelling
patient stories can be a powerful way for promoting front-
line engagement in practice development. This poster reports
the perspective of staff on using videos and reflexive groups
to develop person-centred care in a medical unit. Methods
consisted of video interviews with patients with dementia
and 31 focus groups with a total of 50 staff, including nurs-
ing, physicians, and allied health. Five substantial themes
emerged as important roles of the video reflexive groups in
contributing to creating collective commitment and actions
to improve dementia practice in the medical unit: (a) seeing
through patients eyes, (b) seeing normal strange, (c) seeing
inside and between, (d) seeing with others inspires actions,
and (e) seeing team support builds a safe culture for learning.
The findings suggest that videos reflexive groups can be an
effective strategy for mobilizing positive change in acute hos-
pital wards. In this study, staff participants described visual
methods brought a fresh and practical approach to practice
development in acute care.
HEALTH AND WELL-BEING OF RETIREES: THE
ROLES OF SOCIAL INTERACTION AND EXCHANGE
RECIPROCITY
Y.Wang, Boston College, Boston, Massachusetts
Utilizing two psychosocial frameworks the social rela-
tionships perspective and the exchange reciprocity theory,
this study examines how social interaction and exchange rec-
iprocity affects health and wellbeing of retirees, and whether
the effects vary by gender.
Data from the 8th and 9th wave of the Health and
Retirement Study (HRS) were analyzed to look into the
health and retirement satisfaction of retirees. Logistic regres-
sion was used to examine social interaction (positive, and
negative social support, self-perceived social hierarchy),
exchange reciprocity and demographic information on retire-
ment satisfaction. Heterogeneous choice model was used to
examine social interaction, exchange reciprocity and demo-
graphic information on retirees self-reported health. Gender
interactions were tested.
Results indicate that positive social interaction and
exchange reciprocity were positively related to retirement
Innovation in Aging, 2017, Vol. 1, No. S1
satisfaction and self-reported health, while negative social
interaction was negatively related to retirement satisfaction
and self-reported health. Having the same level of positive
social interaction, women have higher odds of reporting more
retirement satisfaction. Having the same level of exchange
reciprocity, men have higher odds of reporting more retire-
ment satisfaction and better self-reported health.
Incorporating the psychosocial framework helped to
understand multiple facets of predictors in affecting retire-
ment wellbeing. It also helped to further our understand-
ing of the gender heterogeneities in successful retirement.
Clinical intervention and public policy aiming to target both
genders in retirement will be discussed.
ITEMS FOR MEASURING PERSONNEL RETENTION
IN INTENSIVE CARE HOME FOR THE ELDERLY
A.Ogata1, K.Ogiso2, S.Toida3, S.Yamashita4,
M.Watanabe5, N.Aida6, 1. Nogoya University Graduate
School of Economics, Nagoya, Japan, 2. Gifu University
Nursing Course, School of Medicine, Gifu, Japan, 3.
Shubun University Faculty of Nursing, Ichinomiya, Japan,
4. Chubu Gakuin University Faculty of Human Well-being,
Seki, Japan, 5. School of Health Sciences, Gifu University
of Medical Science, Seki, Japan, 6. Institute of Health
Science, Academic Assembly School of Medicine and Health
Sciences, Shinshu University, Matsumoto, Japan
There is no scale for measuring the retention of nurs-
ing and caregiving personnel at intensive care home for the
elderly (facilities covered by public aid providing long-term
care to the elderly), and the topic has therefore not been dis-
cussed. The objective of this research was to find out suit-
able proposed items for a scale to measure the personnel
retention.
Using the Delphi method, 111 prospective items were con-
verged as basic scale items by three rounds. An eight-member
panel of experts was convened that consisted of nursing and
caregiving researchers and personnel from facilities covered
by public aid providing long-term care to the elderly.
The study was approved by the bioethics review commit-
tee of the Nagoya University Graduate School of Economics.
As a result, the 111 items were organized into two catego-
ries: working environment and personnel support. Atotal of
29 items, 15 in the working environment category and 14 in
the personnel support category, were compiled as proposed
scale items.
Because the research yielded basic scale items for measur-
ing personnel retention, it was concluded that a scale for per-
sonnel retention can be established by examining reliability
and validity with large-sample survey.
WHAT FEELINGS DO PEOPLE WANT TO FEEL WHEN
FUTURE TIME IS LIMITED?
D.Jiang1, H.H.Fung2, T.Sims3, J.L.Tsai3, 1. The Education
University of Hong Kong, Hong Kong, Hong Kong, 2.
Chinese University of Hong Kong, Hong Kong, Hong Kong,
3. Stanford University, Stanford, California
Socioemotional selectivity theory suggests that people pri-
oritize emotionally meaningful goals and are motivated to
experience their desired emotion, when they perceive future
time as more limited (e.g., at an advanced age). Then, what
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
affective states do people desire to feel when future time
is limited? The present research examined the relationship
between future time perspective and the affective states that
people ideally want to feel (ideal affect) using a combination
of survey, experience sampling, and experimental methods.
Two hundred Ninety-nine Hong Kong Chinese aged 18 to
80years (M=46.64years, SD=20.81years; 46% female) Y.Park, D.Z.Bliss, University of Minnesota, Minneapolis,
participated in the survey and 106 of them participated in
the experience-sampling study. Across two methods, we
found that people who perceived their future time as more
limited valued low-arousal positive states (e.g., calm and
peaceful) more than did people who perceived future time as
more expanded. Such finding was robust in both trait (from
the survey) and momentary (from the experience-sampling)
ideal affect. Then, we conducted an experiment among 258
Hong Kong Chinese aged 1880 years (M = 43.31 years, and Geobase databases (years 20072017) were searched for
SD=20.66years; 57% female), in which participants were
primed with either a limited future time perspective or an
expanded future time perspective. We found that participants
in the limited future time condition valued low arousal posi-
tive sates more and high arousal positive states (e.g., excited
and enthusiastic) less than did participants in the expanded
future time condition. These findings broaden our under-
standing of emotional goals in limited (vs. expanded) future
time perspective.
END-OF-LIFE DECISION MAKING FOR BLACK
OLDER ADULTS WITH DEMENTIA
K.Moss2, N.Deutsch1, P.Hollen1, K.Rose3, V.Rovnyak1, utilization [n=3].
I.C.Williams1, 1. University of Virginia, Charlottesville,
Virginia, 2. Case Western Reserve University, Cleveland,
Ohio, 3. University of Tennessee Knoxville, Knoxville,
Tennessee
Black older adults with dementia worldwide are at risk
of facing the end of life without advance care plans, leav-
ing family caregivers struggling to make life-altering, health-
related decisions on their behalf. The purpose of this study
was to examine surrogate end-of-life decision making for
Black older adults with dementia, including understanding
of end-of-life terminology, health-related quality of life, and
self-efficacy for surrogate decision making. A mixed meth-
ods approach was used for cross-sectional data collected
from Black caregivers of Black older adults with dementia
(N=65) in the United States. A subset of caregivers (n=18)
completed qualitative interviews. Data were analyzed using
content and thematic analyses, and statistical analyses of
health-related quality of life and self-efficacy. Most caregiv-
ers reported the existence of a formal end-of-life plan for
their care recipient. The term end of life was interpreted as
either healthcare received prior to death, such as cardio-
pulmonary resuscitation, funeral arrangements, or both.
Caregivers reported high levels of self-efficacy for themselves
and high levels of health-related quality of life for their care
recipients. However, neither measure was associated with the
existence of a formal care recipient end-of-life plan. Arela-
tionship existed between the presence of formal end-of-life
plans and care recipients age and number of comorbidities.
Study findings support a foundation for effective communi-
cation focused on meaning patients and families attach to
healthcare terminology. They provide a basis for education
and empowerment of Blacks caring for older adults with
IAGG 2017 World Congress
251
dementia internationally, and education of healthcare pro-
viders caring for them.
USE AND OPPORTUNITIES OF GEOGRAPHIC
INFORMATION SYSTEMS IN HEALTH RESEARCH
FOR OLDER ADULTS
Minnesota
Geographic Information Systems (GIS) enable examina-
tion of complex interactions of the environment and health.
GIS is a powerful tool for influencing health policy, surveil-
lance of infections, and investigating risks for diseases. The
purpose of this systematic review was to describe application
of GIS in health research for older adults aged 60+ and iden-
tify opportunities for future GPS use. Pubmed, Compendex,
studies using the terms older adults and GIS.
The search yielded 43 studies subsequently organized
by topic, GIS methods/measures, and region. Study topics
were in 5 areas: Influence of the built-neighorhood on health
behaviors (e.g., walking, diet, socialization [n=13 studies],
and on health status (self-rated health, mental health, frailty,
disability [n=8]); impact of environmental hazards on health
and disease risk [n=7]; and the measured activity space of
older adults neighborhoods [n=2]. Epidemiological analyses
focused on distribution of diseases/conditions (e.g., breast
cancer, chronic conditions, respiratory problems [n=8 stud-
ies]) or healthcare facilities [n=3], and patterns of healthcare
GIS methods/measures were GIS-derived measures (e.g.,
distance, density [n=13 studies]), geospatial analysis [n=16],
geocoded data [n=6], mapping [n=5], and global-positioning
systems [n=2]. Geographic regions were mainly urban areas
in US [n=17 studies], Europe [n=10], Asia/Pacific [n=10], and
North and South America [n=6].
There are numerous other health problems of older adults
(e.g., memory loss, heart disease, incontinence, infections)
and factors promoting well-being (e.g., safety, social center
locations) as well as issues of healthcare accessibility in rural
areas that may benefit from insights derived from GIS.
MAKING THE MOST OF MEALTIMES: WHO IS
PRESCRIBED MODIFIED TEXTURE FOODS IN
CANADIAN LONG-TERM CARE
V.Vucea1, H.H.Keller1,2, J.M.Morrison1, A.M.Duncan2,3,
L.Duizer2,3, C.Steele4,5, 1. University of Waterloo,
Waterloo, Ontario, Canada, 2. Schlegel-University of
Waterloo, Research Institute for Aging, Waterloo, Ontario,
Canada, 3. University of Guelph, Guelph, Ontario, Canada,
4. Toronto Rehabilitation InstituteUniversity Health
Network, Toronto, Ontario, Canada, 5. University of
Toronto, Toronto, Ontario, Canada
Research suggests modified texture foods (MTFs) are
prevalent among older adults in long term care (LTC), but
characteristics of residents prescribed MTFs are sparsely
documented. Making the Most of Mealtimes (M3) is a cross-
sectional multi-site study with data from 32 LTC homes
in four Canadian provinces (AB, MB, NB, ON). This sec-
ondary data analysis applied standardized terminology
to examine the current prevalence of prescribed MTF and
resident characteristics associated with their prescription.
252
Resident characteristics were collected from health records
and standardized procedures. Homes used 67 different
terms to describe MTFs. Diets were re-categorized using
the International Dysphagia Diet Standardization Initiative
(IDDSI) Framework (pureed, minced, moist and soft/bite
sized textures). Bivariate analyses were performed. MTFs
were prescribed to 47% (n=298) of the M3 sample (n=639)
and significantly differed across provinces (p<0.0001).
Resident characteristics significantly associated with MTFs
included: longer length of admission; dysphagia and malnu-
trition risk; dementia diagnosis; fewer vitamins/mineral sup-
plements; prescription of oral nutritional supplementation;
lower body weight, body mass index, and calf circumference;
greater need of physical assistance; poor oral health status;
and more challenges with eating, activities of daily living and
impaired cognition. The prevalence of prescribed MTFs was
high and diverse across provinces in Canada and residents
on MTFs were more vulnerable than residents on regular
texture diets. These findings demonstrate the value of using
standardized terminology to inform policy and help identify
subgroups more likely to consume these diets. (Funded by
Canadian Institutes of Health Research).
WORKING LIFE EXPECTANCY WITH AND WITHOUT
DISABILITY AT AGE 55 IN THE NETHERLANDS,
GERMANY AND USA
M.van der Noordt1, T.Van Tilburg4, S.van der Pas1,
C.Tesch-Roemer3, C.F.Mendes de Leon2, D.J.Deeg1, 1.
VU University medical center, Amsterdam, Netherlands, 2.
University of Michigan, Ann Arbor, Michigan, 3. German
Centre of Gerontology (DZA), Berlin, Germany, 4. VU
University, Amsterdam, Netherlands
Due to population aging, many countries are reforming
their policies by abolishing early retirement routes and rais-
ing statutory retirement ages. As health deteriorates with age,
many older workers may experience that health limits their
workability. The necessity to continue working may depend
on the flexibility and generosity of a national pension sys-
tem. Flexibility refers to early retirement opportunities and
their entitlement conditions, and generosity to the post-
retirement income as percentage of pre-retirement income.
This study compares working life expectancies at age 55
(WLE55) with and without disability across countries dif-
fering in pension system. Three countries were selected with
decreasing flexibility and generosity: Netherlands, Germany,
and United States, using data from the Longitudinal Aging
Study Amsterdam (LASA), German Aging Study (DEAS)
and the Health and Retirement Study (HRS), respectively.
Participants aged 5565years at baseline (2002) with a paid
job were selected and followed up to 2012/2014 (n=385,
n=273 and n=2335, respectively). Two health states were
distinguished based on difficulty climbing stairs: with and
without disability. WLEs were estimated using the MSM
and ELECT packages in R.In the Netherlands, total WLE55
was 5.3years of which 0.6 with disability. In Germany, total
WLE55 was 4.6 years of which 1.1 with disability. In the
US, total WLE55 was 7.4years of which 2.4 with disability.
Flexibility and generosity seem to affect the number of work-
ing years of older adults both in total and with disability.
Governments should be aware that disabled workers need
special attention regarding their work environment.
Innovation in Aging, 2017, Vol. 1, No. S1
FRAGMENTATION OF PHYSICAL ACTIVITY IS
STRONGLY ASSOCIATED WITH GAIT SPEED AND
FATIGABILITY
P.Kuo1, V.Zipunnikov1, J.Di1, A.A.Wanigatunga1,
E.M.Simonsick2, S.A.Studenski2, L.Ferrucci2, J.Schrack1,
1. Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, 2. National Institute on Aging,
Baltimore, Maryland
Low daily physical activity has been linked to poor health
and functional performance with aging. However, the health
implications of the daily patterns/temporal accumulation
of physical activity remain unknown. We created an activ-
ity fragmentation index (AFI) to account for the number
and duration of daily active bouts using 7-day accelerom-
etry data from the Baltimore Longitudinal Study of Aging
(n=734, mean age 67.813.2years, 50% female). Minute-
epoch activity counts were dichotomized into active or sed-
entary states, and summarized according to the distribution
of active bout durations. AFI was calculated as the recipro-
cal of the average duration of the active bouts. Total daily
volume of physical activity was summarized using total
log-transformed activity counts (TLAC). Using multiple lin-
ear regression models adjusted for age, sex, height, weight,
TLAC, and disease conditions, AFI was negatively associated
with gait speed ( = -0.06 m/s, p < 0.004), and positively
associated with laboratory assessments of high fatigability
(p < 0.001). TLAC was a significant predictor of gait speed
and fatigability until AFI was added to the model, suggest-
ing that the duration and number of active bouts throughout
the day mediates the associations among TLAC, gait speed,
and fatigability. Together, these results imply that accounting
for fragmented daily physical activity may be more impor-
tant than total volume of physical activity when assessing
functional performance in older adults. Further research is
needed to validate this measure and determine the longitu-
dinal value of activity fragmentation in predicting adverse
outcomes in older adults.
NURSING HOME RESIDENTS NARRATIVES OF
THEIR INTERPERSONAL RELATIONSHIPS
B.Kang1, E.S.McConnell1,3, K.Scales1,2, Y.Song1,
M.Lepore4, K.N.Corazzini1, 1. Duke University School
of Nursing, Durham, North Carolina, 2. Duke University
Center for the Study of Aging and Human Development,
Durham, North Carolina, 3. Durham Veterans Affairs
Medical Center, Durham, North Carolina, 4. RTI
International, Atlanta, Georgia
The cultivation of interpersonal relationships is central
to promoting quality of life in nursing homes (NHs), as it
is through these relationships that residents, family mem-
bers and staff come to be valued as unique persons and are
empowered as partners in care (Owen & Meyer, 2012).
Beyond the care provider-recipient relationship, little research
has considered the broader network of relationships experi-
enced by residents. This study aims to explore residents per-
spectives regarding the meaning of their relationships with
co-residents, families, and staff in NHs. We analyzed indi-
vidual and group interviews with residents (N=12 sessions;
N=12 participants) from two NHs in North Carolina, which
were conducted as part of a larger study on person-directed
care planning. Informed by narrative inquiry (Jovchelovitch
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
& Bauer, 2000), the analysis explored various interpersonal
relationships and their context through each residents nar-
ration, using a two-cycle coding approach (Saldaa, 2012).
Three consistent themes emerged: (i) residents perceived
interpersonal relationships as supporting their needs, includ-
ing the need to feel connected, respected, and supported; (ii)
when residents needs were met through relationships, it led
to positive outcomes perceived by residents, such as feeling
significant and capable; and (iii) when residents needs were
not attained in particular relationships, it led to negative
outcomes including feelings of being neglected, isolated, and
helpless. The importance of the findings about interpersonal
relationships is discussed in relation to appreciative inquiry
(Cooperrider etal., 2003), a strengths-focused approach for
helping NH residents, families, and staff co-create personally
meaningful living and working environments.
POSTURAL STABILITY AND FALLS RISK IN
THE ELDERLY IN BIODEX BALANCE SYSTEM:
ARELIABILITY STUDY
P.Garcia1, P.G.de Oliveira1, J.F.da Silva1, A.S.Abreu1,
L.P.Paz1, L.L.Martini2, 1. Physical Therapy, University of
Brasilia, Braslia, Distrito Federal, Brazil, 2. Secretary of
State for Health of the Federal District, Braslia, Distritro
Federal, Brazil
Background: The Biodex Balance System (BBS) platform is
an important tool for assessing postural stability and risk of
falls in the elderly. The objective of this study was to evaluate
the inter-rater and test-retest reliability of the postural stability
measures and the agreement of the identification of the risk of
falling of the elderly in BBS. Methods: methodological study
approved by ethics committee (n=34 elderly). The elderly were
assessed in the Falls Risk (FR) and Postural Stability (PS) pro-
tocols. The platform was unstable in the FR (level 6-2, three
repetitions of 20s). The stability was evaluated with and with-
out visual feedback and with closed eyes in the PS (level 4, a
repetition of 20s for each visual condition, unstable and stable
platform). The elderly were assessed in two days. On the first
day two evaluators assessed for inter-rater reliability and con-
cordance study. One of the examiners re-evaluated the elderly
after nearly one week to study test-retest reliability and agree-
ment. Results: The FR measurements of the two evaluators
were significantly different. The inter-rater interclasscorrelation
coefficient (ICC) ranged from 0.48 to 0.71: very good reliability
with unstable surface and good to very good reliability with
stable surface. The ICC test-retest ranged from 0.64 to 0.91,
featuring very good to excellent reliability. Moderate test-retest
agreement (Kappa=0.529, p=0.002) and poor inter-rater agree-
ment (Kappa=0,368, p=0,013) were found. Conclusions: the
measures of postural stability and risk of falls in the elderly in
BBS are reliable. Familiarization with the instrument may have
improved retest performance evaluations.
THE ASSOCIATION OF CHILDHOOD
SOCIOECONOMIC DISADVANTAGE WITH
COGNITIVE IMPAIRMENT IN OLDER JAPANESE
M.Sugiyama1, H.Murayama2,1, H.Inagaki1, C.Ura1,
F.Miyamae1, A.Edahiro1, T.Okamura2,1, S.Awata1, 1.
Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan,
2. The University of Tokyo, Tokyo, Japan
IAGG 2017 World Congress
253
Background: Early prevention strategies for cognitive
decline have been proposed, but there is sparse evidence
regarding whether socioeconomic disadvantages in child-
hood are related to cognitive decline in old age. This study
examined the association between childhood socioeconomic
status (SES) and cognitive impairment among older Japanese.
Methods: In 2015, a cross-sectional questionnaire sur-
vey was conducted for all residents aged 65+ in a ward
of the Tokyo metropolitan area (n=132,005). Cognitive
impairment was assessed with a self-administered dementia
checklist. This consisted of 10 items (ranging 1040), and
its validity and reliability were confirmed. The cut-off point
for indication of dementia was 17/18; a score of 18+ indi-
cated cognitive impairment. Childhood SES was determined
with a single item consisting of five categories (high, middle-
high, middle, middle-low, and low). Because the proportion
of responses in the high category was small, we combined
the high and middle-high categories into a single category in
the analysis. Covariates included demographics, adult SES,
health behaviors, health conditions, and body height.
Results: A total of 75,358 questionnaires were received
and analyzed (response rate: 57.1%). Logistic regression
analysis showed that middle-low and low childhood SES
were associated with cognitive impairment, compared to
middle-high/high childhood SES (odds ratio [95% confidence
interval]: 1.14 [1.001.30] for middle-low; 1.23 [1.061.43]
for low), after adjusting for covariates.
Conclusions: Socioeconomic disadvantage in early life
was associated with cognitive impairment in later life. This
suggests the importance of upstream approaches in child-
hood to aid in prevention of cognitive decline.
STRUCTURAL STUDIES OF ATASE1 AND ATASE2:
NOVEL TARGETS FOR ALZHEIMERS DISEASE AND
AGING
M.A.Farrugia1, Y.Ding2, M.Feig3, L.Puglielli1, 1. Medicine,
University of Wisconsin-Madison, Madison, Wisconsin,
2. Eli Lilly, Indianapolis, Indiana, 3. Michigan State
University, East Lansing, Michigan
The endoplasmic reticulum (ER) acetylation machinery
includes AT-1/SLC33A1, a membrane transporter that trans-
fers acetyl-CoA from the cytosol into the ER lumen, and
ATase1 and ATase2, two ER-based N-lysine acetyltrans-
ferases. Mutations, genetic duplications, and increased gene
dosage affecting the ER-based acetylation machinery have
been associated with a familial form of spastic paraplegia,
developmental delay and premature death, autism spectrum
disorder with intellectual disability and progeria-like features,
and late-onset Alzheimers disease (AD). Importantly, AT-1/
SLC33A1 is upregulated in p44+/+ mice, a mouse model of
progeria, and mice overexpressing AT-1/SLC33A1 display a
progeria-like phenotype. Finally, genetic or biochemical inhi-
bition of the ER acetylation machinery can rescue AD in the
mouse. At the mechanistic level, the ER acetylation machin-
ery has been linked to maintenance of protein homeostasis
within the secretory pathway. As such, ATase1 and ATase2 are
currently active targets for therapeutics. Here, we used struc-
tural biochemistry and site-directed mutagenesis approaches
to identify essential features of the enzymes, including the
acetyl-CoA and the peptidyl-lysine binding pockets. We also
explored the likely binding orientations of 31 inhibitors
254
known to affect ATase activity in vitro. Computational dock-
ing of the compounds using AutodockVINA identified 9
inhibitors with strong (< -8 kcal/mol) binding and binding
pockets which differ between ATase1 and ATase2 in both
overall area and residues predicted to be involved in docking.
Varied concentrations of these compounds were used to treat
H4 neuroglioma cells to observe their effect on autophagy
and using electron microscopy and Western blot analysis of
known autophagic markers.
A DECISION SUPPORT APP FOR REGISTERED
NURSES TO FACILITATE AGING IN PLACE OF
PEOPLE WITH DEMENTIA
T.Thoma-Luerken2, M.H.Bleijlevens2, M.A.Lexis1,
J.Hamers2, 1. Zuyd University of Applied Sciences,
Research Centre Technology in Care, Heerlen, Netherlands,
2. Maastricht University, School for Public Health and
Primary Care (CAPHRI), Department of Health Services
Research, Living Lab on Aging and Long-term Care,
Maastricht, Netherlands
Registered nurses (RNs) play an important role in detect-
ing practical problems of persons with dementia and advis-
ing them on (technological) solutions to facilitate aging in
place. Both are challenging tasks knowing that detecting
problems of persons with dementia is very complex and that
the availability of new (technological) aids is rapidly grow-
ing. Therefore, in co-creation with RNs a decision support
app was developed to improve nurses decision-making
and to increase their confidence. The present study aims to
assess the usability of this app and to evaluate its potential
to increase nurses confidence in problem assessment and
advices on solutions. The usability was tested in three itera-
tive rounds by the project team (n=4), technology experts
(n=6) and district RNs (n=9) using heuristic evaluation, a
think aloud approach and the Post Study System Usability
Questionnaire. Subsequently, written cases have been ana-
lyzed with and without the app by RNs. The nurses level of
confidence in problem assessment and advices on solutions
has been assessed on 10-cm VAS-scales. The participants
valued the app as very usable instrument. Tester feedback
resulted in improvements regarding system responses and
interface related problems. The study indicated that the app
has the potential to increase nurses confidence in problem
assessment (mean scores app-users 8.9 versus 7.1 non-users)
and advices on solutions (mean scores app-users 9.5 versus
6.8 non-users). To conclude, a usable decision support app
is available for clinical practice now. However, its effects
should be evaluated in a large sample of RNs, which will be
the next step.
COGNITIVE IMPAIRMENT IN KOREAN OLDER
ADULTS WITH RHEUMATOID ARTHRITIS
S.Shin1, J.Lee2, B.Yoon2, 1. Inje University, Busan, Korea
(the Republic of), 2. Inje University Ilsan Paik Hospital,
Busan, Korea (the Republic of)
Purpose: This study explored the prevalence of cognitive
impairment in Korean older adults with rheumatoid arthritis
(RA) using a set of computerized neurocognitive tests and
the factors that were significantly correlated with cognitive
impairment.
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: Individuals with RA were recruited by their
rheumatologists during follow-up visits at one university
hospital. Cognitive function was assessed using a set of 6
computerized neurocognitive tests yielding 18 indices cover-
ing a range of cognitive domains. Subjects were classified as
impaired if they performed 1 SD below age-based popula-
tion norms on each test. The total cognitive impairment score
was calculated by summing the transformed scores. Pearson
correlation coefficient analyses were conducted to identify
the variables that might be significantly associated with cog-
nitive impairment.
Results: Fifty four subjects with a mean (SD) age of
63.6 (10.5) years were included in the final analyses. 85%
were female and 87% were married. Mean total cognitive
impairment score was 11.1 (4.1, range=218). 92% were
classified as cognitively impaired on five or more test indices.
The proportion of persons who were classified as cognitively
impaired on each test were 37% in executive function, 67%
in visuo-motor coordination, 72% in language memory,
85% in visuo-spatial memory, 85% in continuous attention,
and 92% in selective attention. Education (r=-558, p<.001),
income (r=-.491, p<.001), CVD risk factors (r=.445, p=.006),
and functional limitations (r=-322, p=.024) were significantly
correlated with total cognitive impairment score.
Conclusion: The burden of cognitive impairment in RA is
significant. Future studies identifying specific etiological con-
tributors to cognitive impairment are warranted.
ASSESSING FAMILY CARE CONFERENCES IN LONG-
TERM CARE: LESSONS LEARNED FROM CONTENT
ANALYSIS
P.M.Durepos1,2, S.Kaasalainen1, S.Tamara3, J.Ploeg1,
D.Parker5, K.Brazil4, A.Papaioannou1,2, 1. McMaster
Universtiy, Hamilton, Ontario, Canada, 2. Hamilton Health
Sciences Corporation, Hamilton, Ontario, Canada, 3.
McGill University, Montreal, Quebec, Canada, 4. Queens
University, Belfast, Ireland, 5. University of Technology
Sydney, Sydney, Ontario, Canada
End-of-life (EOL) communication in long-term care (LTC)
is often inadequate and delayed, leaving residents dying with
unknown preferences or goals of care. Poor communica-
tion with staff contributes to families feeling unprepared,
distressed and unsatisfied negatively effecting bereavement.
Family Care Conferences (FCC) aim to increase structured,
systematic communication around goals and plans for EOL.
FCCs were implemented as part of the Strengthening a
Palliative Approach to Care (SPA-LTC) project in four LTC
sites in Ontario, Canada. The purpose of this sub-study is
to evaluate: a) content, b) processes, and c) interdisciplinary
engagement using mixed methods. Twenty-four FCCs were
held for residents with a Palliative Performance Scale of
40% (nearing death) considered appropriate by staff. Data
was collected from FCC forms (i.e., Family Questionnaires,
Conference Summaries) and electronic charts. Through
directed-analysis, data was analyzed using the Canadian
Hospice Palliative Care Associations Square of Care model
which includes eight domains of care: Disease Management,
Physical, Psychological, Social, Practical, Spiritual, EOL, and
Loss/Bereavement.
Findings showed on average each FCC documented 66%
of domains with physical and EOL care domains being used
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
the most, and content about loss/bereavement documented
the least. Use of FCC hard copy forms had benefits over
standard electronic charts including: higher proportion of
goals, timely completion, category for end-of-life care and
accessibility. FCCs were attended by an average of three
disciplines prompting holistic content although Personal
Support Workers (PSW) and physicians attended minimally.
Implications to optimize FCCs include tailoring use of
FCCs forms, prompting bereavement discussion, furthering
engagement of PSWs and physicians.
GENETIC ASSOCIATION OF THE ABCC9 GENE
WITH HIPPOCAMPAL SCLEROSIS OF AGING
NEUROPATHOLOGY
Y.Katsumata1, P.T.Nelson2,3, S.R.Ellingson4, D.W.Fardo1,3, (ADL), and instrumental-ADL. We found that a better health
1. Department of Biostatistics, University of Kentucky,
Lexington, Kentucky, 2. Department of Pathology,
University of Kentucky, Lexington, Kentucky, 3. Sanders-
Brown Center on Aging, University of Kentucky, Lexington,
Kentucky, 4. Division of Biomedical Informatics, University
of Kentucky, Lexington, Kentucky
Hippocampal sclerosis of aging (HS-Aging) is a common
neurodegenerative condition associated with dementia. To
learn more about genetic risk of HS-Aging pathology, we
tested gene-based associations of the ABCC9 gene, which
was reported to be associated with HS-Aging pathology
in previous studies. Genetic data were obtained from the
Alzheimers Disease Genetics Consortium (ADGC), linked
to autopsy-derived neuropathological outcomes from the
National Alzheimers Coordinating Center (NACC). Of
3,730 subjects with both genotype and autopsy information
available to us, those who died at age 60years or older were
included in this study. After applying inclusion/exclusion cri-
teria and quality control filtering, data from 3,251 partici-
pants of European ancestry were used in the analyses. Of the
3,251 subjects included in the study, 271 (8.3%) were identi-
fied as a HS-Aging case. The ABCC9 gene was significantly
associated with HS-Aging when assuming a recessive mode
of inheritance. For sensitivity analysis, we confirmed the
same results even in people aged 80years or older at death.
The significant gene-based association between ABCC9 and
HS-Aging appeared to be driven by a region in which sig-
nificant haplotype-based associations were found. We further
tested the haplotypes as an expression quantitative trait locus
(eQTL) using two different public-access brain gene expres-
sion databases. The HS-Aging pathology protective ABCC9
haplotype was associated with decreased ABCC9 expression,
and the results were consistent in two independent datasets.
The gain-of-function haplotype in the ABCC9 gene was pro-
tective for HS-Aging in older people.
A PERSON-CENTERED APPROACH TO PREDICTING
THE USE OF MEDICAL CARE AND SOCIAL SERVICES
IN OLDER ADULTS
G.Santoni1, A.Caldern-Larraaga1,4, A.Marengoni2,1, lack of current theories or models properly fitting or guid-
A.Wimo3, L.Fratiglioni1,5, 1. Aging Research Center (ARC),
Karolinska Institutet, Stockholm, Sweden, 2. University of
Brescia, Brescia, Italy, 3. Karolinska Institutet, Stockholm,
Sweden, 4. Aragon Health Sciences Institute, Aragon, Spain,
5. Stockholm Gerontology Research Cente, Stockholm,
Sweden
IAGG 2017 World Congress
255
As health and health changes in older adults are char-
acterized by great heterogeneity, their needs and demand
for health care also vary widely. Thus, a more personalized
characterization of the care needs of older people is required
to inform policy makers and to provide stakeholders with
more reliable healthcare management tools. The aim of this
study was to determine whether the prediction of the use
of medical care and social services is improved by looking
at a multidimensional health index rather than at individual
health indicators separately. The multidimensional Health
Assessment Tool (HAT) comprehensively appraises health
and functioning in community-dwelling older adults by
integrating five clinical indicators: multimorbidity, physi-
cal function, cognitive status, basic-activities of daily living
status, hence higher values of HAT, was associated with a
lower number of both current (same year of assessment) and
future (within 3-years after assessment) hospital admissions,
hospital days, and hours/month of formal and informal care,
following a clear dose-response trend. The association was
less straightforward with current/future number of specialist
visits and future number of primary care visits. The ability
to predict any of the six health outcomes was significantly
greater for the HAT than for disability and/or multimorbid-
ity alone, with the exception of specialist visits which showed
higher correlation with multimorbidity. In conclusion, our
multidimensional index optimally predicts use of medical
and social care by considering not only the chronic diseases
older people suffer from, but how these interact and impact
on functioning.
IS THEORY UTILIZATION LESSENING? AN ANALYSIS
OF THEORIES IN PSYCHOLOGICAL GERONTOLOGY
RESEARCH
N.Cone2, M.Heinz1, 1. Upper Iowa University, Fayette,
Iowa, 2. Loras College, Dubuque, Iowa
This study examined which theoretical frameworks and
models were most prevalent in the Journal of Gerontology,
Psychological Sciences through a content analysis of the arti-
cles published between years January 2012 to November
2016. Two hundred and seventy-three articles where exam-
ined and 152 articles included a theoretical or model frame-
work. Although some researchers included a framework,
not all researchers fully used a theory or model as a basis
for their research. For example, some articles only briefly
mentioned a theory in the discussion section of the paper.
Of those 152 articles, 98 incorporated theory substantially,
whereas 54 articles only mentioned theory briefly. With com-
bined results, the most frequently cited or used theory was
Socioemotional Selectivity theory (n=33). This was followed
by the Five-Factor Model (Big Five Personality; n=9) and
Selection, Optimization, and Compensation theory (n = 7).
Interestingly, 162 of the articles did not specifically present
a model or theoretical framework. This might signify a
ing the research. However, other factors may have impacted
the results. Circumstances such as a large focus on biologi-
cal research and/or a special addition specifically focused
on widowhood. These initial findings give the gerontologi-
cal community a critical look at how theory and models
shape gerontological research and current/future directions
256
of examination. Further research and examination of theo-
retical and/or model framework usage amongst gerontology
research will help determine the validity of these results.
METABOLIC CROSS-TALK BETWEEN ER,
MITOCHONDRIA, AND NUCLEUS: POSSIBLE IMPACT
IN AGING
I.A.Dieterich, Q.Yu, K.Overmyer, J.Coon, L.Li, with a stronger association for women after adjusting for
L.Puglielli, Neuroscience Training Program, University of
Wisconsin, Madison, Madison, Wisconsin
N-lysine acetylation in the lumen of the endoplasmic
reticulum (ER) regulates quality control and proteostasis
within the secretory pathway. Mechanistically, it has been
established that the import of acetyl-CoA into the ER lumen
by the membrane transporter AT-1/SLC33A1 is an essential
biochemical component of the ER acetylation machinery.
Homozygous mutations in AT-1 are associated with devel-
opmental delay and childhood death while heterozygous
mutations are associated with a familial form of spastic
paraplegia. Finally, gene duplications of AT-1/SLC33A1 have
been identified in patients with autistic-like features, intel-
lectual disability and dysmorphic features that are consist-
ent with a diagnosis of segmental progeria. Neuron-specific
overexpression of AT-1 in the mouse leads to an autistic-like
phenotype while systemic overexpression leads to a progeria-
like phenotype that mimics an accelerated form of aging.
While dissecting the phenotype of these mice, we discovered
the influx of acetyl-CoA into the ER causes epigenetic and
mitochondria adaptation. In light of the strong relationship
between mitochondria biology and TCA engagement with
aging and several age-associated diseases, we decided to use
a combination of proteomic and metabolomic approaches
to dissect the biochemical and molecular mechanisms that
mediate the metabolic and functional adaptation of the mito-
chondria in the above progeria-like animals. These studies
were paralleled by ex vivo genetic approaches to identify
novel key regulatory elements. The results show that ACLY,
SLC13A5 and SLC25A1 are essential in maintaining acetyl-
CoA flux within the cell and a functional cross-talk between
the ER and the mitochondria.
CHILDHOOD DISADVANTAGE AND METABOLIC
SYNDROME: AN EXAMINATION OF GENDER AND
HEALTHY LIFESTYLES
C.Lee1, V.Tsenkova1, J.Boylan2, C.D.Ryff1, 1. University plasma differential proteomes between normal adults (n=20)
of Wisconsin-Madison, Madison, Wisconsin, 2. University
of Colorado-Denver, Denver, Colorado
Objectives: We investigate (a) the extent to which healthy
lifestyles (physical activity and diet) explain the association
between childhood disadvantage and metabolic syndrome
(MetS) in midlife, and (b) whether there are gender differ-
ences in the associations.
Methods: Data on 1,054 respondents came from the
Biomarker Subsample of the Midlife in the U.S. Study.
Childhood disadvantage was measured with four indica-
tors: parental education, parental occupational prestige,
financial level growing up, and welfare status. MetS is the
total number of MetS symptoms defined by the National
Cholesterol Education Program. Physically intense activities
(> 500 metabolic equivalent minutes per week) were catego-
rized into three domains: leisure, work, and chores. Food
Innovation in Aging, 2017, Vol. 1, No. S1
consumption consists of two domains: healthy foods (fruits/
vegetables, whole grains, fish, lean meat, non-meat protein)
and unhealthy foods (sugary beverages, fast food, high-fat
meat).
Results: After adjusting for life course confounding fac-
tors, individuals who were disadvantaged in childhood are
less likely to participate in physically intense leisure activities
adult SES. The association between childhood disadvantage
and diet, however, appears stronger for men. Compared to
advantaged men, those who were disadvantaged in child-
hood tend to consume more unhealthy food. In the asso-
ciation between childhood disadvantage and MetS, leisure
activity is a significant mediator for women; unhealthy food
consumption is a significant mediator for men.
Conclusions: Disadvantages in early life shape healthy
lifestyles in adulthood. Life-course perspectives and gender-
specific approaches are important for behavioral interven-
tions to improve the cardiometabolic health of adults.
EFFECTS OF TAI CHI CHUAN ON IMMUNE AND
INFLAMMATORY MAKERS OF ELDERS WITH AND
WITHOUT DIABETES
K.Yang1,2, W. Chang3, H.Chuang3, S.Yeh2, 1. Mackay
Memorial Hospital, Taipei, Taiwan, 2. Mackay Medical
College, New Taipei City, Taiwan, 3. Kaohsiung Chang
Gung Memorial Hospital, Kaohsiung, Taiwan, Taiwan
Background: We have previously shown that moder-
ate exercise of Tai Chi Chuan exercise could increase
complement factor H with a decrease of factor B as a pro-
teomic biomarker of Tai Chi Chuan exercise (Clin Chem.
2010;56:12731.), and diabetic patients with different
complications have varied proteomic markers (J Diabetes
Metab Disord. 2016;15:24.). This study has further ana-
lyzed whether a 12-week program of Tai Chi Chuan exer-
cise improves the inflammatory markers of type 2 diabetes
mellitus (T2DM) patients in comparison to aged matched
normal elders.
Methods: Plasma low abundance proteins were enriched
by depletion of 14 high abundance proteins by an affinity
removal system, and subjected to nanoflow liquid chroma-
tography electrospray ionization (nano LC-ESI) mass spec-
trometry after a gel electrophoresis with in-gel digestion
for 8 pairs of plasma from normal elders and T2DM. The
and diabetic patients (n= 24)before and after a 12-week Tai
Chi Chuan exercise were validated by enzyme-linked immu-
noassay (ELISA).
Results: Atotal of 826 proteins in plasma were consist-
ently identified from 8 plasma samples of normal adults,
and 817 were consistently identified in 8 plasma samples of
T2DM patients. Using the MetaCore analysis, we found the
low abundance proteins in plasma between normal adults
and T2DM patients were significantly different in 5 func-
tional pathways. We next selected the 6 proteins (DPP4,
PIP, NGAL, L1CAM, THBS2, and GLP1) associated with
metabolism or inflammation for validation by enzyme-linked
immunoassay. We found that PIP, THBS2, L1CAM and
NGAL levels were significantly (p<0.013, Bonferroni correc-
tion adjust) higher in T2DM patients than in normal adults.
Interestingly, Tai Chi Chuan exercise significantly (p=0.04)
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
increased DPP4 levels in normal elders but not in diabetic
patients. The higher expression of PIP, THBS2, L1CAM and
NGAL inflammatory markers in T2DM were not signifi-
cantly reduced after Tai Chi Chuan exercise.
Conclusions: This study identified that Tai Chi Chuan
exercise could increase DPP4 levels in normal elders, but did
not significantly reduced inflammatory biomarkers in dia-
betic patients. Further studies to find another moderate exer-
cise for improvement of inflammatory markers of T2DM
patients are needed.
INTERNET-BASED INTERVENTIONS FOR
CAREGIVERS OF ASSISTIVE TECHNOLOGY USERS:
NEEDS AND PERCEPTIONS
D.Glinas Bronsard1,2, B.Mortenson3,4, S.Ahmed2,5,
C.Guay1,2, C.Auger1,2, 1. Rehabilitation, Universit de
Montral, Montral, Quebec, Canada, 2. Center for
Interdisciplinary Research in Rehabilitation of Greater
Montreal (CRIR), Montreal, Quebec, Canada, 3. University
of British-Columbia, Vancouver, British Columbia, Canada,
4. GF Strong Rehabilitation Center, Vancouver, British
Columbia, Canada, 5. McGill University, Montreal,
Quebec, Canada
Providing home-based care to older adults using assistive
technology (AT) (e.g. mobility aids, communication aids)
can be challenging for family caregivers. MOvIT-PLUS
is an Internet-based intervention aiming to offer remote
monitoring, support and training to dyads of family caregiv-
ers and older adults using AT in their daily lives. Using an
iterative user-centred design approach, 30 semi-structured
interviews were conducted with end-users and key inform-
ants to i) identify end-user needs through discussion about
past experiences with AT, and ii) explore end-users percep-
tions of a mock-up of MOvIT-PLUS. Amodified content
analysis approach was used to identify themes from a mix
of emerging and expected concepts. Results indicate AT
procurement is viewed as an ongoing cyclical process, with
potential unmet needs at key moments before and after AT
procurement. When expressing their preferences about the
MOvIT-PLUS mock-up, end-users and key informants
were generally supportive of automated monitoring calls
and asynchronous training features, such as skill-based video
bank. Moreover, end-users express their appreciation regard-
ing professional-led counselling and training features such
as videoconferences, but key informants had divergent opin-
ions. These results are guiding the MOvIT-PLUS prototype
design towards a graded support approach, starting with
empowering end-users to resolve AT-related challenges and
then adding professional support when needed. This study
highlights that Internet-based interventions dedicated to
family caregivers should consider concrete daily task chal-
lenges, ensure adequate follow-up and offer human support.
EDUCATIONAL LEADERS IN GERONTOLOGY:
INTRODUCING COMPETENCY-BASED
GERONTOLOGY EDUCATION IN KAZAKHSTAN
G.Yermakhanova1,2, K.Absattarova1,2, L.Waters1,
E.F.Ansello1, 1. Virginia Commonwealth University,
Richmond, Virginia, 2. National Center for Health
Development, Ministry of Health, Astana, Kazakhstan
IAGG 2017 World Congress
257
There are no courses in gerontology in Kazakhstan to train
its medical students; however, this is about to change. Two
Kazakh Scholars received 10-month internships at Virginia
Commonwealth University. As part of their internship, they
completed the 160-hour Faculty Development Program
(FDP) by the Virginia Geriatric Education Center. The FDP is
a case-themed, interprofessional curriculum grounded in evi-
dence-based practices, with objective competencies reflecting
the PHA; format is an in-person, monthly, interactive semi-
nar series designed to increase knowledge and competency in
interprofessional geriatrics and clinical care skills. To fulfill
requirements of the FDP, participants complete a curricu-
lum project inspired by FDP content. The Scholars designed
a teaching intervention and evaluation plan to address the
gap in gerontology education in Kazakhstan. Their project
led to a 90-hour, two-credit course on the foundations of
gerontology at Medical University that is about to be imple-
mented. The Scholars incorporated the AGHE Gerontology
Competencies for Undergraduate and Graduate Education
as a framework for the curriculum. The primary objective is
to introduce first-year medical students to the foundations
of gerontology. Students will be paired with older adults to
learn about the individuals experiences with health and the
healthcare system. The curriculum reflects not only the tra-
ditional bio-psycho-socio template but also content and
competencies on critical thinking, research, and problem
solving. The overall goal is to establish an effective means of
infusing geriatrics content into the medical school curricu-
lum, while positively affecting mentors and students atti-
tudes toward each other. Obstacles to implementation and
successful processes are critically examined.
DEVELOPMENT OF ARAT CLINICAL FRAILTY
INDEX
A.E.Kane, A.Yorke, C.Hancock Friesen, S.E.Howlett,
S.OBlenes, Pharmacology, Dalhousie University, Halifax,
Nova Scotia, Canada
There has been a recent focus on the development of pre-
clinical models of frailty in mice. A mouse clinical frailty
index (FI) was developed based on the concept that frailty
can be quantified as the accumulation of deficits in health,
as originally shown in humans. Rats are a commonly used
model for aging studies, so the current study aimed to
develop a FI that measures the accumulation of clinically-
evident health-related deficits in rats. Male Fischer 344
rats were aged from 6 to 9months (n=12), and from 13 to
21months (n=41). AFI comprised of 27 health-related defi-
cits was developed from a review of the literature and con-
sultation with a veterinarian. Deficits were scored 0 if absent,
0.5 if mild or 1 if severe. AFI score was determined for each
rat every 34 months, and for the older group mortality
was assessed up to 21months. Mean FI scores significantly
increased at each time point for the older rats (13months,
0.060.00; 17months, 0.130.01; 21months 0.210.01;
p<0.0001). The rate of deficit accumulation, and the maxi-
mum FI score (0.40) were similar to those observed in previ-
ous mouse and human FI studies. Ahigh FI score measured at
both 17months (p<0.0001) and 21months of age (p=0.007)
was also associated with decreased probability of survival as
assessed with Kaplan-Meier curves. The rat clinical FI has
258
significant value for use in aging and interventional studies,
and will contribute to translational research in this field.
MULTIMORBIDITY PATTERNS PROVIDE ADDED
PROGNOSTIC INFORMATION BEYOND FRAILTY
STATUS IN OLDER ADULTS
Q.Nguyen1, C.Wu4, M.Odden4, D.Kim2,3, 1. University
of Montreal, Montreal, Quebec, Canada, 2. Brigham and
Womens Hospital, Boston, Massachusetts, 3. Beth Israel
Deaconess Medical Center, Boston, Massachusetts, 4.
Oregon State University, Corvallis, Oregon
Assessing frailty is useful in measuring heterogeneity
of health status and predicting prognosis in older adults.
However, individuals in a given frailty state have diverse
multimorbidity patterns, some of which may portend
poorer prognosis. This retrospective cohort study aimed to
evaluate the impact of frailty and multimorbidity patterns
on mortality in 7197 community-dwelling older adults in
the National Health and Aging Trends Study 20112015.
Individuals were assessed for the Fried frailty phenotype and
10 chronic conditions in 2011. Latent class analysis uncov-
ered 5 multimorbidity patterns: minimal disease (n=1780),
cardiovascular disease (CVD) (n=2087), non-CVD (n=1968),
neuropsychiatric disease (n=641), and very sick (n=721).
Robust individuals had minimal disease (41.4%), CVD
(27.6%), or non-CVD (26.0%), whereas frail individuals
had CVD (24.7%), non-CVD (21.9%), neuropsychiatric
disease (22.7%), or very sick patterns (23.6%). During the
4-year period, the mortality risk was 6.6% for the robust
(n=147/2213), 15.4% for the pre-frail (n=561/3647), and
37.7% for the frail (n=504/1337). Within each frailty state,
the mortality varied substantially across the multimorbidity
patterns, with minimal disease being the lowest and neu-
ropsychiatric disease being the highest: 5.019.2% for the
robust, 12.525.3% for the pre-frail, and 27.755.6% for
the frail. Notably, compared with minimal disease, CVD
was significantly associated with increased mortality only
in robust and pre-frail individuals, not in frail individuals.
Neuropsychiatric disease and very sick patterns were signifi-
cantly associated with increased mortality only in pre-frail
and frail individuals. These findings underscore the impor-
tance of considering clinically meaningful multimorbidity
patterns in addition to frailty for better prognostication in
older adults.
DESCRIPTIVE COMPARISONS BETWEEN PATIENTS
WITH STROKE IN INPATIENT AND SKILLED
NURSING REHABILITATION
I.Hong, A.Karmarkar, W.Chan, C.Andersen, Y.Kuo,
K.J.Ottenbacher, J.S.Goodwin, T.Reistetter, Division
of Rehabilitation Sciences, University of Texas Medical
Branch, Galveston, Texas
Comparison of stroke rehabilitation outcomes across
post-acute care (PAC) settings has been questioned because
of the different patient and facility characteristics (i.e., func-
tional status or stroke comorbidities) across PAC settings.
Therefore, we explored differences in patient discharged to
inpatient (IRF) and skilled nursing (SNF) rehabilitation fol-
lowing an ischemic or hemorrhagic stroke. We conducted a
secondary analysis of data from the Centers for Medicare
and Medicaid Services (CMS). The study included those
Innovation in Aging, 2017, Vol. 1, No. S1
who sustained an ischemic or hemorrhagic stroke who were
discharged to inpatient or skilled nursing rehabilitation
from 2013 to 2014. Descriptive analyses were performed to
explore patient and hospital differences in discharges to IRF
and SNF. The final sample included 122,084 patients across
3,677 acute hospitals with 3,649 hospitals discharging indi-
viduals with an ischemic stroke compared to only 1,832
hospitals discharging patients with a hemorrhagic events.
Across the sample, 88.6% of patients had ischemic event
with 54.6% of patient being discharged to IRF. Patients
85 years and older were more likely to discharge to SNF.
Similarly, there were greater numbers of comorbid condi-
tions among those discharged to SNF. Comparison of self-
care and mobility across settings suggest that IRF patients
have higher functional abilities at admission to rehabilita-
tion. This study suggests considerable differences in acute
hospital discharge practices for ischemic and hemorrhagic
stroke patients who receive IRF and SNF rehabilitation.
Furthermore, these differences highlight the need for careful
consideration and matching of patient and facility charac-
teristics when comparing outcomes of care for post-acute
care rehabilitation.
PSYCHOTROPIC MEDICATIONS AND QUALITY OF
LIFE IN RESIDENTIAL AGED CARE FACILITIES
S.Harrison1,3, C.Bradley1,3, R.Milte1,3, E.Liu1,3,
L.Kouladjian ODonnell1,2, S.N.Hilmer1,2, M.Crotty1,3,
1. NHMRC Cognitive Decline Partnership Centre, Sydney,
New South Wales, Australia, 2. University of Sydney,
Sydney, New South Wales, Australia, 3. Flinders University,
Adelaide, South Australia, Australia
Recent clinical recommendations state that many psycho-
tropic medications should be avoided wherever possible in
people with cognitive impairment and dementia. Psychotropic
medications have been associated with increased risk of falls,
hospitalization, stroke and mortality in residents of aged
care facilities. The objective of this study was to examine
associations between psychotropic medications and quality
of life in older adults living in residential care facilities. The
population was from a cross-sectional study of 537 residents
from 17 different residential aged care facilities in Australia,
with a high prevalence of cognitive impairment and demen-
tia. Overall, 70.8% (n=380) of the population had been pre-
scribed/dispensed at least one psychotropic medication in the
100days prior to recruitment. Participants residing in facili-
ties which had adopted a person-centred, cottage model
of residential care had a lower prevalence of psychotropic
medications (OR (95% CI): 0.26 (0.14, 0.52), p<0.001). An
increased number of psychotropic medications were asso-
ciated with poorer quality of life according to DEMQOL-
Proxy-Utility scores ( (SE): -0.012 (0.006), p=0.03) and
EQ-5D-5L scores (-0.026 (0.011), p=0.02) after adjustment
for resident-level and facility-level characteristics. Analysis of
the individual classes of psychotropic medications showed
antipsychotics were associated with poorer DEMQOL-
Proxy-Utility scores (-0.030 (0.013), p=0.03) and benzodiaz-
epines were associated with poorer EQ-5D-5L scores (-0.062
(0.024), p=0.01). In conclusion, an increased number of
psychotropic medications were associated with poorer qual-
ity of life. These medications have many adverse effects and
the use of these medications should be re-examined when
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
investigating approaches to improve quality of life for older
people in residential care.
POSTMENOPAUSAL SEXUAL ACTIVITY: OLDER
MENS OPINIONS IN SOUTHWESTERN NIGERIA
O.C.Omobowale, Community Medicine, University of
Ibadan, Nigeria, Ibadan, Oyo State, Nigeria
Postmenopausal sexual activity is considered a taboo in
some Nigerian societies with existing information focused
on the women, the men often neglected. This study assessed
older mens perceptions of postmenopausal sexual activity.
A community based study was conducted among men
who are 60years and above in Southwestern Nigeria. Using
a Focus Group discussion guide, opinions of community
dwelling men on postmenopausal sexual activity and associ-
ated sociocultural beliefs were explored. Eight focus group
discussions were conducted in all and data were analyzed
thematically.
The mean age of the respondents was 64.03.6years. All
the respondents were married and most of them had no for-
mal education. The men listed the following socio-cultural
beliefs associated with post-menopausal sexual activity:
menopause makes a woman biologically manlike; sex after
menopause is evil, causes swollen abdomen due to accu-
mulated semen, makes one sick, indicates promiscuity and
women are less sexually attractive after menopause. More
than half of the respondents agreed with at least one of the
socio-cultural beliefs. The majority were of the opinion that
menopause marked cessation of sexual activity and many of
the physical changes seen in old age including body weak-
ness, urinary incontinence and loss of sight were ascribed
to post-menopausal sexual activity. More than 70% of the
discussants had stopped having sex and were of the opin-
ion that post-menopausal sexual activity can cause chronic
abdominal pain for women, semen contamination and
weakness of manhood for men (erectile dysfunction). I
would rather take another younger wife, than risk being
impotent for life
Sociocultural beliefs adversely affected postmenopausal
sexual activity among these men, which has implications
on the men seeking alternative sexual partners with the
attendant problems of sexually transmitted infections /HIV.
Educational interventions targeted at changing these errone-
ous beliefs should be developed and implemented.
YOUNG ADULTS CONCERNS AND COPING
STRATEGIES REGARDING INTERACTIONS WITH
GRANDPARENTS WITH DEMENTIA
A.R.Ebert, A.M.Miron, A.E.Thompson, S.H.McFadden,
University of Wisconsin Oshkosh, Appleton, Wisconsin
Concerns and coping strategies related to face-to-face
interactions between young adults and their grandparents/
great-grandparents with dementia were explored through
the lens of a solidarity-versus-conflict conceptual frame-
work. Participants indicated concerns about their inability
to maintain the relational connection, not knowing what
to say or how to behave, their lack of perspective-taking
skills and emotion-regulation strategies, interacting with
an ever-changing other, as well as concerns about other co-
participants in the interaction. Participants coping strategies
were classified along two interaction dimensions: solidarity
IAGG 2017 World Congress
259
(e.g., desire to maintain and improve the interaction with
the grandparent by seeking the others company, loving the
other, and maintaining and celebrating the others human-
ity/personhood) and conflict (e.g., dealing with self-focused
concerns and the lack of skills and knowledge by engaging
in substitute avenues for communication and using emotion-
regulation strategies to reduce negative affect). Reducing
grandchildrens self-focused interaction concerns could lead
to more meaningful interactions in which focus is switched
from the grandchilds concerns about their own interaction
competence to concerns about the grandparents wellbeing.
PREVENTING READMISSIONS AND INCIDENT
DELIRIUM IN ELDERLY (PRIDE) PROGRAM
G.Gnanasekaran1,2, S.Gravenstein1,2, B.Idemoto1,
M.Singh1,2, C.Liu2, 1. University Hospitals of Cleveland,
Cleveland, Ohio, 2. Case Western Reserve University,
Cleveland, Ohio
Low cost intervention hospital based care models can
reduce length of stay and decrease readmission rates of elderly
patients, while improving patient care quality. Programs like
Hospitalized Elder Life Program (HELP) and Coleman Care
Transition Intervention (CTI) have independently dem-
onstrated better patient outcomes. Collectively, programs
that improve outcomes do better with a comprehensive
approach in primary prevention of delirium and providing
safe transition of care. PRIDE (Preventing Readmissions and
Incident Delirium in Elderly), a Quality Improvement (QI)
initiative derives its program themes from the Hospitalized
Elder Life Program (HELP) and Coleman Care Transition
Intervention to prevent delirium and provide safe care
transitions for elderly hospitalized patients. An electronic
dashboard identifies elderly patients admitted at a large aca-
demic hospital at risk for delirium and readmissions. Two
fold interventions are then provided. Delirium Prevention:
Trained volunteers cognitively and functionally engage
patients in structured activities adapted from HELP. Improve
Care Transitions: APatient Centered Health record (PRIDE
Journal) empowers patients with self- management tools to
raise awareness on functional independence and medica-
tion self-management on discharge. Preliminary data shows
improved outcome with reduced LOS (5.8days vs 7.7days,
N=45), reduced readmission rates (9% vs 42 %, N= 45).
94% of patients endorsed improved self-management skills.
The program also demonstrates better staff satisfaction in
patient care. PRIDE program is able to demonstrate better
quality of care for a hospitalized elderly patient and improve
care transitions.
ESTABLISHING BIOLOGICAL PLAUSIBILITY FOR
COGNITIVE FRAILTY: SYSTEMATIC REVIEW
L.Sargent1,2,3, A.Starkweather4, S.Hobgood5,6,
H.Thompson7, M.Nalls2, A.Singleton2, E.J.Amella3, 1.
Virginia Commonwealth University School of Nursing,
Richmond, Virginia, 2. NIH/NIA Division of Neuroscience,
Bethesda, Maryland, 3. Medical University of South
Carolina School of Nursing, Charleston, North Carolina,
4. University of Connecticut School of Nursing, Storrs,
Connecticut, 5. Virginia Commonwealth University
Hospitial - VCU Health, Richmond, Virginia, 6. Virginia
Commonwealth School of Medicine, Richmond, Virginia,
260
7. NIH Library, Division of Library Services, Office of
Research Services, National Institutes of Health, Bethesda,
Maryland
On April 16th, 2013 the International Consensus
Group (I.A.A.A/I.A.G.G) formally defined the novel phe-
notype cognitive frailty; a condition characterized by the
co-occurrence of physical frailty and cognitive impairment.
We hypothesize that there are biological factors to describe
the interconnection between physical frailty and cognitive
impairment. This systematic review focuses on identifying
the shared measurable biological and genomic mechanisms
for physical frailty and cognitive decline. Two independent
reviewers assessed the eligibility of each report based on
predefined inclusion criteria to ensure interrater reliabil-
ity; a third reviewer resolved conflicting assessments. The
review was conducted using PubMed, Embase, Scopus,
Web of Science, LILACS, Gene Indexer, and GWAS Central.
Findings resulted in 1232 abstracts for full review, 335 arti-
cles were included in the final review. Data extraction iden-
tified a correlation between 14 distinct inflammatory and
protein markers with biomarker-related gene expression
for cognitive frailty. Meaningful findings were identified in
the relationship between key inflammatory (IL6, IL8, CRP,
and Fibrinogen, TNF-alpha, and homocysteine) and clini-
cal (gait, BMI, and anticholinergic medications) markers,
and cognitive frailty. The abstract presents the first findings
of the underlying biological characteristics for cognitive
frailty providing evidence for converging pathophysiologi-
cal pathways.
NATIVITY DIFFERENCES IN RECOVERY AND
DETERIORATION IN LATE-LIFE DISABLEMENT
R.Wang, Syracuse University, Syracuse, New York
The current older adult population in the United States
is not only one of the historically largest older adult popu-
lations, but one of the most racially and ethnically diverse,
in part due to the growing number of aging immigrants.
Despite sharing a racial or ethnic category, the lived expe-
riences of immigrants may diverge from their native born
counterparts. Moreover, with the greater prevalence of dis-
ability, it is critical to understand how older populations
move through the disablement process. Using longitudinal
panel data from the NHATS (2011) this research focuses on
nativity differences in recovery and deterioration in late-life
disablement between US-born and immigrant older adults
living in the US. This research uses hazard models to pro-
vide a more nuanced picture of immigrant and non-immi-
grant old adult disablement, using a multi-stage measure of
mobility and self-care disablement from NHATS. Results
indicate that nativity differences in both recovery and dete-
rioration in late-life disablement is mediated by early- and
mid-life socioeconomic contexts. Additional models suggest
that life course timing of migration shapes late-life disable-
ment among immigrant older adults in the US. Developing
greater knowledge on this process has implications on costs
and possibilities for earlier interventions and the delay of
more severe disability in later life for both US-born and
immigrant older adults in the US.
Innovation in Aging, 2017, Vol. 1, No. S1
SERUM SIRTUINS AS NOVEL PROTEIN MARKERS
FOR FRAILTY
S.Dey, A.Singh, N.Rai, S.Shekhar, A.B.Dey, Biophysics,
All India Institute of Medical Sciences, New Delhi, New
Delhi, India
Frailty has emerged as a major health issue among older
patients. The syndrome of frailty is a multi-organ dysfunc-
tion in sub-cellular level, affects older people and progresses
irreversibly if not intervened at very early stage. Sirtuins
(SIRT), a conserved family of NAD-dependent proteins,
is one of the many mimics of calorie restriction which
improves lifespan and health in experimental animals. In
this cross sectional study, association of serum sirtuin con-
centration was assessed in frail and non-frail older subjects
with an objective of examining it as a marker of frailty in
old age. Serum SIRT1, SIRT2, SIRT3, SIRT4, SIRT5, SIRT6
and SIRT7 were estimated by real time label free Surface
Plasmon Resonance (SPR) and Western Blot in 119 non-frail
and 81 frail individuals, diagnosed by Frieds criteria. Serum
SIRT level in MeanSD; SIRT1 (non-frail-4.67
0.48ng/
l; frail-3.720.48ng/l), SIRT2 (non-frail-15.182.94ng/
l;frail-14.192.66ng/l), SIRT3 (non-frail-7.721.84ng/
l; frail-6.120.97ng/l) SIRT5 (non-frail8.713.48ng/
L; frail7.253.13ng/L), SIRT6 (non-frail9.823.64ng/
L;frail8.363.33ng/L) and SIRT7 (non-frail19.263ng/
L;frail16.963.33ng/L) levels were significantly lower
among frail patients compared to the non frail. However,
SIRT4 was not significantly different between the groups. In
multivariable regression analysis, lower SIRT1 and SIRT3
level were significantly associated with frailty after adjusting
age, gender, diabetes mellitus, hypertension, cognitive status
(MMSE) and number of co-morbidities. For detecting the
optimum diagnostic cut-off value a ROC analysis was car-
ried out. The area under curve for SIRT1 was 0.9037 (cut-
off-4.29ng/l; sensitivity-81.48%; specificity-79.83%) and
SIRT3 was 0.7988 (cutoff-6.61ng/L; sensitivity-70.37%;
specificity-70.59%). The present study shows that lower cir-
culating SIRT1 and SIRT3 levels can be distinctive marker
of frailty.
THE ASSOCIATION BETWEEN FILIAL DISCREPANCY
AND DEPRESSIVE SYMPTOMS: FINDINGS FROM THE
PINE STUDY
M.Li, X.Dong, Y.Hua, Rush University Medical Center,
Chicago, Illinois
Background: The relationship between filial piety and
depressive symptoms has been widely discussed, but lim-
ited research focused on the gap between filial expectations
and filial receipt. This study aims to investigate the associa-
tion between filial discrepancy and depressive symptoms.
Methods: Data were derived from the Population Study of
Chinese Elderly (PINE), a community-engaged, population-
based epidemiological study of US Chinese older adults aged
60 and above in the Greater Chicago area. Depressive symp-
toms were measured by the Patient Health Questionnaire-9.
Overall filial discrepancy was evaluated by filial receipt minus
expectations. Levels of overall filial discrepancy divided
older adults into four groups based on the medium value
of filial expectations and receipt. Logistic regression analy-
ses were performed. Results: Older adults with greater filial
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
receipt than expectations were more likely to have lower risk
of depressive symptoms (OR, 0.95, (0.920.97)). The group
with high expectations and low receipt has the highest risk
of depressive symptoms among the four groups (OR, 1.51,
(1.072.13)). Greater receipt than expectations in care (OR,
0.83, (0.760.92)), make happy (OR, 0.77, (0.690.86)),
greet (OR, 0.88, (0.790.97)), obey (OR, 0.76, (0.680.86))
and financial support (OR, 0.80, (0.710.89)) was associ-
ated with lower risk of depressive symptoms. Conclusions:
This study goes beyond previous research by examining the
association between filial discrepancy domains and depres-
sive symptoms. Cultural relevancy of health interventions
is important in the context of Chinese communities. Health
care professionals are suggested to be aware of the depressive
symptoms of US Chinese older adults with high filial expec-
tations and low receipt.
LONG-TERM EFFECTS OF PREDIABETES AND
DIABETES ON COGNITIVE TRAJECTORIES IN
APOPULATION-BASED COHORT
A.Marseglia, A.K.Dahl Aslan, L.Fratiglioni,
N.L.Pedersen, W.Xu, Karolinska Institutet, Stockholm,
Sweden
Diabetes has been linked to dementia risk, however, the
cognitive trajectories in older adults with diabetes remain
unclear. We aimed to investigate the effect of prediabetes and
diabetes on cognitive trajectories among cognitively intact
older adults in a longterm followup study.
Within the Swedish Adoption/Twin Study of Aging, 793
cognitively intact older adults aged 50 were identified at
baseline and followed for up to 23years. Cognitive domains
(verbal, spatial/fluid, memory, speed) were assessed at base-
line and up to seven followups. Prediabetes was defined
according to blood glucose levels in diabetesfree partici-
pants. Diabetes was ascertained based on selfreport, hypo-
glycemic medication use and blood glucose levels. Data
were analyzed with linear mixedeffect models adjusting for
potential confounders.
At baseline, 68 participants (8.6%) had prediabetes and
45 (5.7%) had diabetes. Compared to diabetesfree indi-
viduals, people with diabetes had lower performance in spa-
tial/fluid abilities ( -2.63; 95% CI -5.36, 0.05; p=0.058),
and an accelerated linear decline over time in verbal abilities
( -0.15; 95% CI -0.29, -0.01; p=0.041). Prediabetes was
associated with an accelerated decline in processing speed
( -0.01; 95% CI -0.02, -0.004; p=0.041), but with a bet-
ter maintenance of memory ( 0.23; 95% CI 0.05, 0.42;
p=0.013) over the follow-up.
Prediabetes may accelerate processing speed decline, and
diabetes is associated with the verbal ability decline, suggest-
ing that diabetes and even prediabetes affect especially the
cognitive domains of fluid intelligence at the early stages of
cognitive impairment.
UNDERSTANDING THE DETERMINANTS OF FLUID
INTAKE IN LONG-TERM CARE
A.M.Namasivayam1,2, J.M.Morrison3, N.Carrier4,
C.Lengyel5, S.Slaughter6, C.Steele1,2, H.H.Keller3,7,
1. University of Toronto, Toronto, Ontario, Canada,
2. Toronto Rehabilitation Institute - University Health
Network, Toronto, Ontario, Canada, 3. University of
IAGG 2017 World Congress
261
Waterloo, Waterloo, Ontario, Canada, 4. University of
Moncton, Moncton, New Brunswick, Canada, 5. University
of Mantioba, Winnipeg, Ontario, Canada, 6. University
of Alberta, Edmonton, Ontario, Canada, 7. Schlegel-UW
Research Institute for Aging, Waterloo, Ontario, Canada
Dehydration is estimated to be present in almost half
of long term care (LTC) residents, and many residents do
not consume the recommended levels of daily fluid intake
(3700mL and 2700mL in men and women respectively)
(Institute of Medicine of the National Academies, 2004).
This likely has negative consequences for health, well-being
and quality of life. The present study aims to understand the
factors contributing to fluid intake of LTC residents. Data
were collected from 622 LTC residents (31.7% male) from
32 LTC homes in Canada, aged 62107 years (86.87.8).
Total fluid intake was estimated over three non-consecutive
days (meals and snacks), considering estimated volume of
beverages and water content of liquidized food. Average
daily fluid intake ranged from 311-2390mL (1103.9378.7).
Rigorous methods were used to collect resident and unit-
level variables that captured potential risk factors for low
fluid intake such as dementia status, activities of daily living,
eating challenges, and mealtime experiences. Hierarchical
regression analysis using backward elimination revealed that
fluid intake was negatively associated with increased age,
cognitive impairment, eating challenges and increased dining
room staffing. Factors that were positively associated with
intake were: being male, requiring more physical assistance,
and more positive interactions between staff and residents at
meals (R2= 0.41; F88,533=4.20, p < 0.0001). These results
indicate that total fluid intake of LTC residents is insuffi-
cient. Variables identified to predict intake could help inform
strategies and targeted interventions to improve fluid intake
for residents of LTC. Funded by the Canadian Institutes of
Health Research.
UNPLANNED AND EXTENDED NAPPING AMONG
OLDER ADULTS: FREQUENCY, DURATION, AND
PREDICTORS
N.E.Leland1, D.J.Fogelberg2, T.Mroz2, M.V.Vitiello2,
1. Occupational Science and Occupational Therapy,
University of Southern California, Los Angeles, California,
2. University of Washington, Seattle, Washington
Poor sleep is associated with negative health outcomes
among older adults, yet little is known about napping in
this population and research has not distinguished between
planned and spontaneous naps, or duration. This study
examines napping using a retrospective cohort of Medicare
beneficiaries >65 years of age enrolled in year four of
National Health and Aging Trends Study who reported regu-
lar napping (n=1,016). Regressions examined the relation-
ships between sociodemographic and clinical characteristics
and napping outcomes, specifically unplanned or extended
(i.e., >60 minutes) naps. Survey weighting was used for all
analyses.
Among Medicare beneficiaries who nap, 58.7% reported
unplanned naps and 18.5% regularly take extended naps.
Unplanned napping was associated with older age, non-
white race, non-married status, poorer self-reported health,
and shorter nighttime sleep duration. For example, individu-
als 7584 years of age had 2.1 higher odds of unplanned
262
naps compared to those aged 6574. Male sex, poorer self-
reported health, and a greater number of chronic conditions
were associated with higher odds of extended naps. Those
with the worst self-reported health were 2.8 times more likely
to take long naps than those reporting the best health. Pain
and depression were not associated with either outcome.
We found that ~4.3 million older adults in the U.S.reg-
ularly nap without meaning to, and ~1.4 million individu-
als routinely took extended naps. Furthermore, different
constellations of risk factors are associated with unplanned
and extended napping. Research examining the impact of
unplanned and extended napping is warranted to optimize
sleep and other health outcomes.
MUTATIONS IN MITOCHONDRIAL ALH-6 RESULT
IN EARLY REPRODUCTIVE SENESCENCE
C.Yen, D.Lynn, S.Curran, University of Southern
California, Los Angeles, California
Reproduction is essential to perpetuate life. Animals must
utilize strategies in order to allocate the necessary resources
for the energy-costly process of reproducing. Here, we show
that C. elegans with mutation in alh-6, a conserved mito-
chondrial proline catabolism gene known to cause mito-
chondrial defects show a diet-independent decline in fertility.
These animals have altered expression of metabolism and
male-reproduction genes and display several sperm-specific
defects. We identify that PRDH-1 is essential to confer these
phenotypes and identify key metabolites and molecules that
influence this premature reproductive senescence. Altogether,
our data reveal new insights in reproductive aging and
describes how important proper mitochondrial function is
for reproductive capacity.
DANCE-MOVEMENT THERAPY LEADS TO ALOWER
CORTISOL AWAKENING RESPONSEA SIGN OF
STRESS REDUCTION?
T.Vrinceanu1,2,3, A.Esmail1,2,3, D.Predovan4, J.Pruessner5, trolling for critical factors that influence hospital stay costs
L.Bherer2,3,6, 1. Concordia University, Montreal, Quebec,
Canada, 2. Institut Universitaire de Griatrie de Montral,
Montreal, Quebec, Canada, 3. Montreal Heart Institute,
Montreal, Quebec, Canada, 4. Universit du Qubec
Montral, Montreal, Quebec, Canada, 5. McGill University,
Montreal, Quebec, Canada, 6. Faculty of Medicine,
Universit de Montral, Montreal, Quebec, Canada
Aging is associated with numerous chronic conditions
that can be worsened by stress.
There are already some interventions that are targeting
stress but no research to date has looked at the effects of
Dance/Movement Therapy (DMT) on chronic stress (meas-
ured by the cortisol awakening response CAR). To inves-
tigate this, 40 healthy adults over the age of 60 (M=67.5,
SD=5.3) were randomised into three groups: waiting list
(WL; n=14), DMT (n=12), and Cardiovascular Training
(CT; n=14). The CT consisted of high intensity activity on a
recumbent bicycle, while the DMT was comprised of exer-
cises including coordination, body awareness, and socialisa-
tion. The two training groups were supervised by licensed
instructors and met three times a week for three months.
Before and after the training program all participants pro-
vided saliva samples on three days at 0, 30 and 60-minutes
after awakening, and had their fitness level evaluated.
Innovation in Aging, 2017, Vol. 1, No. S1
A group x time interaction was found (F(2,35)=5.256,
p=.01, 2partial=.231), with the DMT group showing
lower salivary cortisol values post-training, while the other
two groups showed no change from baseline in their corti-
sol response to awakening. Physical assessments (VO2max,
and 10-meter walk) showed the greatest improvement in the
CT group, moderate or no improvement in DMT, and no
improvement in the WL. None of the changes of cardiovas-
cular improvement were related to cortisol, suggesting that
the change in cortisol seen in the DMT group is unrelated
to fitness improvement. The results are further discussed in
terms of psychological mechanisms that could explain the
change in cortisol.
HOSPITALIZATION COSTS OF OLDER ADULTS WITH
CO-DIAGNOSES OF ALZHEIMERS DISEASE AND
TYPE 2 DIABETES
N.Barragan1,2, V.Shiau1,2, T.Kuo1,2, 1. University of
California, Los Angeles, Los Angeles, California, 2. Los
Angeles County Department of Public Health, Los Angeles,
California
Along with other dementias, Alzheimers disease (AD)
costs in the U.S. were estimated to exceed $235 billion in
2016. To date, there is a paucity of literature examining the
costs of acute hospitalizations of patients with AD, especially
when type 2 diabetes (T2DM) is present. In this study, we
address this gap by comparing the costs of hospitalizations
for patients aged 65years and older who had AD, T2DM, or
both. The present analysis draws from the Healthcare Cost
and Utilization Projects National Impatient Sample (NIS)
data from the Agency for Healthcare Research and Quality.
NIS represents all-payer, encounter-level hospital care data
and is weighted to yield national estimates of hospital inpa-
tient stays. The mean hospital stay costs were $9,808 for
patients with AD, $12,966 for patients with T2DM, and
$10,511 for patients with both conditions. Even after con-
(e.g., payer, length of stay, severity of disease, patient demo-
graphics, number of comorbid conditions, and number of
procedures), regression analysis consistently indicated that
while patients with both AD and T2DM incurred higher
costs than patients who were diagnosed solely with AD, their
costs did not exceed those with T2DM alone. Results from
the present study have health policy implications and can
inform hospitalization planning and practices for patients
with AD.
COMMUNITY PRACTITIONER PERSPECTIVES ON
HEALTHY AGING: AFOCUS GROUP STUDY
R.Dev, O.Zaslavsky, B.B.Cochrane, N.F.Woods, Nursing,
University of Washington, Seattle, Washington
Perspectives of older adults only may not fully explain the
phenomena of healthy aging. This project aimed to expand
knowledge on healthy aging by exploring the perspectives
of community-based professionals working directly with
older adults. We purposively sampled community practi-
tioners including nurses, social workers, and other health
professionals (n=12), and conducted three in-depth focus
group discussions of two hours each. Verbatim transcript
data were analyzed using an inductive content analysis with
consensual validation. Community practitioners suggested
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Innovation in Aging, 2017, Vol. 1, No. S1
various characteristics of healthy aging under person-spe-
cific, social, and spiritual components. Person-specific com-
ponents included characteristics at the physiological, basic
needs (nutrition, housing, medical), psycho-emotional and
cognitive levels, whereas social components encompassed
creating and contributing to the community. Aspiritual com-
ponent incorporated cultural aspects of elders. Practitioners
viewed promotion of healthy aging as meeting the needs of
older adults and making sure they have access to resources.
They further emphasized, resources is a broader term than
just financial resources that includes personal resources,
physical wellness, able to live independently and be socially
connected. Practitioners identified facilitators and barriers
towards healthy aging in terms of care recipients and care
providers. Two themes emerged about programs and activi-
ties: promoting fitness and promoting wellness. Although
practitioners perspectives had some overlap with traditional
research and medical views on healthy aging, the unique
and holistic model derived provides a more refined founda-
tion for supporting aging and addressing health disparities.
Rapidly changing demographics and aging in the United
States necessitate such culturally sensitive and empirically
driven practices to promote healthy aging.
BLUNTED RESPONSE TO STRESS IN YOUNG
IL-10TM/TM MICE: IMPLICATION FOR THE
VULNERABILITY IN FRAILTY
N.Ge2,1, H.Yang2, R.Westbrook2, R.Marx-Rattner2,
T.Burks2, J.Langdon2, P.Abadir2, J.D.Walston2, 1. Center
of Geriatric Medicine and Gerontology, West China
Hospital, Sichuan University, Chengdu, Sichuan, China, 2.
Department of Medicine Division of Geriatric Medicine
and Gerontology, Johns Hopkins University, Baltimore,
Maryland
The hypothalamic pituitary adrenal axis (HPA axis) is
a major neuroendocrine system for stress response and for
regulating the immune system. Aged rats as well as older
humans demonstrate progressive loss of control of the HPA
axis, resulting in impaired diurnal rhythm and hypersecre-
tion of glucocorticoids during times of stress. Higher levels
and a blunted diurnal rhythm of cortisol have been observed
in frail compared to more robust older adults. Understanding
the factors underlying disturbed glucocorticoid secretion
that precede age-related diseases and frailty are of consider-
able importance to prevent vulnerability and disability in late
life. In order to study this system in vivo, we utilized a mouse
model of chronic inflammation and as frailty and measured
changes in plasma corticosterone and pro-inflammatory lev-
els after acute cold stress. The plasma corticosterone level
was determined 2 weeks before cold stimulation in 10 young
(3 months), 10 old (21 months) C57BL/6J mice, and 10
young IL-10 tm/tm (3months). 5 mice from each group were
exposed to cold stress, the remainder served as controls and
were not exposed to cold. The treatment groups were exposed
to four degrees Celsius for 5 hours and the controls were
kept in room temperature conditions at twenty five degrees
Celsius. The results showed higher basal plasma corticoster-
one (P<0.01) and normal IL-6 and TNFR-1 levels in young
IL-10tm/tm, compared to young and old C57BL/6J mice.
However, there were unchanged corticosterone level and
higher IL-6 and TNFR-1 levels (P=0.04, 0.02, respectively) in
IAGG 2017 World Congress
263
young IL-10tm/tm mice after acute cold stress compared to
young wild type mice. Lower GRa mRNA expression in hip-
pocampus was also observed in control and treated young
IL-10tm/tm (P<0.01), compared the age-matched wild type
mice. These findings provide initial evidence for the hypoth-
esis that HPA axis dysfunction is through whole life of frail
subjects and even earlier than changes in immune system.
EFFICACY OF SKIN MOISTURIZER WITH ADVANCED
CERAMIDE AND FILAGGRIN TECHNOLOGY IN
CHINESE ELDERLY
A.Ikoma2, Q.Gao1, A.Lin4, L.Zang1, I.Philp3, N.Wang1,
1. Pinetree Care Group, Beijing, China, 2. Nestle Skin
Health, Tokyo, Japan, 3. Heart of England NHS Foundation
Trust, Solihull, United Kingdom, 4. Galderma, Shanghai,
China
Chronic itch is a common health problem in the elderly,
frequently associated with skin dryness. However, it is often
the case that little attention is paid to skin care until scratch-
ing due to itch damages skin and leads to inflammatory
lesions that need medical treatments. Apilot study was con-
ducted in China to test the efficacy in the elderly of an easy-
to-do skin care regimen with moisturizer that was developed
using advanced ceramide and filaggrin technology. Atotal of
60 volunteers (26 males and 34 females, 72.6 +/- 8.7years
of age) with moderate dry skin and itch participated in the
study and experienced a 2-week self-treatment with moistur-
izer and body wash. The change in skin dryness severity, itch
severity, and quality of life (day- and night-time) was assessed
1 and 2 weeks after the initiation of treatment. As a result, all
of skin dryness, itch, and quality of life rapidly improved at 1
week and further improved at 2 weeks with statistical signifi-
cance compared to the baseline (P<0.001). The acceptability
questionnaire completed by the participants at the end of
the study showed their high satisfaction with the regimen.
One case of contact dermatitis was reported and no other
treatment-related adverse events occurred. In conclusion, this
result provides evidence that the skin care regimen tested in
this study is effective in the elderly, not only on skin dryness
or itch but also on the quality of life, with a good tolerability
and acceptability.
SESSION 615 (SYMPOSIUM)
THE EXPANDING ROLE OF U.S. EMERGENCY
DEPARTMENTS IN THE CARE OF VULNERABLE
OLDER ADULTS
Chair: A.Lo, The University of Alabama at Birmingham,
Birmingham, Alabama
Discussant: K.Flood, University of Alabama
Adults 65 years and older account for 20 million emer-
gency department (ED) visits annually, resulting in 20% of
all ED visits and 36% of all hospitalizations despite repre-
senting only 13% of the U.S.population. The traditional U.S.
ED model is ill-equipped to address the complex health care
needs of older adults. The estimated 7,700U.S.geriatricians
are too few in numbers to absorb the care transitions of all
older adults following their emergency care. Consequently,
the responsibility of identifying individuals at higher risk
for mobility impairment, functional decline, suicide risk and
264
elder abuse is often thrust upon emergency physicians. The
nascent subspecialty of geriatric emergency medicine and
recently developed care guidelines reflect the evolution of the
EDs role in the U.S. This symposium discusses advances and
challenges in current geriatric emergency care in terms of: (i)
understanding how changes in function, mobility and social
support increase utilization of emergency care; (ii) screening
for suicide risk in older adults; (ii) identifying and assess-
ing elder abuse, neglect and exploitation, and (iv) innova-
tive ED-based short-stay units that provide comprehensive
geriatric assessments at the time of ED visits. We offer insight
into strategies of promoting care protocols despite the rigid
metrics of U.S.fee-for-service emergency care or the absence
of safety-net features found in socialized medical systems of
other countries. Advances in geriatric emergency medicine in
the U.S.are critical to addressing the unmet health care needs
of older adults and signal an opportunity for collaborative,
interdisciplinary, care initiatives involving all aging-related
health professionals.
THE ROLE OF SOCIAL SUPPORT, FUNCTION, AND
MOBILITY ON EMERGENCY CARE UTILIZATION BY
U.S. OLDER ADULTS
A.Lo, R.E.Kennedy, C.Brown, The University of Alabama tunity to identify elder abuse, but providers rarely recognize
at Birmingham, Birmingham, Alabama
Population-based data on the impacts of social sup-
port, function and mobility on emergency department
(ED) utilization among older adults are limited. We exam-
ined data on socio-demographics, social support, function
(using Activities of Daily Living, ADL) and mobility (using
life-space) from a population-based cohort of community-
dwelling adults 65 years. ED utilization was determined
via 6- and 12-month follow-up interviews. We used multi-
variable logistic regression models. In the 12 months after
baseline, 145 (15.5%) of 936 persons utilized an ED. Social
support was not associated with ED utilization. ADL impair-
ment and reduced life-space were associated with higher ED
utilization, but their effects were stronger in individuals with
social support (ADL Odds Ratio=2.11, p=0.038; life-space
OR=1.27, p=0.004) than those without social support (ADL
OR=1.63, p=0.042; life=space OR=1.15, p=0.011). Older
adults seeking care in the ED should be screened for impair-
ments in function and mobility, even if they have strong
social support.
SCREENING FOR SUICIDAL THOUGHTS AND
BEHAVIORS AMONG OLDER PATIENTS VISITING
THE EMERGENCY DEPARTMENT
M.Betz1, S.A.Arias2, D.L.Segal3, I.Miller2, C.A.Camargo5, M.Moseley, Emergency Medicine, The Ohio State
E.D.Boudreaux4, 1. Emergency Medicine, University of
Colorado--Denver, Denver, Colorado, 2. Brown University,
Providence, Rhode Island, 3. University of Colorado
- Colorado Springs, Colorado Springs, Colorado, 4.
University of Massachusetts Medical School, Worcester,
Massachusetts, 5. Massachusetts General Hospital, Boston,
Massachusetts
Depression, suicide ideation (SI) and suicide attempts (SA)
are common among older adults, representing serious pub-
lic health problems. Individuals with multiple comorbidities
and frequent contact with hospitalbased emergency depart-
ments (ED) may have elevated but unrecognized risk. To
Innovation in Aging, 2017, Vol. 1, No. S1
inform future interventions, we describe the prevalence of
self-harm/SI/SA among older ED patients, including differ-
ences by age, sex, and race/ethnicity. We reviewed consecu-
tive patient charts (20112014) at 8 EDs in 7 states, all with
protocols to screen every patient for suicide risk. Among
142,534 patient visits, 23% were by patients aged 60years.
Documented screening for self-harm/SI/SA declined with
age, from 81% in younger age groups to 68% among those
aged 85 years. This decline may be due to age biases or
to patient-level factors precluding screening (e.g., altered
mentation). Our findings support the need for more detailed
examination of the best methods for identifying and treat-
ing suicide risk among older adults.
PROVIDER PERSPECTIVES ON AMULTI-
DISCIPLINARY EMERGENCY DEPARTMENT
INTERVENTION FOR ELDER ABUSE
T.Rosen1, M.Stern1, M.R.Mulcare1, T.J.McCarthy1,
V.LoFaso1, E.M.Bloemen2, R.Breckman1, M.S.Lachs1,
1. Weill Cornell Medical College, New York, New York,
2. University of Colorado School of Medicine, Aurora,
Colorado
An emergency department (ED) visit provides an oppor-
or report. We have begun designing a multi-disciplinary
ED-based consultation service to improve identification,
medical and forensic assessment, and treatment for poten-
tial victims. We qualitatively explored provider perspec-
tives to inform intervention development. We conducted 16
semi-structured focus groups at a large, urban hospital with
providers, including social workers, emergency physicians,
geriatricians, and nurses. Focus groups were transcribed,
and data was analyzed to identify themes. Providers believed
an ED-based consultation service would be frequently uti-
lized and would increase identification, improve care, and
help ensure safety. Participants identified challenges includ-
ing determining capacity for potential victims requesting
discharge. They emphasized the value of coordinating with
in-patient and out-patient medical and service provid-
ers. Providers suggested geriatric nurse practitioners may
have ideal clinical and personal care training to contribute
and highlighted the importance of social workers in care
coordination.
INCORPORATION OF MULTIDISCIPLINARY
GERIATRIC CARE INTO AN EMERGENCY
DEPARTMENT OBSERVATION UNIT
L.T.Southerland, L.Kunduru, T.R.Gure, J.Caterino,
University, Westerville, Ohio
Multidisciplinary geriatric assessment is difficult in the
Emergency Department (ED) due to time limitations, patient
volume, and specialized staffing needs. One solution is ED
Observation Units which provide extended patient evalua-
tions for up to 24 hours. Our ED implemented multidiscipli-
nary geriatrician assessment including geriatric consultation,
physical therapy assessment, and case management care
coordination, available to any observation unit patients. We
conducted a retrospective chart review of randomly selected
adult observation unit patients 65years old (n=111). Few
were observed purely for geriatric assessment (7.2%, n=8),
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
but 25% (n=28) accessed at least one of the multidiscipli-
nary assessments. The admission rate was 24% with average
length of stay 15.5 hours. The admission rate for patients
placed specifically for geriatric assessment was 62% (n=5/8).
Multidisciplinary geriatric assessment is frequently utilized
and feasible in an ED observation unit, but a higher admis-
sion rate should be anticipated in patients observed for this
purpose only.
SESSION 620 (SYMPOSIUM)
SYSTOLIC BLOOD PRESSURE INTERVENTION
TRIAL: FINDINGS THAT IMPACT OLDER
HYPERTENSIVE PATIENTS
Chair: M.A.Supiano, University of Utah, Utah
Co-Chair: J.Williamson, Wake Forest University
Results from the Systolic Blood Pressure Intervention
Trial (SPRINT) which compared usual (< 140mm Hg)
with intensive (< 120mm Hg) SBP targets (ClinicalTrials.
gov, NCT01206062) demonstrated that a lower SBP tar-
get may be safely recommended for many older patients.
SPRINT included 2636 community living subjects aged
75 and older (28% of the entire study population) who
were assessed for frailty status including usual gait speed,
cognitive function, orthostatic hypotension, and adverse
events including injurious falls. In the group of older sub-
jects randomized to the intensive arm there was a 34%
reduction in the primary composite CVD outcome and
a 33% reduction in all-cause mortality at 3.14 years of
follow-up when the trial ended early (numbers needed to
treat 27 and 41 respectively). These results did not differ
for the most frail subgroup nor for those with impaired
gait speed. While some adverse events were higher in the
intensive group, there was no difference observed in seri-
ous adverse events including injurious falls. This sympo-
sium will provide additional SPRINT results of relevance
to older hypertensive patients including: 1) predictors of
adherence and retention; 2)results for the impact of inten-
sive versus standard treatment goals on incident heart fail-
ure with and without reduced ejection fraction, 3)arterial
stiffness as a predictor of SPRINT outcomes, and 4)results
for the impact of intensive versus standard treatment goals
on transitions in frailty status.
BASELINE PREDICTORS OF RETENTION AND
ADHERENCE IN THE SYSTOLIC BLOOD PRESSURE
INTERVENTION TRIAL
M.Vitolins, J.Williamson, Wake Forest University,
Winston-Salem, North Carolina
The internal validity and statistical power of a clinical
trial depends on participant retention and good protocol
adherence. Retention and adherence rates may be lower in
older trial participants. We will report data from the Systolic
Pressure Intervention trial (SPRINT) which involved 9361
hypertensive persons (2636 age 75+) who were assigned to
a systolic blood-pressure target of less than 120mm Hg or
a target of less than 140mm Hg. Retention and adherence
rates by study arm after a median of 2.36years of follow-
up will identify baseline predictors of retention and adher-
ence in SPRINT stratified by age and frailty status. Close
IAGG 2017 World Congress
265
examination of predictors of adherence and retention will
lead to new strategies for blood pressure management by
identifying risk factors for non-adherence and study discon-
tinuation. These results will aid clinicians in identifying older
adults at increased risk for difficulty with adherence to blood
pressure lowering therapy.
IMPACT OF INTENSIVE BLOOD PRESSURE
CONTROL ON INCIDENCE AND TYPE OF HEART
FAILURE IN THE ELDERLY
B.Upadhya2, J.Williamson1, D.Kitzman1, 1. Wake Forest
University, Advance, North Carolina, 2. Wake Forest
University, Winston-Salem, North Carolina
Population based studies show that the majority of per-
sons in the community, particularly in the older age range,
who develop heart failure (HF), have a preserved ejection
fraction (HFpEF). The prevalence of HFpEF is rising, with
morbidity, mortality, and healthcare costs now equal to HF
with reduced ejection fraction (HFrEF). Multiple lines of evi-
dence suggest that hypertension (HTN) may be even more
closely linked to the development of HFpEF than HFrEF.
Among patients with hypertension, lower blood pressure
(BP) treatment goals could potentially have a differential
impact on the development of HFpEF vs HFrEF Thus, treat-
ing to lower BP goals in SPRINT could produce divergent
responses, due to differences in both ischemic heart disease
burden and in LV hypertrophic remodeling. We will present
results from SPRINT characterizing the impact of inten-
sive versus standard SPB therapy on middle aged and older
patients with hypertension who develop incident HFrEF vs
HFrEF.
ARTERIAL STIFFNESS AS APREDICTOR OF
OUTCOMES IN THE SYSTOLIC BLOOD PRESSURE
INTERVENTION TRIAL
M.A.Supiano, University of Utah, Salt Lake City, Utah
Arterial stiffness is a major determinant of the age-
related increase in systolic blood pressure (SBP) and is an
independent predictor of cardiovascular events. The Systolic
Blood Pressure Intervention Trial (SPRINT) affords a unique
opportunity to determine if the difference in peripheral SBP
that developed between the intensive treatment group (target
SBP < 120mm Hg) and the usual care group (target SBP <
140mm Hg) an average delta of 14.8mm Hg will be
accompanied by significant differences in measures of vas-
cular stiffness (aortic pulse wave velocity, PWV) and central
(aortic) BP. In a subset of 648 SPRINT participants, PWV and
pulse wave analysis measures were completed prior to rand-
omization and annually throughout three years of follow-up.
Results will be presented pertaining to the hypothesis that
measures of vascular stiffness at year 3 will be predictive
of the main SPRINT outcomes independent of the achieved
peripheral SBP.
TRANSITIONS IN FRAILTY STATUS IN THE
SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL
N.Pajewski1, J.Williamson1, M.A.Supiano2, 1. Wake Forest
School of Medicine, Winston-Salem, North Carolina, 2.
University of Utah, Salt Lake City, Utah
SPRINT results indicate that treating to a systolic
blood pressure <120mm Hg (intensive) confers benefits on
266
cardiovascular morbidity and mortality compared to a tar-
get of <140mm Hg (standard). These benefits were apparent
even among older (age 75years or older) participants. While
serious adverse events were not amplified overall in inten-
sively treated participants, older patients may be more con-
cerned about the impact of intensive treatment on frailty an
increased vulnerability to stressful events associated with
aging than with traditional adverse outcomes. Based on
a model of deficit accumulation, we have previously devel-
oped a frailty index to characterize SPRINT participants at
baseline incorporating information on self-ratings of health,
depressive symptoms, lab measurements, cognitive and phys-
ical functioning, and comorbidity. To better inform future
hypertension treatment strategies, we will present longitudi-
nal results comparing the incidence and progression of frailty
between the SPRINT treatment groups, and in the subgroup
of older adults.
SESSION 625 (SYMPOSIUM)
SUPPORTING PROFESSIONALS TO DELIVER BETTER
QUALITY END-OF-LIFE CARE IN DEMENTIA
Chair: J.van der Steen, VU University Medical Centre,
Amsterdam, Netherlands
There is increasing policy focus on improving the qual-
ity end of life (EoL) care for older people and those living
with non-cancer related long term illness. For people with
dementia and their families the organisation and provision
of care, towards and at the EOL, continues to be challenging
with research revealing sub-optimal symptom control and a
significant proportion dying in acute hospitals. Health care
professionals can find EOLC in dementia difficult due to dif-
ficulties in prognostication and impaired communication and
mental capacity in the dying person. The costs of dementia
care, especially in the last year of life, are also considerable.
With an ageing population potentially rapidly increasing
such costs, it is crucial to explore more effective, integrated
models of care and interventions which improve quality of
care and facilitate preferred place of dying.
IMPROVING END-OF-LIFE CARE IN DEMENTIA: KEY
AREAS FOR IMPROVEMENT
C.Bamford, M.Poole, R.Lee, E.McLellan, C.Exley, improved. We developed the Compassion Intervention to
L.Robinson, Institute of Health and Society & Newcastle
University Institute for Ageing, Newcastle University,
Newcastle, United Kingdom
Relatively little is known about how good end of life care
(EoLC) for people with dementia is supported or constrained
in practice. As part of a five year research programme, we
used qualitative methods to explore the delivery of EoLC
from the perspectives of people with dementia, family car-
ers, frontline staff and service managers. Integrative analy-
sis highlighted seven key issues influencing the provision of
EoLC spanning from early discussions to care after death.
These issues have informed the development of an evi-
dence-based intervention comprising a Dementia Care
Facilitator and newly developed resources to promote
change. The resources include evidence-based scenarios
illustrating common problems in EoLC, one of which will
Innovation in Aging, 2017, Vol. 1, No. S1
be presented. Discussion points accompany the scenarios to
engage staff and encourage the development of local strate-
gies to improve practice. Together with other components of
the intervention, the scenarios will be evaluated in a pilot
trial in the UK.
DEVELOPMENT OF HEURISTICS TO GUIDE
DECISION MAKING AT THE END OF LIFE FOR
SOMEONE WITH DEMENTIA
N.Davies1, K.Lamahewa1, R.Mathew1, J.Wilcock1,
J.T.Manthorpe2, E.L.Sampson1,3, S.Iliffe1, 1. University
College London, London, United Kingdom, 2. Kings
College London, London, United Kingdom, 3. North
Middlesex University Hospital, London, United Kingdom
The end of life for someone with dementia can present
a series of challenges for practitioners. Challenges may be
eased with the development of heuristics (rules-of-thumb).
For example, FAST is used in stroke: Facial-weakness,
Arm-weakness, Slurred-speech, Time to call 911. Through
a co-design process we developed a toolkit of heuristics to
aid practitioners making difficult decisions when caring
for someone with dementia at the end of life. The heuristic
toolkit consisted of four areas which were considered dif-
ficult decisions at the end of life; eating/swallowing difficul-
ties, agitation/restlessness, reviewing treatment/interventions,
and providing routine care. Each heuristic consists of a logic
tree of rules. For example, eating/swallowing difficulties have
two rules; ensure eating/swallowing difficulties do not come
as a surprise and reflection about comfort-feeding only or
time-trialled artificial feeding. Teams appreciated the sim-
plicity of the heuristics, allowing their use in educating less
experienced colleagues and as an aid to conversations with
families.
IMPLEMENTING AN END-OF-LIFE CARE
PROGRAMME FOR NURSING HOME RESIDENTS
WITH DEMENTIA: ROLE OF CONTEXT
K.J.Moore, B.Candy, S.Davis, J.Harrington, N.Kupeli,
V.Vickerstaff, L.Jones, E.L.Sampson, University College
London, London, United Kingdom
Nursing homes are a common place of death for people
with dementia, however, quality of end-of-life care could be
promote interdisciplinary care for residents with advanced
dementia. We implemented a naturalistic study with an
Interdisciplinary Care Leader working across two nursing
homes in the UK. Based on reflections of the Interdisciplinary
Care Leader and 48 interviews with healthcare professionals
and care workers involved with the two homes, we examined
how the intervention worked in practice. Contextual differ-
ences were identified between the two sites, with Care Home
2 having lower involvement with external healthcare services
and less developed training procedures. Core components
were implemented in both care homes but multidiscipli-
nary meetings were only established in Care Home 1. The
Intervention prompted efforts to improve advance care plans,
pain management and person-centred care. Further testing of
the Interventions effectiveness in improving end-of-life care
is recommended.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
EFFECTS OF AUDIT AND FEEDBACK ON THE
QUALITY OF CARE AND COMFORT IN DYING WITH
DEMENTIA (FOLLOW-UP)
J.van der Steen1,2, J.Boogaard3, M.van SoestPoortvliet4,
J.Anema3, A.Francke3,5, W.Achterberg1, H.de Vet3, 1.
Leiden University Medical Center, Leiden, Netherlands,
2. Radboud University Medical Center, Nijmegen,
Netherlands, 3. VU University Medical Center, Amsterdam,
Netherlands, 4. Netherlands Institute of Mental Health and
Addiction, Utrecht, Netherlands, 5. Netherlands Institute of
Health Services Research, Utrecht, Netherlands
The Feedback on End-of-Life care in dementia
(FOLlow-up) project examined the effects of two audit and
feedback strategies on quality (satisfaction) with care and
comfort when dying with dementia in in a 3-armed cluster
randomized controlled trial. In 18 nursing homes, after death
(January 2012-July 2014), a total of 668 families (response
rate: 69%) rated the End-of-Life in Dementia (EOLD)
instruments. A generic audit and feedback strategy used
group mean EOLD-scores and a patient-specific strategy
used individual family reports of EOLD scores. Compared
to no feedback, the generic strategy resulted in LOWER sat-
isfaction in both adjusted and unadjusted analyses, while
the patient-specific strategy increased comfort in unadjusted
analyses only, due to a decrease in dying symptoms (one of
four CAD subscales). We discuss possible explanations of
disappointing effectiveness such as feedback with high mean
baseline scores, and explanations based on an evaluation of
the implementation processes. Trial number: NTR 3942.
SESSION 630 (PAPER)
FALL PREVENTION AND REDUCTION
THE STEPS TO AVOID FALLS IN THE ELDERLY (SAFE)
STUDY
D.Matchar2, P.Duncan5, C.T.Lien1, M.E.Ong3, M.Lee4,
R.Sim2, K.Eom2, 1. Changi General Hospital, Singapore,
Singapore, 2. Duke-NUS Graduate Medical School,
Singapore, Singapore, 3. Singapore General Hospital,
Singapore, Singapore, 4. St Andrews Community Hospital,
Singapore, Singapore, 5. Wake Forest School of Medicine,
Winston Salem, North Carolina
A multi-center, two arm, parallel group, randomized con-
trolled trial: study participants were screened, assessed for
risk factors and randomized (control or intervention) based
on the SPPB score at baseline. High-risk participants (SPPB
less or equal 6)were given a home-based exercise program
up to 12 sessions (3 times per week) that specifically targets
and modifies impairments that interfere with engaging in
exercise in a group setting. When the high-risk participants
attained SPPB > 6, they transitioned to a community-based
group exercise program and continued until the end of active
intervention phase. Low-to-moderate risk patients (SPPB >
6) were directly enrolled into an evidence-based one-hour
group exercise program, which was offered up to 24 sessions
with free transportation (2 times a week). The primary out-
come measure was the number of fallers at the end of the
nine-month study period. All analyses performed were on an
intention-to-treat basis.
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267
Between December 2012 and July 2014, 354 patients
who were at least 65 years old and visited the Emergency
Department for falls or fall-related injuries were recruited
(177 participants in each group). At the end of the nine-
month follow-up period, 37.9% of the control group and
30.5% of the intervention group fell at least once. The inter-
vention program significantly reduced the number of fallers
adjusting for critical comorbidities (odds ratio 0.33 [0.15
0.74], p=0.004). We also observed that the intervention
group had a lower proportion of individuals with injurious
falls and significantly less reduction in physical performance
by SPPB. No adverse events were reported during the study
period.
The SAFE study showed that screening, risk modification
and intensive, consistent and progressive physical therapy
can effectively reduce the number of fallers and injurious
falls.
This study is registered with the U.S. Clinical Trials
Registry, number NCT01713543 and was funded by
Ministry of Health Singapore under its Health Services
Research Competitive Research Grant (Grant Number:
HSRG10MAY002).
SOCIAL DANCING TO REDUCE FALLS IN OLDER
ADULTSA CLUSTER RANDOMISED CONTROLLED
TRIAL
D.Merom1, E.Mathiew2, E.Cerin2, R.L.Morton5,
K.Anstey7, C.Sherrington4, S.Lord6, R.Cumming3, 1.
School of Science and Health, Western Sydney University,
Penrith, New South Wales, Australia, 2. Australia Catholic
University, Nirth Sydney, Austria, 3. The University of
Sydney, Sydney, New South Wales, Australia, 4. The George
Institute for Global Health, University of Sydney, Sydney,
New South Wales, Australia, 5. Clinical Trials Centre, The
University of Sydney, Sydney, New South Wales, Australia,
6. NeuRA, University of New South Wales, Randwick,
New South Wales, Australia, 7. The Australian National
University, Canberra, Australian Capital Territory, Australia
Small-scale trials have indicated that diverse dance styles
can improve balance and gait of older adults, two of the
strongest risk factors for falls in older people, but none
of these studies has examined the effect of dance on falls.
Acluster randomized controlled trial was undertaken in 23
self-care retirement villages around Sydney, Australia, involv-
ing 530 seniors (mean age 78years, 85% women) without
cognitive impairment. Intervention villages (12 clusters) were
offered twice weekly one-hour social dancing class (folk or
ballroom dancing) over 12months (80 hours). The partici-
pants in the control villages (11 clusters) were advised to
continue with their regular activities. Data on falls obtained
from 522 (98%) participants and 424 (80%) attended the
12-month reassessment, which was lower among folk dance
participants (71%) than ballroom dancing (82%) or con-
trol participants (82%, P=0.04). During the period 444 falls
were recorded; there was no significant difference in fall rates
between the control group (0.80 per person-year) and the
dance group (1.03 per person-year). Using negative bino-
mial regression the adjusted IRR was 1.19 (95% CI: 95%
CI=0.831.71). In post hoc sub-group analysis, the rate of
falls was higher among dance participants with a history of
multiple falls (IRR=2.02, 95% CI: 1.153.54, p=0.22 for
268
interaction) and in the folkdance intervention (IRR=1.68,
95% CI:1.03 -2.73). Social dancing did not prevent falls or
its associated risk factors among villages residents. Modified
dance programmes that contain training elements to better
approximate structured exercise programs, targeted at low
and high-risk participants, warrant investigation.
DOES DEPRESCRIBING FALL-ASSOCIATED DRUGS
REDUCE FALLS AND ITS COMPLICATIONS?:
ASYSTEMATIC REVIEW
J.Lee2,4,6, A.Negm1,2, E.Wong5, A.Holbrook3,6,7, 1.
McMaster University, Hamilton, Ontario, Canada, 2.
Geriatric Education and Research in Aging Sciences
(GERAS) Centre, Hamilton, Ontario, Canada, 3. Center
for Evaluation of Medicines, Hamilton, Ontario, Canada,
4. Division of Geriatric Medicine, McMaster University,
Hamilton, Ontario, Canada, 5. Department of Medicine,
McMaster University, Hamilton, Ontario, Canada, 6.
Department of Clinical Epidemiology & Biostatistics,
McMaster University, Hamilton, Ontario, Canada, 7.
Division of Clinical Pharmacology & Toxicology, McMaster
University, Hamilton, Ontario, Canada
Falls are the leading cause of injury and injury-related
hospitalizations for seniors in Canada with annual health-
care costs exceeding $2 billion. Despite limited evidence of
effectiveness, the withdrawal (discontinuation or dose reduc-
tion) of fall-risk increasing drugs (FRIDs) is typically part
of falls prevention strategies and hospital accreditation initia-
tives. The study objectives were to determine the preventative
efficacy of FRID withdrawal on falls and fall-related compli-
cations. An electronic search was conducted in MEDLINE,
EMBASE, CENTRAL and CINAHL. Agrey literature search
included trial registries and conference abstracts. All rand-
omized controlled trials in adults age 65 evaluating FRID
withdrawal compared to usual care on falls rate or incidence,
fall-related injuries, fractures or hospitalizations and/or
adverse effects related to the intervention were included. Two
reviewers independently screened eligible studies, abstracted
data and assessed risk of bias. The GRADE criteria were used
to rate overall confidence in effect estimates for outcomes.
Five trials involving 1309 participants met eligibility criteria
for inclusion. A FRID withdrawal strategy did not signifi-
cantly change the rate of falls (RaR 0.98, 95% CI 0.63 to
1.51), number of fallers (RR 1.06, 95% CI 0.84 to 1.34)
or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to
1.39) over a 6 to 12month follow-up period. There is insuf-
ficient evidence that a FRID withdrawal strategy is effective
for preventing falls. Based on very low quality evidence, it is
uncertain whether FRID withdrawal leads to any apprecia-
ble clinically important benefit. Data evaluating the potential
harms of FRID withdrawal is lacking.
EXERCISE TO PREVENT FALLS IN OLDER ADULTS:
AN UPDATED SYSTEMATIC REVIEW AND
META-ANALYSIS
C.Sherrington1, Z.Michaleff1,2, N.Fairhall1,
A.Tiedemann1, J.Whitney3, R.Cumming1, J.Close4,
S.Lord4, 1. University of Sydney, Sydney, New South Wales,
Australia, 2. Keele University, Keele, United Kingdom,
3. Kings College Hospital, London, United Kingdom, 4.
Innovation in Aging, 2017, Vol. 1, No. S1
University of New South Wales, Sydney, New South Wales,
Australia
Previous meta-analyses have found exercise as a single
intervention prevents falls in older people. This updated sys-
tematic review with random effects meta-analysis and meta-
regression aimed to test whether this effect is still present
when new trials are added and explore trial characteristics
associated with greater fall prevention effects. One hundred
comparisons from 89 randomised trials with 19,869 par-
ticipants were available for meta-analysis. Overall, exercise
reduced the rate of falls in community dwelling older peo-
ple by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85,
p<0.001, I2 47%, 67 comparisons) with greater effects seen
from exercise programs that challenged balance and involved
more than three hours per week of exercise. Together these
variables explained 76% of the between-trial heterogene-
ity and in combination led to a 39% reduction in falls (IRR
0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a
fall prevention effect in community-dwelling people with
Parkinsons disease (pooled rate ratio 0.47, 95% CI 0.30 to
0.73, p=0.001, I2 65%, 6 comparisons) or cognitive impair-
ment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004,
I2 21%, 3 comparisons) but not in residential care settings
or among stroke survivors, people with severe visual impair-
ment or people recently discharged from hospital. Exercise as
a single intervention can prevent falls in community dwell-
ing older people, promising results are seen in people with
Parkinsons disease or cognitive impairment but its impact in
other clinical groups and aged care facility residents requires
further investigation.
FALLS AND THE SOCIAL ISOLATION OF OLDER
ADULTS IN THE NATIONAL HEALTH AND AGING
TRENDS STUDY
J.Pohl, B.B.Cochrane, K.G.Schepp, N.F.Woods, University
of Washington School of Nursing, Seattle, Washington
Falls among community-dwelling older adults can be life
threatening. While an association between social isolation
and falls has been described, the nature of that relation-
ship is not well documented and could be important for fall
prevention interventions. Study objectives were to describe
the incidence of falls, prevalence of social isolation, and
extent to which social isolation predicts falls in older adults.
Secondary analysis of longitudinal data from the National
Health and Aging Trends Study, involving a nationally rep-
resentative sample of Medicare beneficiaries, included four
rounds of annual interviews in participants homes (round
one n=7,609). Social isolation was operationalized for the
current analysis as a multiple-indicator, domain-inclusive
construct based upon the Social Network Index. Falling
during the previous year was self-reported. Incidence of falls
ranged from 22.426.2% across the four rounds. Social
isolation prevalence ranged from 19.821.9%. The prob-
ability of falling increased with each increase in social isola-
tion construct score. Even after adjusting for age, gender,
and education, social isolation significantly predicted fall-
ing (OR=1.08; CI=1.021.14). Adding self-reported general
health, depression, and worry about falling to the model
weakened the relationship between social isolation and
falls (OR=1.02; CI=0.961.08). Adding the Short Physical
Performance Battery, assistive mobility device use, and
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 269

activities of daily living to the model weakened the relation- COGNITIVE FUNCTION AND HORMONAL
ship further (OR=0.99; CI=0.941.04). Social isolation as THERAPY ADHERENCE IN ACOHORT OF OLDER
a predictor of falls is partially explained by the strong rela- SURVIVORS: CALGB 369901
tionship between social isolation and physical performance. S.Bluethmann4, C.Alfano2, J.Clapp1, L.Faul1, G.Luta1,
Fall-prevention interventions targeting social isolation could J.Mandelblatt1, 1. Georgetown University, Washington,
have an important impact on physical performance and District of Columbia, 2. American Cancer Society,
future falls. Washington, District of Columbia, 4. Pennsylvania State
University, Hershey, Pennsylvania
SESSION 635 (PAPER) Background: Adjuvant hormonal therapy is the standard
of care for estrogen-receptor-positive (ER+) breast cancer
survivors, but up to half of survivors do not adhere to rec-
CANCER-RELATED MORBIDITY AND MORTALITY
ommended treatment (5 years+). Adherence may be more
ISSUES
complicated in women older than 65years (the majority of
survivors) due to adverse effects of hormonal therapy, such
A CLINICAL SCORE TO PREDICT THE EARLY DEATH
as cognitive impairment. However, the relationship between
AT 100 DAYS IN ELDERLY METASTATIC CANCERS
cognitive function and hormonal therapy adherence is
R.Boulahssass, S.Gonfrier, M.Sanchez, C.Rambaud,
poorly understood. The objective of this study is to examine
A.Gary, J.Turpin, I.Bereder, O.Guerin, CHU de Nice
the relationship of cognitive function and hormonal therapy
UCOG PACA East, Nice, France
adherence over 5years in older breast cancer survivors.
Background: Trying to predict the very early death after
Methods: A cohort of cognitively intact ER+, non-met-
a CGA is difficult in elderly metastatic cancers. Last year, we
astatic breast cancer survivors (65 years and older) that
presented a clinical score to predict this risk in 815 elderly
initiated hormonal therapy were recruited from 78 sites
cancer patients (Boulahssass et al 9511 ASCO 2015). The
between 20042011 (n=909). Follow-up data were collected
aim of this new study is the next step by developing a score
at 6months and annually for up to 7years. Cognitive func-
to estimate the risk of early death at 100days in metastatic
tion was self-reported using EORTC-QLC30. Group-based
cancers (MC) in order to have the collective wisdom not to
trajectory modeling determined groups based on the high-
overtreat this population.100 days is nearly 3 months, if
est probability of membership and logistic regression was
patients are going to die within 3months, its maybe neces-
used to test associations with discontinuation of hormonal
sary to provide them best supportive care alone.
therapy before at least 5years of prescribed medication use.
Methods: This is a multicentric and prospective cohort
Results: The mean cognitive score for survivors at base-
study approved by an ethics committee. At the baseline,
line was 93.2 points (SD=12.3). Most breast cancer survivors
a standardized CGA was performed (MMSE,MNA,Grip
were in early to middle stages of disease (i.e., stage 1=47.4%,
strength, ADL, IADL,CIRSg, Charlson, lee,PS,Gait speed,
stage 2a=31.4% and stage 2b-3=21.3%). Approximately
QLQc30, G8, Balducci), type and localization of metastases
30% of women reported early discontinuation of hormo-
were collected. During the follow up of 100 days, events,
nal therapy. Many women (42%) had high cognitive func-
treatments made and targeted geriatric interventions were
tion that remained stable over time; more (49.1%) showed
collected. A multivariate logistic regression permits to
a phase shift (i.e., slight decline) in cognitive function with
select risk factors.The internal validation was performed
time. Only 9.2% of survivors showed a pattern of acceler-
by a bootstrap with randomized samples. Score points were
ated cognitive decline over time. Survivors with accelerated
assigned to each risk factors by using the coefficient. The
decline were more likely than those who maintained high
accuracy of the score was assessed with the mean c-statistic
function to discontinue hormonal therapy (OR 1.49: 95%
and the calibration with the Hosmer-Lemeshow goodness
CI, 0.882.55, p=0.14), controlling for age, stage and prior
of fit test.
use of chemotherapy. Additionally, survivors who exhibited
Results: In the cohort 312 patients had a MC with
a phase shift in cognitive function were significantly more
a median age of 82y. The indepedent predictors of death
likely than survivors who maintained high function to dis-
at 100 days in MC were: Age > 85y (OR 2,1 p=0,03),
continue hormonal therapy (OR 1.40: 95% CI 1.031.91,
Metastatic localizations (ML): 2ML (OR 2,4 p=0,004),>2
p=0.03), also controlling for age, stage and prior use of
ML (OR 6,3 p=0,001),MNA <17 (OR 8,7 p<0,0001) or
chemotherapy.
23,5 and 17 (OR 5,4 p=0,002), Home confinement (OR
Conclusions: Cognitive dysfunction is a relevant yet
1,8 p=0,047),ADL<5,5 (OR 2,1 p=0,017),Cancers with
understudied side effect of hormonal therapy in older sur-
global risk of early death at 100 days >30% (OR 2,05
vivors and may affect the duration of medication adherence.
p=0,016)
Our preliminary results suggest that survivors with cognitive
We assigned in the score: 3 points for: MNA 23,5, ML>2
decline may play a role in early discontinuation of hormonal
and 1 point for home confinement, ADL<5,5, ML=2, age
therapy in older survivors. This will be an important area for
>85y and types of cancers at risk >30%
future research on temporality of these effects and has clini-
The risk of death at 100days in MC was 4 % for 0 to
cal implications for survivorship care.
2pts, 18% for 3 to 4pts,33% for 5pts and 44% for 6pts
and 83% for > 6pts.
THE NONAGENARIAN PATIENTS WITH CANCER IN
Conclusion: In daily practice, this score should help to
THE UCOG PACA-EST COHORT
avoid unnecessary treatment for patients with a high risk of
C.Rambaud1, R.Boulahssass2, S.Gonfrier3, M.Sanchez2,
death, especially for those with a score> 6.
D.Borchiellini4, M.Durand5,6, G.Sacco1, O.Guerin7,8, 1.

IAGG 2017 World Congress

270
Soins de suite et de radaptation, Hpital de Cimiez, CHU
Nice, Universit Nice Sophia Antipolis, Nice, France, 2.
UCOG, Hpital de Cimiez, CHU Nice, Universit Nice
Sophia Antipolis, Nice, France, 3. USLD, Hpital de
Cimiez, CHU Nice, Universit Nice Sophia Antipolis, Nice,
France, 4. Centre Antoine Lacassagne, NICE, Nice, France,
5. Service dUrologie, dAndrologie et de Transplantation,
Hpital Pasteur 2, CHU Nice, Universit Nice-Sophia-
Antipolis, Nice, France, 6. INSERM, U1189, ONCO-
THAI, F-59037, Lille, France, 7. Hpital de Cimiez, CHU
Nice, Universit Nice Sophia Antipolis, Nice, France, 8.
Unit CNRS UMR6267/INSERM U998, Nice, France
Introduction: The number of nonagenarians people
in the world is steadily growing. Decision making about
those patients concerning cancer treatment is difficult due
to the lack of recommendations. Comprehensive Geriatric
Assessment (CGA) is a help for clinicians to take a deci-
sion concerning this treatment. UCOG PACA-Est Cohort is
a large multicenter prospective cohort of geriatric patients
with cancer. The aim of our study is to describe the popula-
tion of patient age over 90 years old in the UCOG PACA-
Est cohort.Methods: All patients included in the cohort have
benefited from a standardized CGA before the treatment
decision. The CGA included (not exhaustive): MMSE, ADL,
IADL, gait speed, one-leg standing, Charlson comorbidity
index (CCI). Characteristics of cancer, social and demo-
graphic data were also collected. During a 100-days follow
up, the rate of death, and targeted CGA interventions were
collected.Results: On the 860 patients of the cohort, there
were 101 nonagenarians with a mean age of 92 years (SD
2y). There were 65% of women and 20% of the patients had
a metastatic cancer. The nonagenarians were significantly
(p<0,001) more dependent for ALD (OR=2,5 [1,6-3,9]) and
IADL (OR= 3,2 [1,9-5,5]) than the rest of the cohort. They
were more cognitively impaired (MMSE < 24, OR=2,1[1,4-
3,3], p<0,001). They had a slower walking speed (OR = 2
[1,3-3,1], p=0,003). One-leg standing was often less feasi-
ble (OR =5,4 [2,3-12,6], p<0,001), and patients were more
frequently confined at home (OR= 3 [2-4,6], p<0,001). An
increase in CCI was associated with the age > 90y (OR=4,3
[1,5-11,9], p=0,005). After the CGA, the initial cancer treat-
ment plan was modified for 32% of nonagenarians, versus
20% for the rest of the cohort (OR=1,89 [1,2-3],p=0,006).
The targeted geriatric interventions were not significantly
different except for physiotherapys and pains care (OR= 1,5
[1-2,3],p=0,046 and OR=2,2 [1,1-4,3], p=0,02). The rate of
death at 100-days follow up was more important for nonage-
narians (OR= 1,8 [1,1-2,8], p=0,013).Conclusion: The study
suggests a high vulnerability for nonagenarians patients with
cancer. In spite of the altered cognitive status and the loss of
autonomy, the targeted geriatric interventions differ only for
physiotherapys care and pains care. The study shows the
influence of the geriatrician in the decision making of the
oncologist. It also confirms the importance of a CGA in very
old people.
COMPARISON OF OLDER PEOPLE WITH CANCER
ACCORDING TO THE FRIED OR THE G8 CRITERIA
S.C.Gerard, S.Sourdet, S.Lozano, D.Brechemier,
L.Balardy, Y.Rolland, Gerontopole Toulouse University,
Toulouse, France
Innovation in Aging, 2017, Vol. 1, No. S1
Background: Both the Fried criteria and the G8 have been
proposed to screen for frailty in older patient with cancer.
Frail older patients may benefit of a Comprehensive Geriatric
Assessment (CGA). Our aim was to compare the character-
istics of older patients with cancer according to the Fried or
the G8 score.
Method: 70years and older outpatient patients with solid
tumors or hematologic tumors were included. The Frieds
criteria, the G8 score, and a CGA including physical per-
formances tests (Short Physical Performance Battery, SPPB)
were performed.
Results: 286 patients (mean age 82.9years 5.3), mainly
with solid tumor (urologic, 28%, digestive, 20%, gyneco-
logical, 13%, at local stage, 83%) were included. 77.4 % of
the cohort had G8 positive and 92.7% were classified frail
or pre-frail with the Fried criteria (38 and 54.7% respec-
tively). 69 patients with frailty or pre-frailty based on the
Fried criteria (24% of the cohort) were not detected as frail
by the G8. In this sub-group, CGA found poor physical per-
formances (low SPPB, low gait speed). 70% and 60% had a
gait speed below 1 and 0.8 m/s respectively) and 63% had a
SPPB <9/12.
Conclusions: Prevalence of frailty was higher using the
Fried criteria compared to the G8. Patients undetected by
the G8 as frail but detected by the Fried criteria had low
gait speed and low SPPB score. Poor physical performances
are relevant predictors of adverse event in older patient with
cancer suggesting that the Fried criteria are more appropri-
ated to screen for frailty.
CASE-CONTROL STUDIES OF VAGINAL AND VULVAR
CANCERS AND GYNECOLOGICAL SCREENING:
ASEER-MEDICARE ANALYSIS
E.Osterbur, Health Sciences and Informatics, St. Louis
University, St. Louis, Illinois
This study was conducted to determine the association
between Pap smear and pelvic examination screenings and
the development of invasive vaginal and vulvar cancers in a
Medicare population using a matched case-control design.
Matched casecontrol data sets were constructed from
the SEER-Medicare database that links the Surveillance
Epidemiology and End Results (SEER) cancer registry
data and Medicare enrollment and claims data of subjects
who received care between the years 1991 and 1999 aged
65years or older. The study identified vaginal (N=328) and
vulvar (N=1,103) cancer cases. Controls were matched to
vaginal (N=2,624) and vulvar (N=8,825) cancer cases rep-
resenting up to eight matched controls for a single case. The
association between screening tests (Pap smears and pelvic
examinations) and invasive vaginal and vulvar cancers uti-
lized a design matched on age and geographic location. The
association between gynecologic screenings and the develop-
ment of invasive disease was ascertained using conditional
logistic regression analysis. The risk of regional and distant
stages of invasive vaginal (OR 0.55, 95% CI 0.310.99) and
vulvar (OR 0.70, 95% CI 0.421.00) cancers was reduced by
Pap smear and pelvic examination screenings. This matched-
case control design found evidence that Pap smear and pelvic
examination screenings were beneficial for older women due
to the decreased risk of regional and distant stages of inva-
sive vaginal and vulvar cancers.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 640 (SYMPOSIUM)
MANAGEMENT ISSUES IN DELIRIUM
Chair: N.ORegan, Western University, London, Ontario,
Canada
Co-Chair: M.Dasgupta, Western University, London,
Ontario, Canada
Delirium is extremely common, and leads to adverse out-
comes. Delirium can be preventable, but is frequently missed.
Much remains unknown about management of actively delir-
ious individuals. In this symposium, we present the results of
novel research from five centres, focusing on risk stratifica-
tion, case identification and interventions for delirium. Our
first abstract reports the prevalence of hypoactive delirium in
older medical inpatients, the most underdetected and prog-
nostically serious form. Our second abstract describes a brief
two-step diagnostic approach which shows promise as a sen-
sitive delirium identification method. Thirdly, we present a
novel delirium risk stratification method for pre-operative
cardiac surgery patients, using frailty assessment. Next, we
report findings which indicate improvement in delirium
symptoms with physical therapy. Finally we highlight the
potential harm related to the oft-prescibed antibiotic treat-
ment of asymptomatic bacteruria in delirious patients. This
symposium will highlight new research, across a breadth of
issues related to delirium.
FREQUENCY AND STABILITY OF MOTOR SUBTYPES
IN OLDER MEDICAL INPATIENTS WITH DELIRIUM
N.ORegan1,2,5, D.Adamis3, D.W.Molloy2, D.Meagher4,
S.Timmons2, 1. Division of Geriatric Medicine, Department
of Medicine, Western University, London, Ontario, Canada,
2. Centre for Gerontology and Rehabilitation, School of
Medicine, University College Cork, Cork, Ireland, 3. Sligo
Mental Health Services, Sligo, Ireland, 4. Department of
Psychiatry, Graduate Entry Medical School, University of
Limerick, Limerick, Ireland, 5. Lawson Health Research
Institute, London, Ontario, Canada
Hypoactive delirium is most commonly missed and
yields the worst outcomes. Little is known about longitu-
dinal course of motor subtypes, as most studies are cross-
sectional in nature. We aimed to investigate the frequency
and stability of motor subtypes in incident delirium in
older medical inpatients. Medical inpatients of 70 years
without prevalent delirium on admission underwent daily
assessment for 7days for incident delirium. Motor activity
profile was established using the Delirium Motor Subtype
Scale-4 (DMSS-4). Longitudinal subtypes were ascertained
by examining the daily profiles of each delirious patient. In
total, 1219 assessments were performed in 191 patients, 61
with incident delirium. Hypoactive subtype was most preva-
lent on any given delirium day (n= 75/113, 66.4%) and was
the most common longitudinal subtype (n=38/61, 62.3%).
Hypoactive delirium is highly prevalent in older medical
inpatients. Hence, delirium education programmes should
focus on improving understanding and awareness of this
subtle presentation amongst clinicians.
IAGG 2017 World Congress
271
PILOT STUDY OF ADELIRIUM DETECTION
PROTOCOL ADMINISTERED BY AIDES, PHYSICIANS,
AND REGISTERED NURSES
D.M.Fick1, S.K.Inouye3, C.McDermott1,
L.Ngo2, J.Gallagher2, J.McDowell1, J.L.Penrod1,
E.R.Marcantonio2,3, 1. College of Nursing, The
Pennsylvania State University, University Park,
Pennsylvania, 2. Beth Israel Deaconess Medical Center,
Boston, Massachusetts, 3. Harvard Medical School, Boston,
Massachusetts
Delirium is prevalent, costly, and morbid, yet underde-
tected by clinicians. We tested feasibility and acceptability of
a 2-step delirium identification protocol. Step 1, a screener,
consists of What is the day of the week? and Months
of the year backwards. If either/both items are incorrect,
step 2, a 3-minute diagnostic assessment (3D-CAM) follows.
Trained researchers enrolled 23 older hospitalized adults
and identified 22% to be delirious after a reference stand-
ard assessment. Thereafter, physicians, and nurses, completed
the 2-step protocol, while certified nursing assistants (CNAs)
completed the screener only, all on the same patients. The
screener took a median of 36 seconds to administer, with sen-
sitivities: nurses-100%, CNAs-100%, physicians-80%. The
2-step protocol achieved sensitivities: nurses- 100%, physi-
cians-80%, and specificities: nurses-89%, physicians-78%.
Barriers and facilitators to implementation were also col-
lected. We conclude that our screener and 2-step protocol
can be feasibly implemented by clinicians, and is a promising
approach to improve delirium identification.
IMPACT OF FRAILTY ON THE OCCURRENCE OF
DELIRIUM IN THE POSTOPERATIVE CARDIAC
SURGERY PATIENT
R.C.Aurora, University of Manitoba, Winnipeg, Manitoba,
Canada
There is a lack of information on the interaction of
frailty and the occurrence of delirium after cardiac sur-
gery. Specifically, it is unclear if the addition of preoperative
frailty screening to existing surgical perioperative risk mod-
els improves the prediction of postoperative delirium (PoD).
In a prospective observational study, preoperative assess-
ments of frailty (Modified Fried Criteria, the Short Physical
Performance Battery and a 35-item Frailty Index) was per-
formed in elective cardiac surgery patients. The primary
outcome was PoD, assessed using the Confusion Assessment
Method. Seventy-two (54.1%) of the 133 participants were
deemed frail. After adjusting for the traditional preop-
erative risk score (EuroSCORE II), frail patients were at
increased risk of PoD ([OR], 5.05, 95%CI, 1.5816.13).
The inclusion of a formal assessment of frailty significantly
improved the discrimination of the EuroSCORE II in predict-
ing PoD, pointing to opportunities for improved prevention
and management.
INTERVENTIONS FOR ICU DELIRIUMEFFECT
OF PHYSICAL THERAPY ON ATTENTION IN
CRITICALLY ILL PATIENTS
K.Neufeld, Psychiatry and Behavioral Sciences, Johns
Hopkins Univeristy School of Medicine, Baltimore,
Maryland
272
Delirium, or acute change in cognition and decreased
attention, is a common neuropsychiatric syndrome in up
to 80% of critically ill adults. It is associated with nega-
tive outcomes including increased mortality and morbidity.
Multimodal nonpharmacological interventions including
physical therapy are associated with decreasing delirium
incidence and severity. This study examined the impact of
routine physical therapy on performance of attention tasks in
CAM-ICU defined delirious and non-delirious (n= 60)criti-
cally ill patients. Patients in an intensive care unit were given
an attention task, utilizing the Edinburgh Delirium Test Box,
requiring the patient to count a series of flashing lights prior
to, and up to 4 hours following clinically-prescribed physical
therapy. Delirious patients had lower baseline performance
and greater change in attention following physical therapy
compared to non-delirious patients. The results are discussed
in the larger context of early mobilization as an important
non-pharmacologic prevention strategy for delirium.
TREATMENT OF ASYMPTOMATIC UTI IN OLDER
DELIRIOUS MEDICAL INPATIENTS: APROSPECTIVE
COHORT STUDY
M.Dasgupta1,2, C.Brymer1, S.Elsayed1, 1. Western
University, London, Ontario, Canada, 2. Lawson Health
Research Institute, London, Ontario, Canada
Despite clinical practice guidelines, asymptomatic bac-
teriuria in older people is commonly treated because of a
change in mental status. We sought to determine how often
asymptomatic urinary tract infection (UTI) is treated in
older delirious individuals, and whether treatment is asso-
ciated with functional recovery. Consecutive older medical
in-patients were screened for delirium, and followed in hos-
pital. Of 343 delirious in-patients, 237 (69%) had poor func-
tional recovery (death, new institutionalization or decreased
function at 3months). Ninety four (27%) were treated for
asymptomatic UTI, which was associated with poor recov-
ery compared to those who were not (RR 1.30, 95% CI:
1.141.48 overall; RR 1.34). Clostridium difficile infection
was significantly more common in the treated group (n=7,
7.5%) compared to the untreated group (n=8, 3.2%), OR
2.45, 95% CI: 0.866.96. Treatment of asymptomatic UTI in
older delirious medical in-patients was common, and poten-
tially harmful. Further research is needed to validate these
findings.
SESSION 645 (SYMPOSIUM)
INNOVATIONS IN PALLIATIVE CARE COMPETENCY
IN NURSING PRACTICE: ELNEC, AACN, AND
COMMUNITY PARTNERSHIPS
Chair: C.R.Shillam, University of Portland, Portland,
Oregon
Co-Chair: P.Mazanec, Case Western Reserve University,
Cleveland
For 20 years, the American Association of Colleges of
Nursing (AACN) has endorsed a set of standardized end-of-
life (EOL) nursing care competencies. Since then, the demand
for nursing competency in palliative care has risen to the
forefront. The End-of-Life Nursing Education Consortium
(ELNEC), an education initiative to improve palliative and
Innovation in Aging, 2017, Vol. 1, No. S1
EOL care, has emerged as an international leader in ensur-
ing all nurses attain competency. Using a train-the-trainer
model, ELNEC provides nursing faculty, CE providers, staff
development educators, and specialty nurses with training
in palliative care to teach essential information in educa-
tion and practice. Today, emphasis on palliative care across
the illness trajectory from time of diagnosis through EOL,
and across the lifespan, is required in all practice settings. In
2016, an expert panel of nursing faculty and leaders in pal-
liative care revised the AACN EOL competencies to establish
comprehensive palliative care competencies. The resulting
AACN Palliative CARES document serves as a foundation to
online teaching modules embedded in ELNEC curriculum.
This symposium provides an overview of the AACN/ELNEC
work, and how these modules are being used in a variety of
ways to improve palliative care across settings. Presentations
of this symposium will describe:
1. The AACN/ELNEC process of developing and advanc-
ing a new set of nursing care competencies in palliative care;
2. Creating and disseminating online modules to increase
access to educational offerings;
3. Implementing the modules in an academic setting; and
4. Collaborating with community partners to incorporate
community-created online learning modules into the ELNEC
curriculum.
DEVELOPING AND ADVANCING NURSING CARE
COMPETENCIES IN PALLIATIVE AND END-OF-LIFE
CARE
B.Ferrell1, P.J.Malloy2, P.Mazanec3, 1. City of Hope
National Medical Center, Duarte, California, 2. American
Association of Colleges of Nursing, Washington, District of
Columbia, 3. Case Western Reserve University, Cleveland,
Ohio
In 2015, AACN and ELNEC convened a national panel
of experts in nursing education, gerontology, and palliative
care to revise the 1997 AACN Peaceful Death document and
establish palliative and end-of-life nursing care competen-
cies. The ELNEC train-the-trainer project to date has over
21,100 trainers training over 550,000 professionals in all 50
states and 88 countries. ELNEC has incorporated the newly-
revised 17 palliative care competencies into 6 one-hour
online modules available for implementation in nursing cur-
riculum. To facilitate dissemination, the modules are avail-
able to all schools of nursing in four northwest states free of
charge, and to all other schools across the country at a mini-
mal cost, for one year. The use of these competencies, when
embedded in the undergraduate curriculum, will empower
future nurses to be leaders in advocating for access to quality
palliative care and to compassionately promote and provide
this essential care to older adults.
CREATING AND DISSEMINATING ONLINE
MODULES TO ADVANCE COMPETENCIES IN
PALLIATIVE AND END-OF-LIFE CARE
P.Mazanec2, B.Ferrell3, P.J.Malloy1, 1. American
Association of Colleges of Nursing, Washington, District of
Columbia, 2. Case Western Reserve University, Cleveland,
Ohio, 3. City of Hope National Medical Center, Duarte,
California
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
After AACN endorsed the Palliative CARES document,
outlining 17 key competencies for palliative and end-of-life
nursing care, ELNEC developed 6 one-hour online modules:
1) Introduction to Palliative Nursing; 2) Communication
in Serious Illness; 3) Pain Assessment and Management;
4) Symptom Assessment and Management; 5) Loss, Grief,
and Bereavement; and 6) Care of the Imminently Dying
Patient. Modules can be used for online, face to face, or
blended formats. They include limited text, with student
interaction required in case studies, short videos, and exami-
nation questions. Faculty in nursing programs and continu-
ing education control administration of modules in a variety
of ways to meet learning needs of students and practicing
nurses. This innovative curriculum increases access to pallia-
tive care education in nursing schools, meets palliative care
competencies outlined in the AACN CARES document, and
strengthens the palliative care workforce nationwide, provid-
ing greater access to palliative care for patients with serious
illness.
IMPLEMENTATION OF ONLINE EDUCATION TO
ADVANCE COMPETENCIES IN PALLIATIVE AND
END-OF-LIFE CARE
M.A.Kozy1, C.R.Shillam1, A.Davis2, M.Lippe3, 1. School
of Nursing, University of Portland, Portland, Oregon, 2.
Washington State University, Vancouver College of Nursing,
Spokane, Washington, 3. Capstone College of Nursing, The
University of Alabama, Tuscaloosa, Alabama
All schools of nursing in four northwest pilot states were
invited to participate in the implementation of the six AACN/
ELNEC Palliative CARES competency one-hour online mod-
ules. AACN/ELNEC leaders provided face-to-face one-day
workshops to faculty in each of the four states. The work-
shop outlined the background on the development of the
Palliative CARES competencies, the materials and format for
the online modules, and strategies for implementation of the
modules into existing nursing curricula. Attendees then par-
ticipated in a brainstorming discussion to generate additional
innovations in supporting faculty and students in use of the
modules in both online and face to face formats. Schools
agreeing to participate in the pilot dissemination phase of the
modules incorporate the six modules into existing nursing
courses, evaluate the learning outcomes of students in those
courses, and provide feedback to AACN/ELNEC regarding
the facilitators and barriers to implementation.
INNOVATIVE COMMUNITY COLLABORATIONS TO
ADVANCE CULTURALLY SENSITIVE PALLIATIVE
AND END-OF-LIFE CARE
C.R.Shillam1, P.Mazanec2, M.Dahlstrom3, S.Williams1, In 2008 DCU engaged in a process which resulted in launch-
1. School of Nursing, University of Portland, Portland,
Oregon, 2. Case Western Reserve University, Cleveland,
Ohio, 3. Familias en Accion, Portland, Oregon
Continuing education and lifelong learning are essential
to providing high-quality, safe nursing care to older adults.
During development of AACN/ELNEC Palliative CARES
online modules, an academic-practice partnership between
the University of Portland and Familias en Accion resulted
in evidence-based, culturally-sensitive palliative care online
resources for continuing education purposes for health-
care providers. Collaboration between the university and
IAGG 2017 World Congress
273
AACN/ELNEC revealed a fit between Familias resources
and needs for culturally-sensitive materials in the Palliative
CARES online modules. Expanding the original purpose of
these high-quality, community-developed online modules,
the modules are now embedded into undergraduate nurs-
ing education and ELNEC train-the-trainer core and geriat-
rics curriculum. This partnership provides greater return on
investment for funders, and expands the reach of the indi-
vidual projects, ultimately reaching more nurses. Use of these
online modules can streamline efforts to ensure older adults
have access to goal-directed, high-quality health care across
the continuum of disease trajectory and across the lifespan.
SESSION 650 (SYMPOSIUM)
CO-HOST AGHE: BEING AN AGE-FRIENDLY
INSTITUTION OF HIGHER EDUCATION
PERSPECTIVES FROM GLOBAL PARTNERS
Co-Chair: K.Farah, Lasell College, Newton, Massachusetts
J.M.Montepare, Lasell College, Newton, Massachusetts
Discussant: N.M.Silverstein, University of Massachusetts
Boston
The aim of this symposium is to illustrate the role higher
education can play in responding to the challenges and
opportunities associated with shifting demographics and the
aging of populations being witnessed locally and globally. In
this symposium we will describe the Age-Friendly University
(AFU) initiative launched by Irish Taoiseach Enda Kenny
and Dublin City University President Brian MacCraith
that resulted in the development of the 10 AFU Principles.
Now endorsed by international partners in Ireland, UK, US,
Canada, and the Association for Gerontology in Higher
Education (AGHE), the AFU Principles provide a valuable
guiding framework that colleges and universities can use
for distinguishing and evaluating age-friendly programs and
policies, as well as identifying institutional gaps and oppor-
tunities for growth. Global partners will describe how their
institutions are using the AFU principles and AGHE presi-
dent will discuss needed efforts moving forward.
IMAGINING AND REALISING AN AGE-FRIENDLY
UNIVERSITY
C.OKelly, Dublin City University, Dublin, Ireland
The number of people in Ireland aged over 65 is expected
to double from 11% to 22% over the next twenty years.
This cohort of the population has diverse educational needs
which are currently inadequately provided for within higher
education and the pressure to meet these needs will increase.
ing Ten Principles of an Age Friendly University. Our vision
is to lead a global initiative to embrace the opportunities of
an aging population by providing a place for older adults
to learn, and where DCU will lead a centre of excellence
(research, innovation, teaching, advocacy, engagement) with
older adults, harnessing and developing areas of expertise.
Opportunities to engage in authentic dialogue with older
people also raise awareness within the traditional student
cohort to embrace the longevity dividend and inform their
own ageing process contributes to the transformational goals
of DCU.
274
TEACHING AND LEARNING ON AN AGE-FRIENDLY
INTERGENERATIONAL CAMPUS
J.M.Montepare, K.Farah, RoseMary B.Fuss Center for
Research on Aging and Intergenerational Studies, Lasell
College, Newton, Massachusetts
Lasell College, in Newton, Massachusetts, USA, has the
distinction of being the first age-friendly intergenerational
campus in the state with its recent endorsement of the 10
Age-Friendly University Principles developed by Dublin City
University and global partners. Like age-friendly communi-
ties, age-friendly universities aim to enable older adults to
participate in activities that promote positive and healthy
aging. Moreover, age-friendly universities aim to promote
greater age-diversity and inclusion across disciplines and
departments and a breaking down of age-segregation in the
classroom. Age-friendly universities also seek to support
aging research by including older adults in research initia-
tives and by developing research agendas that are informed
by the diverse educational needs of an aging society. In this
presentation we describe how Lasell College has been work-
ing to meet these aims in its intergenerational teaching and
learning collaboration with Lasell Village, a university-based
independent living community, situated on the Lasell campus.
ENGAGING AN ENTIRE UNIVERSITY IN AGE-
FRIENDLY UNIVERSITY PRINCIPLES
M.M.Porter, University of Manitoba, Winnipeg, Manitoba,
Canada
The Centre on Aging at the University of Manitoba, as a
research centre, has a 30+ year history of conducting and dis-
seminating research on aging, as well as training students in
research and aging. In May of 2016 the University of Manitoba
officially endorsed the Age-Friendly University Principles,
becoming the first University in Canada to do so. While the
University of Manitoba is already actively engaged in all ten
principles, this initiative brings the impetus to take a more con-
certed approach to enhance all of its activities. The presenta-
tion will outline what approach the University of Manitoba has
taken to enhance its age-friendliness, including its reach across
campus and to the broader community, and who the key indi-
viduals and departments have been in these efforts.
SESSION 655 (SYMPOSIUM)
ROLE OF MICROBES IN THE DEVELOPMENT OF
ALZHEIMERS DISEASE: STATE OF THE ART
Chair: A.E.Barron, Stanford University, Stanford,
California
R.Itzhaki, University of Manchester & University of
Oxford, Manchester, United Kingdom
Discussant: J.Miklossy, Prevention Alzheimer International
Foundation. International Alzheimer Research Center,
Martgny, Switzerland
Alzheimer disease (AD) is one of the most devastating
diseases and aging is one of the most important risk fac-
tors. For many years huge efforts have been made to better
understand the etiopathogenesis of AD. Also, many treat-
ment trials have been performed. At present, we do not what
is the exact cause of AD nor how to treat it but we know
Innovation in Aging, 2017, Vol. 1, No. S1
that neuroinflammation plays an important role, the latter
occurring even some 20 years before the clinical appear-
ance of the disease. For the last 25 years, infections have
been suspected to play a role in the pathogenesis of AD, and
recently, there has been much interesting progress on this
aspect. This symposium, with prestigious speakers, would
describe recent exciting advances in the field of AD. The
main themes would be the general overview on the role of
infections in the development of AD; the role of Spirochetes
and Chlamicia pneumoniae in the development of AD; the
role of amyloid beta (Ab) as an antimicrobial agents and
the future for treatment and the interaction between other
antimicrobial agents.
THE ROLE OF HERPES SIMPLEX VIRUS TYPE 1
(HSV1) IN ALZHEIMERS DISEASE (AD)
R.Itzhaki, University of Manchester and University of
Oxford, Manchester, United Kingdom
We discovered that HSV1 is present and active in a high
proportion of elderly brains, and that in brain of carriers of
the type 4 allele of the apolipoprotein E gene (APOE-e4),
HSV1 confers a strong risk of AD. Significantly, we found
also that APOE-e4 is a risk for cold sores. Subsequently, we
showed that HSV1 infection of human neural cells in cul-
ture causes a striking increase in beta amyloid (Abeta) and
AD-like-tau levels, and that Abeta deposits form in brains
of HSV1-infected mice. Further, in AD brains, HSV1 DNA is
located specifically within amyloid plaques. Antiviral agents
reduce greatly A and P-tau levels in HSV1-infected cells,
suggesting that antiviral treatment might reduce the progres-
sion of AD. Epidemiological, genetic, immunological and
virological studies by other groups support the causal link,
HSV1-AD, as well as the proposal to treat AD with antiviral
agents.
ALZHEIMERS DISEASE, SPIROCHETESA CAUSAL
RELATIONSHIP
J.Miklossy, Prevention Alzheimer International Foundation.
International Alzheimer Research Center, Martigny-Combe,
Switzerland
Various spirochetes, in an analogous way to Treponema
pallidum, are involved in the pathogenesis of several chronic
disorders including Alzheimers disease (AD). Borrelia
burgdorferi, the causative agent of Lyme disease and vari-
ous periodontal pathogen Treponemes (T.denticola, T.pec-
tinovorum, T. amylovorum, T. maltophilum, T. medium,
T. socranskii) persist in the brain and cause dementia and
beta amyloid deposition. Spirochetes are able to reproduce
in vitro and in vivo all the pathological and biological hall-
marks defining AD. A strong statistically significant asso-
ciation between spirochetes and Alzheimers disease fulfills
Hills criteria and confirm a causal relationship. Validation
of these observations by historic and recent reports further
confirm that senile plaques are made up by spirochetes and
correspond to biofilms. That host pathogen interactions in
chronic spirochetal infection are identical to those occurring
in AD indicates that escaping host immune reactions, spi-
rochetes sustain chronic infection and cause dementia and
amyloid deposition and that Alzheimers dementia might be
prevented.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THINKING OUTSIDE THE BOX IN ALZHEIMERS
DISEASE: COULD INFECTION BE THE ANSWER
B.Balin, C.Hammond, C.Little, S.Hingley, D.Appelt, innate immune system effector and modulator ubiquitous
Department of Bio-Medical Sciences, Philadelphia College
of Osteopathic Medicine, Philadelphia, Pennsylvania
New concepts of infectious disease are evolving espe-
cially with the development of progressive chronic diseases
that originally were not thought to be infectious. Infection
is well-known to be associated with numerous neurological
diseases. What has remained unclear, however, has been the
role of infection in the development of chronic neurodegen-
erative diseases. In this regard, numerous studies over the
past 25years have investigated an association between vari-
ous infectious agents and Alzheimers disease (AD), the most
prevalent condition accounting for dementia in the elderly.
Of the pathogens being considered, Herpes Simplex Virus 1
(HSV-1), Borrelia species, and Chlamydia pneumoniae have
garnered significant attention. Work from other laboratories
on systemic infections has also led to further interest in the
role that infection may play in the neurodegenerative process
in older populations. Data from all of these investigations
have led to a renewed interest in investigating the role(s) of
pathogens in the etiology of sporadic late-onset AD.
AMYLOID BETA PEPTIDES AS ANTIMICROBIAL
PEPTIDES: RELEVANCE FOR ALZHEIMERS DISEASE?
B.Karine, G.Dupuis, E.H.Frost, T.Flp, Medicine, prevalent but, as contemporary cohorts are living longer and
Universite De Sherbrooke, Sherbrooke, Quebec, Canada
Amyloid (A) peptides generated by the amyloidogenic
pathway of amyloid precursor protein (APP) processing con-
tribute significantly to neurological degeneration characteris-
tic of Alzheimers disease (AD). Their precise role, whether it
be direct or the indirect target of an inflammatory response,
has been a subject of considerable debate. Data published in
the last 6years by three different groups have added a new
twist by revealing that A peptides could act as antimicro-
bial peptides (AMP). These observations are of significance
with respect to the notion that pathogens may be important
contributors to the development of AD, particularly in the
case of Herpes simplex virus (HSV) infection which often
resides in the same cerebral sites where AD arises. Our recent
data support the interpretation that A peptides behave as
AMP, with an emphasis on studies concerning HSV-1 and a
putative molecular mechanism that suggests that interactions
between A peptides and the HSV-1 lead to impairment of
HSV-1 infectivity by preventing the virus from fusing with
the plasma membrane.
EVIDENCE THAT THE HUMAN LL-37 MAY BE
ABINDING PARTNER OF A AND INHIBITOR OF
FIBRIL ASSEMBLY
M.Chiari2, E.De Lorenzi3, R.Colombo3, M.Cretich2, the level of individuals and society.
L.Sola2, P.Gagni2, A.E.Barron1, 1. Stanford University,
Department of Bioengineering, Stanford, California, 2.
National Research Council of Italy, Institute of Chemistry
of Molecular Recognition, Milan, Italy, 3. University of
Pavia, Department of Drug Sciences, Pavia, Italy
We are investigating the molecular biophysics of the early-
stage etiology of sporadic Alzheimers Disease (AD). What
might cause initial accumulation of A peptide-rich fibrils
and plaques in the AD brain? What is As physiological
IAGG 2017 World Congress
275
function? We focus on As interactions with the human
cathelicidin peptide, LL-37, an antibacterial and antiviral
in tissues, expressed by myriad cell types, yet unique in the
proteome. We present experimental evidence and discuss a
hypothesis that LL-37 is a binding partner of A142 can
inhibit the formation of AD fibrils and plaques. We dem-
onstrate binding between LL-37 and A142 by capillary
electrophoresis, ELISA, Transmission Electron Microscopy
(TEM), and circular dichroism (CD) spectroscopy. TEM
shows that LL-37 inhibits the fibrillization of A142, espe-
cially the formation of long, straight fibrils characteristic of
AD, while CD spectroscopy reveals that LL-37 binding pre-
vents A142 from adopting -type secondary structure.
SESSION 660 (SYMPOSIUM)
PERCEPTIONS, EXPECTATIONS, AND ATTITUDES
ABOUT AGING: IMPLICATIONS AND OUTLOOK
Chair: J.E.Smith, University of Michigan, Ann Arbor,
Michigan
Discussant: D.B.Whitman, AARP
Chronological age per se explains little: It does however
carry information about social expectations, normative
life events, biological processes, and individual beliefs and
behavior. Negative stereotypes and attitudes about aging are
healthier lives, the ways that people think about aging war-
rant a closer look. Speakers in this session consider sources
and effects of attitudes and expectations about aging, and
discuss implications of such self-related beliefs for the well-
being of older adults. Hess and OBrien use data from the
Aging as Future Project to take a cross-cultural look at
associations between subjective perceptions of ones own
aging and beliefs about aging in different domains of eve-
ryday functioning. Giasson and Smith use data from the
Health and Retirement Study to explore links between atti-
tudes about ones own aging and time spent watching televi-
sion. They examine associations with emotional well-being
and discuss implications for daily lifestyle interventions.
Andrews and colleagues report findings from the Baltimore
Experience Corp Trial, a community-based volunteer inter-
vention designed to promote generativity and wisdom. They
examine the role of expectations regarding aging as a media-
tor of intervention-related improvements in cognitive func-
tion. Finally, Chopik and Kim present data from multiple
longitudinal studies that collectively measure changes in
expectations about the future from age 7 to 97. They discuss
the shape and implications of lifespan trajectories in beliefs
about the future. Whitman concludes with an integrative dis-
cussion of current efforts to reshape beliefs about aging at
THE IMPACT OF BELIEFS ABOUT AGING ON
PERCEPTIONS OF ONESELF ACROSS CULTURES AND
BEHAVIORAL DOMAINS
T.M.Hess, North Carolina State University, Raleigh, North
Carolina
Views regarding old age are important determinants of
important physical and psychological outcomes, although
276
the causal underpinnings of these relationships are poorly
understood. With an eye toward identifying potential under-
lying mechanisms, we used data from the Aging as Future
projectwhich included 1891 adults ages 25 99 from
China, Germany, and the United Statesto examine relation-
ships between subjective perceptions of ones own aging and
beliefs about aging in eight different domains of everyday
functioning. Although some variation occurred across cul-
tures and domains, more positive perceptions of ones own
aging process (e.g., younger subjective age, positive percep-
tions of self in old age) were generally associated with more
positive perceptions of the aging process (e.g., greater control
beliefs, lower beliefs in the age-determinancy of change). We
discuss these finding in relation to current theories regarding
subjective influences on the aging process.
AGING ATTITUDES AND TELEVISION WATCHING:
IMPLICATIONS FOR WELL-BEING
H.L.Giasson1, J.E.Smith1,2, 1. University of Michigan,
Ann Arbor, Michigan, 2. Institute for Social Research, Ann
Arbor, Michigan
Television can be an exciting escape, or a self-handicap-
ping behavior adversely linked to health and well-being. We
examine associations between individuals television watch-
ing and their attitudes toward their own aging using data
from the Health and Retirement Study (N=5542). Analyses
revealed that positive aging attitudes like as I get older,
things are better than Iexpected were associated with fewer
hours spent watching television, whereas negative attitudes
like the older Iget, the more useless Ifeel were associated
with a greater number of hours spent watching television.
Additionally, positive aging attitudes were associated with
higher positive affect while watching TV. Negative aging atti-
tudes were associated with lower positive affect and higher
negative affect while watching TV. All analyses controlled for
gender, race, age, education, work status, depressive symp-
toms, functional limitations, day of week, and trait positive
and negative affect. We discuss possible cognitive, affective,
and behavioral mechanisms.
EXPECTATIONS OF AGING AS AMEDIATOR
OF COGNITIVE BENEFITS IN THE BALTIMORE
EXPERIENCE CORPS TRIAL
R.Andrews1,2, T.E.Seeman3, E.Tan4, G.Rebok1,2,
J.Menkin3, J.M.Parisi1,2, T.L.Gruenewald5,
M.C.Carlson1,2, 1. Johns Hopkins University, Baltimore,
Maryland, 2. Center on Aging and Health, Baltimore,
Maryland, 3. University of California Los Angeles, Los
Angeles, California, 4. AARP, Baltimore, Maryland, 5.
University of Southern California, Los Angeles, California
Background: Having low age-expectations is a risk fac-
tor for worse cognitive and physical functions in older
adults. Here, we asked whether a community-based volun-
teer program, designed to promote generativity and wisdom,
improved cognition by increasing positive perceptions of
aging.
Objective: In the Baltimore Experience Corps Trial
(BECT), we examined whether changes in age-expectations
mediated the effect of BECT participation on cognitive func-
tion over 2years, and whether the mediation differed by sex
and age.
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: Expectations Regarding Aging (ERA-12),
Stroop interference, and RAVLT were collected at baseline
and at two annual follow-ups. Mean age of the sample
was 68.0 years, 85% were female and 92% were African
American. We used mediation analysis to assess the mediat-
ing role of intervention-related changes in ERA on cognitive
outcomes, controlling for key characteristics.
Conclusions: These results from a large-scale trial will
inform whether community-based volunteering may impact
cognitive function, in part, by improving age-expectations.
AGE-RELATED CHANGES IN EXPECTATIONS ABOUT
THE FUTURE: IMPLICATIONS FOR HEALTH AND
WELL-BEING
W.Chopik1, E.Kim2, 1. Michigan State University, East
Lansing, Michigan, 2. Harvard University, Boston,
Massachusetts
As individuals get older, they revise their thoughts and
expectations about the future. Several theories in gerontol-
ogy and developmental psychology make predictions about
the ways in which perceptions about the future might change.
However, little empirical data exists on changes in expecta-
tions about the future, particularly over large stretches of an
individuals life. The current study presents data from multiple
longitudinal studies (the Institute for Human Development
Studies, the National Survey of Midlife Development in the
United States, and the Health and Retirement Study) that
collectively measure changes in expectations about the future
from age 7 to age 97. Results demonstrate increasingly posi-
tive evaluations about the future from early life until older
adulthood, followed by more negative evaluations among
the oldest old. Follow-up analyses examine correlations
between future evaluations and changes in physical health.
Implications for lifespan development and perceptions of
aging during the second half of life are discussed.
SESSION 665 (SYMPOSIUM)
THE IMPORTANCE OF CONTROL BELIEFS FOR
SUCCESSFUL AND HEALTHY AGING
Chair: J.Drewelies, Humboldt University Berlin, Berlin,
Berlin, Germany
Co-Chair: D.Gerstorf, Humboldt-Universitat zu Berlin
Discussant: H.Wahl, Heidelberg University, Heidelberg,
Germany
Research has long acknowledged the dynamic nature of
control beliefs across the lifespan and its important role in
facilitating successful and healthy aging. This symposium
brings together four papers that highlight how control beliefs
do shape and are shaped by individual development in dif-
ferent contexts and phases of adult development. Koffer and
colleagues examine how associations among daily stress
processes and negative affect are related to both between-
and within-person control beliefs across the adult lifespan.
Robinson and Lachman examine if perceived control medi-
ates the relationship between conscientiousness and daily
physical activity. Drewelies and colleagues examine how
internal and external control beliefs relate to a broad range of
physical and cognitive functions of everyday using data from
the Berlin Aging Study II. Turiano and colleagues investigate
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
how levels and changes in control beliefs predicted mortal-
ity risk using data from the MIDUS study. The discussion by
Wahl integrates the four papers, highlights their theoretical
and methodological contributions, and considers challenges
and opportunities for inquiries on control beliefs.
DAILY CONTROL MODERATES STRESS REACTIVITY
AND BECOMES INCREASINGLY IMPORTANT WITH
AGE
R.Koffer1, J.Drewelies2, D.Gerstorf2, D.Almeida1, focus is on performance-based indicators of everyday physi-
N.Ram1,3, 1. Pennsylvania State University, University Park,
Pennsylvania, 2. Humboldt-Universitt zu Berlin, Berlin,
Germany, 3. German Institute for Economic Research
(DIW), Berlin, Germany
This study examines how associations among daily stress
processes and negative affect are related to both between-
and within-person control beliefs across the adult lifespan.
Analyses included participants from the Intraindividual Study
of Affect Health and Interpersonal Behavior, with N=150
adults aged 1889 assessed over T=63days. Multilevel mod-
els indicated that both lower levels of general control beliefs
and days with lower daily control beliefs are associated with
greater stressor reactivity. The association between stressor
reactivity and daily control beliefs is particularly strong
for those who experience generally higher levels of stressor
exposure. Older adults appear to be more vulnerable to the
association between daily control beliefs and stressor reactiv-
ity. We will discuss the theoretical importance of including
multi-time-scale risk and resilience factors when examining
the links between stress and well-being.
CONSCIENTIOUSNESS AND DAILY PHYSICAL
ACTIVITY: PERCEIVED CONTROL AS AMEDIATOR
S.Robinson, M.E.Lachman, Brandeis University, Waltham,
Massachusetts
Both conscientiousness and perceived control are posi-
tively related to health-promoting behaviors such as physi-
cal activity. The goal of the current study was to examine if
perceived control mediated the relationship between consci-
entiousness and daily physical activity. For seven days, 145
adults, ages 22 to 94, recorded physical activity and seden-
tary time with an Actigraph GT3X+, and rated their per-
ceived control over physical activity. Controlling for age, sex,
and education, multilevel models revealed that on days with
higher perceived control there were greater Kcals, METs,
and time-spent in moderate to vigorous physical activity, and
less sedentary time. Conscientiousness was related to greater
daily perceived control over activity and negatively related to
sedentary time; daily control beliefs mediated this relation-
ship. The findings extend our understanding of the mecha-
nisms linking conscientiousness, perceived control, and
physical activity, and suggest that control beliefs and person-
ality should both be considered when developing physical
activity interventions.
EXTERNAL, NOT INTERNAL CONTROL RELATES
TO PHYSICAL FITNESS AND COGNITIVE
PERFORMANCE IN OLDER ADULTS
J.Drewelies1, S.Duezel2, I.Demuth3, E.Steinhagen- now much more varied than it was in the past with oppor-
Thiessen3, U.Lindenberger2,4, J.Heckhausen5, D.Gerstorf1,
1. Psychology, Humboldt University Berlin, Berlin, Berlin,
IAGG 2017 World Congress
277
Germany, 2. Max Planck Institute for Human Development,
Berlin, Berlin, Germany, 3. Charit Universittsmedizin
Berlin, Berlin, Berlin, Germany, 4. Max Planck University
College London Centre for Computational Psychiatry and
Ageing Research, London, United Kingdom, 5. University
of California, Irvine, California
Lifespan research has shown that control beliefs are asso-
ciated with key outcomes of successful aging. However, little
is known about whether such associations exist when the
cal and cognitive. We test how control beliefs relate to physi-
cal and cognitive functioning and investigate age differences
in the direction and size of such associations. We analyzed
data from 1,090 older adults (Mage=70.11 years; SD=3.9;
range 6188; 51% women) who participated in the Berlin
Aging Study-II using structural equation modeling. Results
revealed that external control was related to physical health
(lower grip strength) and cognitive performance-based indi-
cators (poorer working memory) examined. Findings high-
light the differential role of internal and external control
beliefs for successful aging.
CONTROL BELIEFS AND LONGEVITY: ANALYSIS OF
LEVEL AND CHANGE
N.A.Turiano, N.M.Silva, P.S.Mehta, S.Spears, West
Virginia University, Morgantown, West Virginia
Control beliefs, representing an individuals perceived
ability to meet the challenges of life, are associated with
a host of positive developmental and health outcomes.
However, less is known about how changes in control beliefs
are related to health. Utilizing 20-year mortality data from
a national sample of over 6,000 adults from the MIDUS
study, we tested whether baseline levels of control beliefs,
and 10-year change in control predicted mortality risk using
Cox proportional hazards modeling. Net of age, sex, educa-
tion, race, and marital status, results indicated that baseline
control (HR = 0.89; CI = 0.84 - 0.94) as well as 10-year
control change (HR=0.85; CI=0.77 0.94) predicted mor-
tality risk. Individuals endorsing stronger control beliefs, as
well as those who increased in control over the 10-year fol-
low-up had substantially reduced hazards of dying. Findings
underscore the dynamic shifts in psychological functioning
are important for health and longevity.
SESSION 670 (SYMPOSIUM)
UNDERSTANDING LATER CAREERS:
ACOMPARATIVE ASSESSMENT
Chair: S.Vickerstaff, University of Kent, Canterbury, Kent,
United Kingdom
Discussant: B.Beach, International Longevity Centre - UK,
London, United Kingdom
In much research on older workers the emphasis has been
on transitions to retirement and questions of what encour-
ages people to stay in work. This symposium reorients the
focus slightly to look at later careers or late life employment
experiences. In the popular imagination later working life is
tunities to work flexibly, come in and out of paid employ-
ment or enjoy an encore career. The contributions to this
278
symposium, which brings together a range of international
research projects, have looked critically at these issues from
different perspectives and with different methodological
approaches.
Papers in the symposium cover later careers in the UK, the
US and Switzerland. As a starting point a paper explores the
way in which policies which impinge on later careers may
have unintended consequences. Following this a project tak-
ing a life course perspective explores how certain accumu-
lated disadvantages or advantages can limit the options that
some older workers have. Two further papers utilise sequence
analysis of longitudinal data sets to provide a detailed picture
of the steps people are taking in their later working careers
amplifying both the range of differences between people and
the degree to which individuals are experiencing complex
work endings. Finally combining longitudinal quantitative
data with rich case study based qualitative data provides an
opportunity to look in depth at the constraints on later life
work changes and why people may find it difficult to change
direction or downshift.
THE CONSEQUENCES OF ABOLISHING UK
MANDATORY RETIREMENT AGES
D.Lain, University of Brighton, Brighton, United Kingdom
In 2011 mandatory retirement ages were abolished in
the UK, constraining employers in their ability to retire off
employees at fixed ages. Historically, UK employees have
had few employment rights beyond age 65 and line man-
agers often decided which workers could continue working
(Vickerstaff, 2006). Thus far, there has been little research on
the implementation and impact of this reform at an organisa-
tional level. This paper therefore presents findings from case
study research in which workers, managers, trade unions and
HR professionals were interviewed in four organisations.
The findings show that the impact of these changes depended
upon the organisational context. Furthermore, the reforms
had a number of unintended consequences. This included
one organisation ending a gradual retirement scheme, on the
assumption that such schemes would now be legally indefen-
sible. Policy-makers therefore need much greater awareness
of the implementation of policies such as this at an organi-
sational level.
THE IMPACT OF LIFE-COURSE PSYCHOLOGICAL
HEALTH ON LABOUR FORCE PARTICIPATION AND
EXIT IN LATER LIFE
C.Clark1, M.Smuk1, D.Lain2, S.Stansfeld1, M.van dimensions: working-time, career continuity, retirement tim-
der Horst3, S.Vickerstaff3, 1. Queen Mary University
of London, London, United Kingdom, 2. University of
Brighton, Brighton, United Kingdom, 3. University of Kent,
Canterbury, United Kingdom
Adulthood psychological ill-health has implications for
receipt of disability pension but less is known about the
impact on other types of labour force participation and exit,
or about the role of childhood psychological ill-health. This
study examined associations between labour force participa-
tion at 55years and lifecourse psychological health using the
1958 British birth cohort data. Labour force participation
was self-reported at 55 years. Psychological ill-health was
reported at 7, 11, 16, 23, 33, 42 and 50years. Childhood and
adulthood psychological ill-health were both associated with
Innovation in Aging, 2017, Vol. 1, No. S1
work place exit at 55y in terms of unemployment, permanent
sickness and being a homemaker. The associations observed
between childhood psychological health and labour force
exit at 55y were largely independent of adulthood psycho-
logical ill-health and other adulthood factors. There were no
gender differences. Childhood psychological ill-health may
distally influence labour force participation and exit, having
implications for the extending working lives agenda.
RETIREMENT SEQUENCES OF OLDER AMERICANS:
MODERATELY DE-STANDARDIZED AND HIGHLY
STRATIFIED ACROSS GENDER, CLASS, AND RACE
I.Madero-Cabib1,4, E.Calvo3,4, U.M.Staudinger3, 1.
Universidad de Chile, Santiago, Chile, 3. Columbia
University, New York, New York, 4. Universidad Diego
Portales, Santiago, Chile
This study analyzes the de-standardization in older
Americans later-life careers. The focus is on the complexity
in type, order, and timing of retirement sequences, as well as
on their gender, class, and race stratification. Using sequence
analysis on panel data including 7,881 individuals from the
Health and Retirement Study (HRS), this study identifies six
types of retirement sequencesearly, complete, partial, late,
ambiguous, and compactthat cannot be adequately sum-
marized under the conventional model, where individuals
completely retire from a full-time job. Stratified analyses sug-
gest that retirement sequences for women, individuals with
lower education, and Blacks are more heterogeneous and
precarious than for men, highly educated individuals, and
Whites, respectively. Additional results provide only partial
support for reversible retirement sequences and changes in
labor-force status happening at different ages. Overall, these
findings suggest that retirement sequences in the United
States are fairly de-standardized and strongly shaped by
social stratification factors, but to some extent also irrevers-
ible and age-graded.
THE LIFE COURSE DETERMINANTS OF
VULNERABILITY IN LATE CAREERS
I.Madero-Cabib1,2, 1. Universidad Diego Portales, Santiago,
Chile, 2. Universidad de Chile, Santiago, Chile
Late career is often seen as a more vulnerable life-stage
in the labour market, in which workers may experience a
deterioration in job quality. Using a life course perspective
and longitudinal data, this article analyses the vulnerability
associated with late career by focusing on four occupational
ing and income change. The research is carried out using
data from Switzerland, a country where the age profile of the
labour force is an increasing issue. The paper also adopts a
cumulative disadvantage perspective to examine the impact
of previous work and family life experiences on work life
vulnerability at older age. Our data come from the Survey of
Health, Ageing and Retirement in Europe (SHARELIFE). The
paper uses cluster analysis, sequence analysis and ordered
logistic regression. Results show that women with previous
family responsibilities resulting in long-term unemployment
or caring, often with health complications, are more likely
to be vulnerable to deterioration in job quality in late career.
This suggests that experiences in the last period of the work-
ing life may be just as gendered as earlier periods.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
EXTENDING WORKING LIVES IN THE UK: WHY
DONT WE SEE MORE VARIATION?
M.van der Horst, S.Shepherd, S.Vickerstaff, Social ADULTS
Policy, Sociology and Social Research, University of Kent,
Canterbury, Kent, United Kingdom
In a recent paper we showed that there is less variation
in later life careers than one would expect based on the pop-
ularity of terms like phased retirement, bridge jobs, and shapes health among African Americans. While prior
un-retirement. These concepts seemed more topical than
typical, at least in the UK. In this paper we assess why this
is the case by going more in depth quantitatively and inves-
tigating five qualitative case studies; Transport, Hospitality,
Local Government, Manufacturing, and Mining. We will
place special attention on what individuals say they want in
later working life as well as investigate actual and perceived
barriers. By combining strengths of quantitative and qualita-
tive research we are in a unique position of being able to
provide policy advice based on general patterns as well as a
deeper understanding of why we see these patterns. We also
provide employers with insight on what could extend older
workers labour force attachment.
SESSION 675 (SYMPOSIUM)
DISCRIMINATION AND HEALTH ACROSS THE LIFE
COURSE
Chair: R.J.Thorpe, Johns Hopkins Bloomberg School of
Public Health, Baltimore, Maryland
Co-Chair: C.Hill, NIH\NIA\OD\ODD\SPP
Discussant: T.Lewis, Emory University, Atlanta, Georgia
There is a paucity of research that seeks to understand
why race disparities in health across the life course remain
elusive. One such explanation that has been garnering atten-
tion is discrimination. This symposium contains papers
seeking to address the impact of discrimination on health
or health disparities across the life course. First, Hargrove
investigates the extent to which multiple dimensions of dis-
crimination account for skin color disparities in hyperten-
sion among 976 African Americans adults in the Coronary
Artery Risk Development in Young Adults Study. This author
reports significant intragroup heterogeneity in the discrimina-
tion-health link. Second, Cobb and Thorpe examine the rela-
tionship between the frequency of everyday discrimination
and pulse pressure among 7,181 Black, Latino, and White
older adults who participated in the 2006/2008 Health and
Retirement Study. These authors report that the frequency of
perceived everyday discrimination may differentially affect
pulse pressure of older Whites and Blacks. Third, Thomas
examines the relationship between social class discrimina-
tion (SCD) and mental health among 627 Black adults in
the Nashville Stress and Health Study. This author demon-
strates that SCD impacts mental health across the life course.
Finally, Byrd examines racial disparities in cognitive ability
among 991 older black and white adults in waves 4 and 5 of
the Americans Changing Lives Study. There was no impact
of discrimination on race disparities in cognitive ability over
time. These presentations collectively bolster our knowledge
of how discrimination impacts health and health disparities
across the life course.
IAGG 2017 World Congress
279
SKIN COLOR, DISCRIMINATION, AND
HYPERTENSION AMONG AFRICAN AMERICAN
T.Hargrove1, E.Leslie2, 1. Sociology, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina, 2.
Vanderbilt University, Nashville, Tennessee
Skin color is a significant source of stratification that
research provides evidence that discrimination experiences
vary by skin color, the ways that discrimination influences
the skin color-health relationship remain unclear. This study
investigates the extent to which multiple dimensions of dis-
crimination, including experience, frequency, and degree of
stressfulness, account for skin color disparities in hyperten-
sion among African Americans adults age 43 to 55. Analyses
of three types of discrimination (racial, gender, social class)
in the Coronary Artery Risk Development in Young Adults
Study (N=976) indicate that the health consequences of the
experience of each type of discrimination, and the stressful-
ness of racial discrimination, vary by skin color in ways that
disadvantage those of darker skin. This study demonstrates
that there is significant intragroup heterogeneity in the dis-
crimination-health link. Future research should unpack the
differential health consequences of discrimination among
multiply disadvantaged groups.
EVERYDAY DISCRIMINATION AND BLOOD
PRESSURE IN OLDER WHITES, BLACKS, AND
LATINOS
R.J.Cobb1, R.J.Thorpe2, 1. University of Southern
California, Los Angeles, California, 2. John Hopkins
University, Baltimore, Maryland
Despite ongoing interest in the link between every-
day discrimination and cardiovascular health throughout
the lifecourse, few studies have examined links between
the frequency of everyday discrimination and pulse pres-
sure among older adults. Data from the 2006/2008 Health
and Retirement Study was used to examine whether pulse
pressure varies by exposure to day to day discrimination.
Multivariate linear regression models were conducted to
test associations between frequency of perceived everyday
discrimination and pulse pressure among Whites, Blacks,
and Latinos. In models adjusted for age, sex, education,
health behaviors, and blood pressure medication, recount-
ing frequent everyday discrimination relative to individuals
who reported no exposure to everyday discrimination had
the highest pulse pressure scores. These results indicate that
the frequency of perceived everyday discrimination may dif-
ferentially affect pulse pressure of older Whites and Blacks.
Future research is needed to determine whether this associa-
tion persists over time.
SOCIAL CLASS DISCRIMINATION AND THE MENTAL
HEALTH OF BLACK ADULTS
C.S.Thomas, University of California, Los Angeles, Los
Angeles, California
Self-reported discrimination is a stressor linked to mental
health among Blacks. Although past studies emphasize racial
discrimination, mistreatment on the basis of other statuses
(e.g. social class) may also influence health. This study exam-
ines the relationship between social class discrimination
280
(SCD) and mental health. Data are from 627 Black adults
ages 18 to 69 in the Nashville Stress and Health Study.
Outcomes assessed include depressive symptoms (CES-D)
and psychological distress (0=low, 1=high). Two types of
SCD are examined: major and day-to-day SCD (0=none,
1=SCD, 2=other discrimination). Logistic regression analyses
indicate experiences of major (CES-D: OR=3.80, CI: 1.77
8.16; Distress: OR=3.01, CI: 1.029.26) and day-to-day
(Distress: OR=3.14, CI: 1.029.76) SCD are associated with
poor mental health, but these effects diminish in later life.
Findings demonstrate the impact of SCD on Blacks men-
tal health across the life course. Future research is needed to
understand the protective effect of age in this relationship.
DOES DISCRIMINATION PLAY AROLE IN RACIAL
DISPARITIES IN COGNITIVE ABILITY AMONG
OLDER U.S. ADULTS?
D.Byrd, Community Health Sciences, UCLA Fielding
School of Public Health, Los Angeles, California
Race and stress exposure are associated with cognitive
ability among older adults. This study examines racial dis-
parities in cognitive ability among aging black and white
adults enrolled in waves 4 and 5 of the Americans Changing
Lives Study (N =991). Cognitive ability was assessed at both
waves such that changes in cognitive impairment symptoms
were examined longitudinally, controlling for cognitive sta-
tus and risk factors that were measured at wave 4.Results
show whereas there was no main effect of stressful life events
or discrimination on cognitive ability, there was a significant
race effect, =-.195, p=.013. Inconsistent with predictions, The positive association of greater autonomy with work-
there was no significant interaction between race and dis-
crimination. Thus race, rather than social stressors, appears
to influence cognitive ability among aging adults. In particu-
lar, blacks experience greater rates of cognitive impairment
over time compared to whites. This finding highlights the
importance of addressing racial disparities in cognition.
SESSION 680 (SYMPOSIUM)
INDIVIDUAL AGENCY IN WORK AND CAREER:
ADAPTATION DURING ADULTHOOD AND OLD AGE
Chair: J.Heckhausen, University of California-Irvine,
California
The increasingly globalized world economy has ren-
dered careers and life-course trajectories of employment
less predictable and more responsive to individuals efforts.
Individuals increasingly are expected to shape their job
characteristics and to respond to challenges associated with
aging-related constraints in work demands and job condi-
tions. Presentations in this symposium address the way in
which individuals play an active role in shaping their work
activities and conditions, as well as how they respond to chal-
lenging conditions in their work life. Heckhausen and Shane
present findings from MIDUS I, II, and III (age range: 20 to
93years) on age trajectories of work-related engagement as
a function of age and occupational characteristics. Zacher
examines active job crafting in a sample of workers (age-
range: 18 to 76 years) showing age-differential trends and
effects of increasing structural and social resources as well as
Innovation in Aging, 2017, Vol. 1, No. S1
challenging and hindering demands. Vogelsang, Olson, and
Shultz investigate the social and personal influences on late
life career change and their effects on emotional well being of
older workers, showing a pervasive positive effect of invest-
ing extra financial resources as well as some benefits of fam-
ily support and agency. Scheibe conducted daily surveys with
workers from diverse backgrounds and discovered that older
workers are better able to manage negative emotions associ-
ated with negative work events.
ACTIVE INVESTMENT INTO WORK ACROSS
ADULTHOOD: AGE-GRADED AND OCCUPATIONAL
INFLUENCES
J.Heckhausen1, J.Shane2, 1. University of California-
Irvine, Irvine, California, 2. City University of New York,
Brooklyn, NYC, New York City, New York
How does the amount of thought and effort that individu-
als devote to work change across adulthood? Which individ-
ual and workplace characteristics modify this age trajectory?
We examine these questions using the Midlife in the United
States National Study of Health and Well Being (MIDUS
I, II, and III) that spans 20 years with individuals ranging
in age from 20 to 93years. Participants reported a general
decline in work-related engagement starting in midlife and
dropping off progressively rapidly as they entered into and
passed the typical age of retirement. However, individuals
reported enhanced work-related engagement when working
in a managerial or professional job, their workplace granted
them greater autonomy, and they felt valued and respected.
engagement was most pronounced through midlife, whereas
during older age feelings of being valued and respected at
work were associated with greater work engagement.
JOB CRAFTING ACROSS ADULTHOOD:
IMPLICATIONS FOR FUTURE TIME PERSPECTIVE
AND RETIREMENT INTENTIONS
H.Zacher, University of Leipzig, Leipzig, Germany
Job crafting involves workers actively changing the
demands and resources of their job to increase the fit
between their personal needs and the work environment.
This study examines relationships between worker age
and four dimensions of job crafting: increasing structural
resources, increasing social resources, increasing challeng-
ing job demands, and decreasing hindering job demands.
Moreover, interactive effects of age and job crafting dimen-
sions on workers occupational future time perspective and
retirement intentions are investigated. Data came from 1,779
workers between 18 and 76years. Results showed that age
was positively related to increasing structural resources and
negatively related to increasing social resources and decreas-
ing hindering demands. Increasing structural resources was
more beneficial among younger adults with regard to occu-
pational future time perspective, whereas older workers ben-
efited more from increasing challenging demands in terms
of occupational future time perspective and lower retirement
intentions. Implications for future research and practical
interventions are discussed.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
LATER LIFE CAREER CHANGES AND POSITIVE
EMOTIONAL OUTCOMES: THE ROLES OF AGENCY
AND SOCIAL RESOURCES
E.Vogelsang1, K.S.Shultz1, D.Olson2, 1. California State
University-San Bernardino, San Bernardino, California, 2.
University of La Verne, La Verne, California
More individuals are attempting career changes in later
life as an increasing number of older adults face precarious
retirement prospects. Although many of these older job seek-
ers eventually find new livelihoods, little is known about their
emotional well-being subsequent to these changes. Using
respondents from the 2014 New Careers for Older Workers
Study who successfully navigated a career change after age
45 (n=337), we evaluate the contributions of demographic
characteristics, agency, and resources when estimating three
measures of career-oriented emotional well-being. We found
that having financial resources during the career transition
was associated with all three optimistic emotional outcomes;
while family support and intentionality were also associated
with more positive emotions. Conversely, prior job prestige
and additional job training had no relationships with career-
oriented well-being. These results suggest that later life career
change, despite its challenges, often results in positive emo-
tional outlooksfor those with the resources to support it.
SESSION 685 (SYMPOSIUM)
IMPROVING DEMENTIA CARE AND OUTCOMES
ACROSS SETTINGS OF CARE
Chair: S.Zimmerman, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina
Discussant: L.P.Gwyther, Duke University, Durham, North
Carolina
The number of people with dementia residing in communi-
ties, assisted living, nursing homes, and other aged care homes
across the globe is certain to increase. Despite great strides that
have been made achieving better care and outcomes for people
with dementia, gaps still exist some of which are universal,
and others of which are especially pressing in relation to spe-
cific settings of care. This symposium, sponsored by the Social
Research, Policy, and Practice Section of the Gerontological
Society of America, includes four evidence-based presentations
of new programs and data to improve care and outcomes for
persons with dementia; the work was conducted in the U.S.and
Australia, and is broadly applicable. The first session describes
an efficacious program to help family caregivers attend to
medical signs and symptoms of their relative with dementia;
the second addresses care in assisted living residences, focus-
ing on potentially inappropriate antipsychotic use and other
strategies to address behavioral symptoms of dementia; the
third examines quality of life in relation to behavioral and psy-
chological symptoms of dementia in nursing homes; and the
fourth presents a goals of care intervention fostering focused
communication and care planning in relation to individualized
goals to prolong life, support function, or improve comfort in
nursing homes. The discussant, Lisa Gwyther, is past president
of the Gerontological Society of America and an international
expert on dementia caregiving; she will discuss the global rel-
evance of the findings for caregivers and care settings and how
to improve dementia care moving into the future.
IAGG 2017 World Congress
281
HELPING FAMILY CAREGIVERS ATTEND TO
MEDICAL SIGNS AND SYMPTOMS OF RELATIVES
WITH DEMENTIA
P.D.Sloane1, S.Zimmerman1, A.S.Beeber1, L.P.Gwyther2,
B.Matchar2, C.Lathren1, K.Ward1, 1. University of North
Carolina, Chapel Hill, North Carolina, 2. Duke University,
Durham, North Carolina
Few resources provide guidance to family caregivers when
an individual with dementia has health-related symptoms
and may need medical care. This session will present and dis-
cuss the design and outcomes of web-based resources and a
book, both entitled Alzheimers Medical Advisor, developed
under a grant from the U.S. National Institutes of Health.
To field test these resources, 193 caregivers (142 web ver-
sion, 51 paper version) were enrolled and followed to learn
incident health conditions, use of and attitudes regarding the
resource, and change in caregivers outcomes (confidence,
burden, anxiety, depression). Over six months, nearly 90%
of participating caregivers reported having to address new or
worsening organ-specific, nonspecific, and behavioral symp-
toms; pre-post data indicated significant (p<.001) improve-
ment in caregiver confidence knowing about, deciding about,
taking care of, and enacting behaviors, as well as reduction
(p<0.05) in caregiver role strain.
TREATING BEHAVIORAL SYMPTOMS OF DEMENTIA
IN ASSISTED LIVING
S.Zimmerman1, P.D.Sloane1, S.Miller1, D.Reed1,
J.Preisser1, J.T.Hanlon2, 1. University of North Carolina,
Chapel Hill, North Carolina, 2. University of Pittsburgh,
Pittsburgh, Pennsylvania
Assisted living residences (ALRs) have become a notable
site of care for persons with dementia in the U.S., as have
similar settings across the globe. Concern has been raised,
however, that ALR staff are not trained to address behavioral
symptoms of dementia, and that antipsychotic medications
are being used inappropriately to manage symptoms. This
session will present data on non-pharmacologic and phar-
macologic practices in the U.S., drawing on national esti-
mates, data from 280 ALRs across seven states, and from 90
ALRs in one state. Illustrative statistics are that nationally,
more than one-third of residents display behavioral symp-
toms, almost 60% of who are treated with a medication; that
antipsychotic medications are more often prescribed in ALRs
that have memory care units (p<.05); and that staff largely
have the capacity to implement practices such as therapeu-
tic touch or environmental modification, but rarely do so.
Implications of findings across countries will be discussed.
UNPACKING THE INFLUENCE OF DEMENTIA-
RELATED SYMPTOMS ON QUALITY OF LIFE OF
NURSING HOME RESIDENTS
E.R.Beattie1, E.Fielding1, W. He1, W.Moyle2, 1. Queensland
University of Technology, Brisbane, Victoria, Australia, 2.
Griffith University, Brisbane, Queensland, Australia
The presence and severity of behavioral and psycho-
logical symptoms of dementia (BPSD) influence the eve-
ryday comfort of nursing home residents. Within a larger,
nationally representative study of Australian nursing homes
(n=53) conducted by the Aus-QoL group, this presentation
examines the relationship between BPSD and quality of
282
life (QoL). Depression (Geriatric Depression Scale), agita-
tion (Cohen-Mansfield Agitation Inventory) and wandering
(revised Algase Wandering Scale) were rated by staff and
used as indicators of a latent BPSD variable in relation
to QoL (Quality of Life-Alzheimers Disease scale), with
demographic and health characteristics as exogenous vari-
ables. The relationship between BPSD and staff-rated QoL
was strong and negative (n=216, =-.71). For resident-rated
QoL, the relationship was significant but weaker (n=150,
=-.16). Notable among the correlates was the significant
negative relationship of resident nutrition to all three BPSD
indicators. These results support the need for early individual
attention to ameliorate the impact of BPSD on QoL.
PROMOTING GOALS OF CARE TO IMPROVE
DECISION MAKING IN NURSING HOMES
L.Hanson1, S.Zimmerman1, M.Song2, F.Lin1, S.Dury, L.De Donder, Vrije Universiteit Brussel, Brussels,
C.Rosemond1, T.Carey1, S.Mitchell3, 1. University of Belgium
North Carolina, Chapel Hill, North Carolina, 2. Emory
University, Atlanta, Georgia, 3. Harvard University, Boston,
Massachusetts
In the U.S., two-thirds of people with dementia die in
nursing homes, meaning family members are positioned
to inform care from admission through the end of life.
Unfortunately, communication between family, staff, and
medical providers about issues such as life-sustaining treat-
ments is limited, often resulting in unwanted, aggressive
treatments. This study of a Goals of Care decision aid aimed
to facilitate goals-based communication and care planning
related to prolonging life, supporting function, or improving
comfort. It included viewing a decision aid and participat-
ing in a care plan meeting, and was tested in a cluster rand-
omized trial with 302 family decision-makers in 22 nursing
homes. Results found high fidelity (> 90% received the entire
intervention), and family reported better quality of overall
(p<.05) and end-of-life communication (p<.02); there was
more palliative care content in treatment plans (p<.02), and
significantly fewer hospital transfers. This intervention can
easily be replicated in other countries.
SESSION 690 (SYMPOSIUM)
EFFECTS FROM LABOR MARKET PARTICIPATION
ON FRAILTY AND SOCIAL EXCLUSION IN LATER
LIFE?
Chair: N.De Witte, Vrije Universiteit Brussel, Brussels,
Belgium
Numerous studies have shown that labor market partici-
pation affects living conditions during work life in many fac-
ets (e.g. financial and social). However, less is known how
previous labor market participation affects life in retirement.
In this symposium we discuss the effects of labor market
participation on two later life conditions: social exclusion
and frailty. To explore the underlying processes this sympo-
sium embraces a multi-method, multi-disciplinary and multi-
national approach.
Sofie Van Regenmortel starts with a qualitative study. By
analyzing life story interviews in Belgium, she explores the
influence of labor market participation on old-age social
exclusion. Second, Michael Van der Elst presents a Belgian
Innovation in Aging, 2017, Vol. 1, No. S1
quantitative cross-sectional study in which he examines the
relationship between the timing of labor market exit and
frailty and its different dimensions. Third, Martin Wetzel
presents a study using German longitudinal data in which he
investigates changes in perceived social exclusion at retire-
ment depending on the last labor market status. Patricia
Navarrete demonstrates the association of labor based
employee benefits and frailty among Mexican older adults.
Since the symposium embraces different methods and an
international approach, Nico De Witte will discuss the dif-
ferent findings and summarizes the different effects of former
labor market participation on later life outcomes.
LABOR MARKET PARTICIPATION ACROSS THE LIFE
COURSE: IS THERE ADOMINO EFFECT?
S.Van Regenmortel, A.Smetcoren, B.Fret, D.Lambotte,
Despite an increasing focus on the effects of the life course
on inequalities in health and wellbeing, a life course approach
has found little attention in social exclusion research. One
major aspect of the life course, labor market participation,
is often not included when examining old-age social exclu-
sion. The current study examines qualitatively how labor
market participation across the life course relates to dimen-
sions of old-age social exclusion (e.g. material resources and
participation). This study analyzes life story interviews from
44 Belgian older adults (60+). The interviews are based on
McAdams life story scheme (2008). Results demonstrate
that in older adults life stories, labor market is frequently
mentioned and strongly associated with financial and mate-
rial resources. Throughout the life course, labor market
inclusion strongly influences dynamics in and out of exclu-
sion. The study highlights the evidence for a domino effect
from labor market participation on old-age social exclusion.
THE RELATION BETWEEN EARLY RETIREMENT
AND THE ONSET OF FRAILTY IN BELGIAN OLDER
ADULTS
M.Van der Elst1, B.Schoenmakers1, D.Vert2, L.De
Donder2, N.De Witte2,3, J.De Lepeleire1, and D-SCOPE
Consortium, 1. University of Leuven, Leuven, Belgium, 2.
Free University Brussels, Brussels, Belgium, 3. University
College Ghent, Ghent, Belgium
Studies have shown that on average 11% of the older
adults are frail. People with lower incomes are more likely to
be frail. Research shows that early retirement leads to lower
retirement income, but could also cause loss of social con-
tacts, as the work environment is a source for social contact.
The current study examines the relationship of retirement
age and frailty in the later life and takes various dimensions
(physical, social, psychological and environmental) of frailty
into account. Across-sectional method is used. The data are
retrieved from the Belgian Ageing Studies, a large-scale
survey (N=30 984)of community dwelling older people aged
60 and older. Frailty is operationalized by the Comprehensive
Frailty Assessment Instrument (CFAI). Results are showing
that retirement affects various dimensions of frailty differ-
ently. The discussion highlights the long-term effect of early
retirement.
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Innovation in Aging, 2017, Vol. 1, No. S1
IN OR OUT OF SOCIETY? RETIREMENT AFFECTS
PERCEIVED SOCIAL EXCLUSION IN GERMANY
M.Wetzel1, K.Mahne2, 1. University of Cologne, Cologne,
Germany, 2. German Centre of Gerontology, Berlin,
Germany
Previous studies have shown that perceived social exclusion
(PSE) depends crucially on individual access to resources but
also on the possessed social status. Employment status predicts
both resources and status and thus unemployed show serious
social disadvantages. We expect that the transition into retire-
ment is associated with a loss in resources and status (increasing
PSE) for those previously working while those previously not
working profit due to a change in social status (decreasing PSE).
Using longitudinal data from Germany, we estimated FE-panel
regression models for 627 retirees. Those previously working
report lower levels of PSE than those not working. Contrary to
our expectations, retirement did not affect PSE for those pre-
viously working. However, for those not working previously,
retirement decreased PSE. We hence assume that for those pre-
viously working retirement depicts a transition just from one
valued status to another. For those not working, retirement indi-
cates a reduction of stigmatization.
EMPLOYEE BENEFITS AND FRAILTY IN MEXICAN
COMMUNITY-DWELLING OLDER ADULTS
A.Navarrete-Reyes1, J.Avila-Funes1,2, 1. Instituto Nacional
de Ciencias Mdicas y Nutricin Salvador Zubirn, innovations and collaborations that resulted from the imple-
Mexico City, Mexico, 2. Universit Victor Segalen Bordeaux
2, Bordeaux, France
Frailty has been associated with increased risk for adverse
health-related outcomes. Several factors, including some
financial and labor issues, have been linked to the develop-
ment of such a phenotype.
This cross-sectional study of 927 community-dwelling
older adults living in Mexico City aimed to identify the asso-
ciation between employee benefits (EB) and frailty status.
Eight EB were reported while frailty was identified according
to the phenotype proposed by Fried etal.
Frailtys prevalence was 14.1%. Participants reported
the following EB: bonuses (12.3%), profit sharing (23.6%),
pension (44.9%), health insurance (50.6%), food stamps
(15.7%), housing credit (11.6%), life insurance (13.2%) and
Christmas bonus (54.8%). Multinomial logistic regression
analyses showed that EB were statistically associated with
frailty (OR 0.85; 95% CI 0.740.98; P=0.027).
The found associations and the underlying differences
are important for preventing frailty in the elderly. Further
research with longitudinal data is needed to examine the
underlying mechanisms.
SESSION 695 (SYMPOSIUM)
MEDICARE AND MEDICAID INTEGRATION:
RESULTS OF CALIFORNIAS DUAL FINANCIAL
ALIGNMENT DEMONSTRATION
Co-Chair: C.L.Graham, University of California, Berkeley,
Berkeley, California
B.Hollister, University of California, San Francisco, San
Francisco, California
Discussant: L.OShea, NHS England, London, United
Kingdom
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Over 9.6 million seniors and adults with disabilities in
the United States (US) are dually eligible for Medicaid and
Medicare. These beneficiaries (called duals) have, on aver-
age the most complex care needs and account for a dispro-
portionate share of spending in both programs. The Patient
Protection and Affordable Care Act gave the Centers for
Medicare and Medicaid Services (CMS) the authority to
develop and test new models for integrating care for duals.
Californias dual alignment demonstration (the largest of the
12 state demonstrations) passively enrolled over 120,000
[ML1] dually eligible beneficiaries into Cal MediConnect
(CMC) health plans, where Medicare and Medicaid services
(including long-term services and supports -LTSS) were coor-
dinated through a capitated managed care model. Enrollees
received additional care coordination, transportation ser-
vices, and expanded vision and dental benefits. Beneficiaries
could opt out of the program and keep fee for service
Medicare.
Using a participatory evaluation approach, research-
ers worked with diverse stakeholders including the state
Medicaid agency, CMC health plans, disability advocates,
provider groups and consumers to design an evaluation of
the program. The evaluation sought to document health plan
innovation and health system response to the demonstration,
as well as beneficiaries experiences with care. In this sym-
posium, researchers will present results outlining the unique
mentation of the program. Additionally, results of a repre-
sentative telephone survey of 2,139 beneficiaries examining
the demonstrations impact on access to care, continuity of
care, and managed LTSS will be presented.
HEALTH PLAN INNOVATION IN CALIFORNIAS
DUAL ALIGNMENT DEMONSTRATION
B.Hollister2, C.L.Graham1, 1. School of Public Health,
University of California, Berkeley, Berkeley, California,
2. University of California, San Francisco, San Francisco,
California
The implementation of Californias dual alignment
demonstration resulted in a significant shift in practice for
many stakeholders including: Managed Care Organizations
(MCOs), providers, nursing homes, long term services and
supports (LTSS) providers, and community based organi-
zations that serve dually eligible beneficiaries. Evaluators
conducted 36 key informant interviews with various stake-
holders to document health system response and innovations
resulting from program implementation. Findings reported
will include: (1) health plan innovation and development
of care coordination programs; (2) program impact on
collaboration and coordination across agencies, (3) chal-
lenges, lessons learned, and recommendations for replica-
tion. Anecdotes and case studies are used to tell the story
of, and lesson learned from, Cal MediConnect from various
perspectives.
THE IMPACT OF CARE COORDINATION IN
MEDICARE-MEDICAID INTEGRATION PROGRAMS
C.L.Graham1, P.Liu2, 1. School of Public Health,
University of California, Berkeley, Berkeley, California,
2. University of California, San Francisco, San Francisco,
California
284
This paper presents results of a cross-sectional telephone
survey of 2,139 adult, dually eligible beneficiaries, includ-
ing: 744 enrolled in CMC, 659 eligible beneficiaries who
opted out, and 736 from non-demonstration counties in
California. Results suggest that CMC care coordination
is working well: those using care coordination were more
likely to be satisfied with benefits and scored higher on
measures of access to care than non-users. Of those who
experienced disruptions in care after the transition, care
coordination users were more likely to report those dis-
ruptions resolved than non-users. However, the only char-
acteristic that predicted use of care coordination was use
of behavioral health. Those in poor health and those with
functional limitations, both characteristics that predict
more disruptions in care, were not more likely to receive
care coordination. Presenter will discuss the importance of
risk stratification to ensure that it is being administered to
those with the most complex care needs.
MANAGED LONG-TERM SERVICES AND SUPPORTS
IN CALIFORNIAS DUALS DEMONSTRATION
C.L.Graham1,2, S.Kaye2, 1. School of Public Health,
University of California, Berkeley, Berkeley, California,
2. University of California, San Francisco, San Francisco,
California
Beginning in 2014, Californias duals demonstration
enrolled over 120,000 dually eligible seniors and people with
disabilities into managed care organization (MCO). 44% of
these rely on LTSS, now coordinated by the MCO. Fourteen
focus groups and a representative survey (N=1,306) with
beneficiaries in the demonstration revealed that most ben-
eficiaries are unaware that their LTSS is coordinated by the
plan. LTSS users satisfaction with the plan is lower than
non-LTSS users. And their use of LTSS does not differ from a
control group of LTSS users from non-demonstration coun-
ties. About half still have unmet need for personal assistance,
and over a third have unmet needs for medical equipment
and supplies. Less than half had been contacted by a care
coordinator and only a third remembered getting an indi-
vidualized care plan from the MCO. Challenges to fully
integrating LTSS into MCOs for duals in California will be
discussed by authors.
SESSION 700 (SYMPOSIUM)
A CROSS-CULTURAL COMPARISON OF APPROACHES
TO ELDER MISTREATMENT RESEARCH AND
INTERVENTIONS
Chair: R.Snyder, The John A.Hartford Foundation, New
York, New York
Discussant: T.Fulmer, The John AHartford Foundation,
New York
Elder Mistreatment and Abuse is a growing concern
as populations are ageing around the world. Leaders in
both research and practice have contributed to a body of
literature that provides evidence-based models for assess-
ment and intervention. This symposium brings together
world leaders who are the executives of the International
Longevity Centers in their countries. Each will discuss the
Innovation in Aging, 2017, Vol. 1, No. S1
approaches both in research and practice in their respective
countries that represent of Argentina, Canada, Japan and
the United Kingdom. The president of the International
Network for the Prevention of Elder Abuse will open the
symposium with an overview of the organizations mis-
sion in preventing elder abuse and raising public aware-
ness. The president of the major foundation the focuses on
improving care for older people in the United States, who is
also a prominent researcher and practitioner in elder mis-
treatment, will serve as the discussant to summarize the
overall impact of the current research and best practices
provided by each of the presenters and to provide a review
of how a philanthropic foundation can catalyze programs
for elder mistreatment interventions. The panelists will
engage in a robust discussion on best practices across cul-
tures and will provide useful information on developing
cultural competencies in addressing elder mistreatment
in multi-cultural societies. This session will highlight the
importance of understanding cultural sensitivity in design-
ing research and developing programs in addressing elder
abuse and mistreatment. This is a joint symposium of
The John Hartford A. Foundation and the International
Longevity Centre Global Alliance.
GLOBAL OVERVIEW OF ELDER ABUSE AND THE
INTERNATIONAL ORGANIZATION THAT SEEKS TO
PREVENT IT
S.Somers, The International Network for the Prevention of
Elder Abuse, New York, New York
The International Network for the Prevention of Elder
Abuse is a significant organization that raises the awareness
of abusive and neglectful situations that cause harm to older
people across the globe. This presentation will highlight the
importance for country leaders to share best practices in
research and practice that will not only help raise awareness
throughout societies but will also work collaboratively in
designing programs that will be evidence-based and cultur-
ally sensitive.
SOUTH AMERICAS EXEMPLAR NATIONAL
CAMPAIGN ON ELDERS CRIME PREVENTION IN
ARGENTINA
L.Daichman, International Longevity Center-Argentina,
Buenos Aires, Argentina
A leading geriatrician and expert in elder abuse and for-
mer president of INPEA has spearheaded a public-private
partnership to prevent crimes against older people. Together
with other relevant NGOs, Dr. Daichman helped to develop
a National Campaign on the Prevention of Elder Abuse
and Respect for the Rights of Older Persons. This session
will provide practical information on the feasibility of such
partnerships as well as the preliminary results of the cam-
paigns effectiveness in reducing criminal activities against
Argentinas older citizens.
ADDRESSING ELDER ABUSE IN JAPAN, THE OLDEST
COUNTRY IN ASIA
M.Osako, N.Tsukada, International Longevity Center
Japan, Tokyo, Japan
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Innovation in Aging, 2017, Vol. 1, No. S1
Despite the common perception that Japan with its
traditional emphasis on filial piety would not need laws
protecting older persons against abuse, in 2005 the coun-
try enacted The Law for Preventing the Abuse of Older
People and Providing Assistance to Caregivers. The law
addresses abusive and neglectful acts committed by
caregivers in domestic and institutional settings. This
paper will discuss trends in elder abuse in Japan since
2006 using annual surveys conducted by the Ministry of
Health, Labour and Welfare. It will also explore possi-
ble reasons for certain key findings (such as the marked
increase in violence in institutional settings) as well as
promising features created by the law (e.g., establishment
of municipal shelters for victims). The paper suggests
(a) increasing counseling opportunities for abusers and
(b) reducing caregivers stress and workload as possible
measures to reduce elderly abuse.
IN EUROPE THE UNITED KINGDOMS UNIQUE
CAPABILITY OF INFLUENCING POLICIES RELATED
TO ELDER ABUSE
S.Greengross, International Longevity Centre- United
Kingdom, London, United Kingdom
Baroness Greengross will speak of the United Kingdoms
capability of influencing policies related to elder abuse. The
key issues in the UK include financial abuse and, as the general
incidence of dementia increases, how the impact on cognition
and decision-making capability is adversely affecting the asso-
ciated risk factors for abuse. In terms of improving legislative
protection she will highlight the campaign to introduce a new
aggravated offence of elder abuse designed to help remedy
the failure of the current criminal justice system to adequately
prosecute perpetrators of abuse. Baroness Greengross will
also address the particular issues faced by minority commu-
nities. Additionally, she will discuss the dilemma that often
abuse of older people goes unreported and sometimes can be
passive, either because someone lacks the skills or external
support necessary to adequately care for another person, or
simply through unintentional neglect.
SESSION 705 (SYMPOSIUM)
GAINING ALONGITUDINAL UNDERSTANDING OF
CULTURE CHANGE PRACTICE ADOPTION IN U.S.
NURSING HOMES
Chair: S.C.Miller, Brown University, Providence, Rhode
Island
Discussant: C.E.Bishop, Brandeis University, Weston,
Massachusetts
Nursing home (NH) culture change strives to improve
NH quality through deep systematic change. However,
while studies suggest its implementation is associated with
improved quality outcomes, empirical evidence of its value
is inconclusive due to methodological challenges. To over-
come many of these challenges, we designed a panel study
using our nationally representative Time 1 (2009/10) sur-
vey data from U.S. NHs and newly collected Time 2 sur-
vey data from NHs that responded at Time 1.The Time 1
survey focused on the critical domains of Environmental
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285
Practices (i.e., homelike environment), Resident Care
Practices (i.e., resident-centered/-directed care), and
Workplace Practices (i.e., staff empowerment). The Time
2 survey was expanded to include additional items to
enhance measurement of these three domains as well as to
measure the additional domains of NH Leadership (i.e.,
modeling and enabling of culture change) and Family and
Community (i.e., inclusion/involvement). In early 2016,
the Time 2 survey was administered to 2,152 nursing
home administrators (NHA). While follow-up is contin-
uing, 834 (39%) NHAs have responded. In this sympo-
sium we present findings on the: 1) studys framework
and survey design, including the cognitive-based inter-
viewing performed to identify the NH leader to target at
Time 2; 2)change in practice between 2009/10 and 2016;
3) practice in 2016 for the five measured domains; and
4) associations between domain scores and outcomes of
interest. Study findings indicate significant improvement
in domain scores between Times 1 and 2.Planned research
will examine whether these improvements are associated
with improvements in quality outcomes.
NURSING HOME CULTURE CHANGE: STUDY
FRAMEWORK AND SURVEY INSTRUMENT DESIGN
S.C.Miller1, D.Tyler2, R.Shield1, M.Lepore2, R.Dahal1,
M.Clark3, 1. Brown University, Providence, Rhode Island,
2. Research Triangle Institute (RTI), Washington, District of
Columbia, 3. University of Massachusetts Medical School,
Shrewsbury, Massachusetts
While this study uses the commonly used term cul-
ture change, it is the processes and structures promoting
person-centered care (and their hypothesized outcomes)
that we study. This measurement is guided by the Holistic
Approach to Transformational Change (HATCh) model
that depicts six interrelated domains needed for NHs to
make care more individualized. The Time 2 survey meas-
ures five domains, with the sixth domain (Government
and Regulations) derived from existing data sources. All
time 1 survey items were included in the Time 2 survey.
Additional candidate items came primarily from exist-
ing survey instruments, and are supported through validity
testing. Items were refined through extensive cognitive-
based testing and through guidance from an expert advi-
sory committee representing provider and culture change
organizations. We used an ecological conceptual frame-
work to hypothesize the relationships among domains and
how domain processes and structures are influenced by the
context in which they are performed.
USING COGNITIVE TESTING TO IMPROVE
ACULTURE CHANGE SURVEY
D.Tyler2,1, C.Berridge3,1, R.Shield1, S.C.Miller1, 1. Brown
University, Providence, Rhode Island, 2. RTI International,
Waltham, Massachusetts, 3. University of Washington,
Seattle, Washington
The purpose of this study was to cognitively test ques-
tions for our nursing home (NH) culture change survey
and determine which NH leader to target. Cognitive-
based testing systematically tests survey questions to
determine respondents understanding of questions and
286
reveal thought processes involved in providing an answer
to help increase validity and improve response rates. We
conducted in-person interviews with 30 NH adminis-
trators (NHAs) and directors of nursing (DONs) in 15
NHs. Responses by NHAs and DONs were compared
within facilities and across all facilities. Results showed
that where the NHA and DON from the same facility
provided different answers to the questions, the DON
often provided a higher, more favorable response. Because
data showed DONs tended to rate their facilities higher
than did NHAs across survey domains, and given NHA
responses appeared valid (based on interviews), we deter-
mined the survey should be administered to NHAs.
U.S. NURSING HOME CULTURE CHANGE: THEN
AND NOW
J.C.Lima1, M.Clark2, M.L.Schwartz1, C.Berridge1,
D.Tyler3, R.Shield1, M.Lepore4, S.C.Miller1, 1. Brown
University, Providence, Rhode Island, 2. University of
Massachusetts Medical School, Shrewsbury, Massachusetts,
3. Research Triangle Institute, Waltham, Massachusetts,
4. Research Triangle Institute, Washington, District of
Columbia
We examined culture change practices within the same
U.S.nursing homes (NHs) in 2009/10 and 2016. The propor-
tion of NHs engaged in at least some culture change practices
remained steady (87.2% vs. 87.7%). We calculated changes
in scores across three domains using items measured at both
time points (homelike physical environment, staff empower-
ment, and resident-centered/directed care). Cronbach alphas
ranged from 0.40 to 0.65. For NHs with domain scores at
both time points, more than half scored as high or higher at
Time 2 on staff empowerment and resident care (58% and
70%, respectively) while only 37% scored as high or higher
on physical environment (p values <.01). We recalculated
domain scores at Time 2 using the expanded set of survey
items. Scores correlated well with the original versions and
Cronbach alphas improved (range 0.63 to 0.78). Compared
to T1 measures, on average NHs improved across all three
domains.
FAMILY AND COMMUNITY AND LEADERSHIP
CULTURE CHANGE PRACTICES IN U.S. NURSING
HOMES
M.L.Schwartz1, C.Berridge3, J.C.Lima1, D.Tyler2,
R.Shield1, M.Lepore2, S.C.Miller1, 1. Brown University,
Providence, Rhode Island, 2. RTI International, Waltham,
Massachusetts, 3. University of Washington, Seattle,
Washington
We used data from 834U.S. nursing homes (NH) to
understand culture change practice for the two domains
added to our 2016 survey: family and community, and lead-
ership. Domain scores reflect the average performance on
nine and ten questions respectively, scored from 0 (rare) to
3 (almost always). Mean domain scores were 1.6 (sd=0.46)
for family and community and 1.40 (sd=0.32) for leader-
ship. No differences in performance were observed by nurs-
ing home characteristics for either domain. Performance on
both domains was correlated (p<0.05) with all other survey
domains. We also assessed the relationship between leader-
ship practices (by score quartiles) and the outcome of nursing
Innovation in Aging, 2017, Vol. 1, No. S1
assistant retention above 50% (at 12months), using multi-
variate logistic regression. After adjusting for NH character-
istics, compared to NHs in the lowest quartile of leadership
domain performance, NHs in the highest quartile had 2.04
(95% CI: 1.183.53) greater odds of experiencing retention
above 50%.
STAFFING EMPOWERMENT PRACTICES IN NURSING
HOMES WITH UNIONIZED NURSING ASSISTANTS
C.Berridge1, M.L.Schwartz1, D.Tyler2, R.Shield1,
S.C.Miller1, 1. Brown University, Providence, Rhode
Island, 2. Research Triangle Institute, Waltham,
Massachusetts
A key component of culture change is staffing empow-
erment supported by nursing home management. On the
labor side, collective bargaining is one strategy to improve
labor conditions; however, it is unknown if unionized
facilities implement staff empowerment practices asso-
ciated with culture change. In this paper, we examine
changes in nursing assistant unionization in U.S facili-
ties, compare staff empowerment practices for unionized
and non-unionized facilities, and model the relationship
between empowerment practices, leadership practices, and
union status. Using a 14-item composite measure to score
facilities empowerment practices, we find that unionized
and non-unionized facilities do not differ significantly.
Staff are more often cross-trained in unionized facilities
and less likely to work with the same residents or receive
rewards for extra training/education. After adjustment, we
find that empowerment practices do not differ as a factor
of union status (b=.035; 95% CI: -.022, .092), but are lin-
early associated with higher leadership scores.
SESSION 710 (SYMPOSIUM)
USING TECHNOLOGIES TO IMPROVE HEALTHCARE
AND QUALITY OF LIFE IN THE VULNERABLE
ELDERLY
Chair: G.Leonard, Universite de Sherbrooke/ Research
Center on Aging, Sherbrooke, Quebec, Canada
Discussant: P.Boissy, Universite de Sherbrooke/ Research
Center on Aging, Sherbrooke, Quebec, Canada
N.Lapierre, University of Montreal, Montreal, Quebec,
Canada
Aging is often associated to higher risk for many nega-
tive health related events. For example, it is well known that
falls increase significantly with age and their consequences
are often dramatic. Similarly, the changes observed in sen-
iors, be them associated with normal aging or pathological
processes, often generate important mobility impairments
that can greatly affect quality of life. Finally, behavioral and
psychological symptoms of dementia (BPSD) and chronic
pain are serious health problems in aging populations that
can negatively affect the wellbeing of patients and the work
environment of the healthcare team. Early detection of falls
and limitations in community mobility, as well as identifica-
tion and management of BPSD and chronic pain in elderly
individuals who have difficulty communicating because of
dementia remain a challenge for healthcare providers. The
current symposium will address these important issues and
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Innovation in Aging, 2017, Vol. 1, No. S1
will provide concrete examples on how technologies such as
intelligent videomonitoring, mobile applications on smart-
phones and wearables sensors can be leveraged to provide
outcome measures that can be used to identify elderly indi-
viduals who fall in their environment, have mobility limita-
tions, exhibit disturbing BPSD or who suffer from chronic
pain. More than simply detecting falls, mobility limitations,
BPSD and pain, the proposed technologies offer healthcare
professionals the possibility of assessing the underlying/
contributing factors related to these negative health related
events, in order to propose an approach of care that has a
beneficial impact for the patient and can improve his quality
of life.
BEHAVIORAL SYMPTOMS AND FALLS IN LONG-
TERM CARE FACILITIES: PERCEPTIONS OF
GERONTECHNOLOGY
A.Bourbonnais1,2, J.Rousseau1,2, J.Meunier1, M.Gagnon3,
M.Lalonde1,2, N.Lapierre1,2, D.Trudeau4, 1. Universit de
Montral, Montreal, Quebec, Canada, 2. Research Centre
of the Institut Universitaire de Griatrie de Montral,
Montreal, Quebec, Canada, 3. Universit Laval, Quebec,
Quebec, Canada, 4. Centre Intgr des Services de Sant
et Services Sociaux du Centre-Sud-de-lle-de-Montral,
Montreal, Quebec, Canada
Two of the most frequent problems in long-term care
facilities (LTC) are behavioral symptoms and falls of older
people living with Alzheimers disease or associated disor-
ders. Intelligent videomonitoring and mobile application are
potential gerontechnologies to help manage these problems.
However, evidence about the needs for technologies in LTC is
scarce. The goal of this study was to explore the perceptions
and needs of managers, formal and family caregivers in LTC
regarding these technologies, as well as the conditions and
ethical challenges that could influence their use. Individual
interviews and a content analysis were conducted. Results
show the relevance of these technologies in LTC and the
characteristics that make them useful. Based on these results,
technologies could be developed to improve the quality of
clinical practice in LTC.
OLDER WOMENS PERCEPTION REGARDING
AVIDEOMONITORING SYSTEM AT HOME
N.Lapierre1,2, J.Meunier1, J.Filiatrault1,2, A.St-Arnaud3,
M.Paquin1,2, C.Duclos1,4, C.Dumoulin1,2, J.Rousseau1,2,
1. University of Montreal, Montreal, Quebec, Canada,
2. Centre de Recherche de lInstitut Universitaire de
Griatrie de Montral, Montral, Quebec, Canada, 3. CLSC
Lucille-Teasdale, Montral, Quebec, Canada, 4. Centre de
Recherche Interdisciplinaire en Radaptation, Institut de
Radaptation Gingras-Lindsay- de-Montral, Montral,
Quebec, Canada
Although ambient technologies are promising to Aging-
in-place, few were studied at home. In a project aiming at
monitoring night walks of older women at risk of falls, a
videomonitoring system (VS) was implemented at home.
The study aimed to explore their perception about the VS.
Using a multiple case study design, the study included six
women with the following characteristics: 1) 65 years
old, 2)living alone, 3) 1 fall within the year, 4)waking up
IAGG 2017 World Congress
287
nightly for going to the toilet. Their walks were recorded
seven nights, on movement detection, for a time-window
of their choice. Participants perception was explored
using pre- and post-videomonitoring-installation inter-
views. Data were qualitatively analysed. Participants, who
feared to feel intruded, got used to the system and trusted
it to protect privacy (eg. blurred images). Some technology
features (eg. movement detection) eased their experience.
Results support the use of ambient technologies at home.
QUANTIFICATION OF FREE-LIVING MOBILITY
IN COMMUNITY LIVING OLDER ADULTS USING
WEARABLE SENSORS
P.Boissy1, M.Blamoutier2, C.Duval2, 1. Universit de
Sherbrooke/ Research Center on Aging, Sherbrooke,
Quebec, Canada, 2. Universit du Qubec Montral/
Institut Universitaire de Griatrie de Montral, Montral,
Quebec, Canada
With the advent of miniaturized body worn sensing tech-
nology it is now possible to collect and store data on differ-
ent aspects of mobility under free-living conditions for long
period of time. 88 older adults living in the community in
Montreal (Canada) wore for 12days a data logging platform
incorporating a GPS receiver with an 3D accelerometer. loca-
tion, activity, travel and Geospatial distribution of mobility
were extracted and compared across participants using ICF
measures body structures and function (cognitive status,
depressive symptoms, body composition, pain), personal
(age, gender, education, revenue) and environmental (social
participation, living situation, walking access to shop and
services, access to a car). Results suggest that the proposed
mobility outcomes are sensitive to the different domain of
the ICF with environmental variables contributing signifi-
cantly to variation in mobility of community dwelling older
adults. On-going studies are looking at how aging and dis-
ease affect these mobility outcomes.
USING WEARABLE SENSORS TO IDENTIFY ELDERLY
INDIVIDUALS WHO SUFFER FROM PAIN
G.Leonard1, S.Laroche1, .Lagueux2, P.Boissy1, 1.
Rehabilitation, Universite de Sherbrooke/ Research Center
on Aging, Sherbrooke, Quebec, Canada, 2. Centre de
recherche du CHUS, Sherbrooke, Quebec, Canada
Chronic pain is a significant health problem in the elderly.
The management of chronic pain in this population often
remains a vexing challenge, notably for individuals who have
difficulty communicating because of dementia. The aims of
this study was to document, in these patients: (1) the feasibil-
ity of using a wearable plateform incorporating multiple sen-
sors (electrodermal activity blood volume pulse, acceleration,
heart rate, and temperature) during everyday life activities to
measure the activity of the autonomic nervous system; and
(2) the utility of using such measures to identify patients who
suffer from pain. Preliminary results indicate that wearable
technologies are well tolerated by patients and provide use-
ful information for the management of chronic pain. Clinical
applications, as well as potential barriers and pitfalls will be
discussed.
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SESSION 715 (SYMPOSIUM)
CHRONIC DISEASE MANAGEMENT THROUGH
AMASCULINITY LENS
Co-Chair: S.Solimeo, Department of Veterans Affairs,
Center for Comprehensive Accesss & Delivery Research
and Evaluaiton (CADRE) Iowa City VA HCS, Iowa City,
Iowa
E.H.Thompson, College of the Holy Cross, Broadview
Heights, Ohio
Discussant: T.M.Calasanti, Virginia Tech, Blacksburg,
Virginia
Charmazs 1994 seminal discussion of the identity dilem-
mas among chronically ill men underscored the importance
of masculinity to how men manage and live with a chronic ill-
ness. Recognizing the diversity of masculinities across nations
and communities, this symposium brings together scholars
from different parts of the world to discuss how age and gen-
der intersect to affect older mens chronic illness experiences.
Gibson assesses the disruptions Parkinsons Disease brings to
British mens expectations of a masculine, aging embodiment.
Pietila and Ojala discuss Finnish older mens alliance on their
aging bodies to help dilute how prostate cancer undermines
body integrity and the mens sense of self as men. Drawing
on a small sample of middle aged and older US men diag-
nosed with breast cancer, Thompson discusses the ways men
with breast cancer confront the identity challenges of living
with feminine disease and its gendered treatment protocol.
Solimeo and her colleagues draw on a large sample of older
adults undergoing bone density testing for osteoporosis to
assess the efficacy of how men manage their illness compared
to women vets. Cumming and his colleagues review the bear-
ing of geriatric syndromes and frailty on the independence
among old Australian men as men. Calasantis discussion will
affirm the importance of not only how age and gender intersect
to affect chronic disease experiences but also how masculini-
ties differentially affect chronic disease management. People
attending the symposium will better understand the value of
using a gendered lens when studying disease management.
I EXPECTED TO BE SLOW, BUT NOT THIS SLOW:
PARKINSONS DISEASE AND EMBODIMENT IN
MENS AGEING
G.Gibson, University of Stirling, Stirling, Scotland, United
Kingdom
Fifteen years since Thompsons (2007) call for the study
of mens ageing, theorisation of masculinity and its embodi-
ment as men age remain in their infancy. Despite offer-
ing opportunities to explore both mens bodily states and
hegemonic notions of masculinity as men age, chronic ill-
nesses have only rarely been studied using a lens of mens
ageing. Using data from 30 narrative interviews with 15 men
living with Parkinsons Disease, a progressive neurological
disorder affecting movement and mobility, this presentation
explores the disruptions chronic illness brings to a mascu-
line, ageing embodiment. Drawing on Watsons (2000) male
body schema, PD disrupts visceral, pragmatic and experien-
tial dimensions of embodiment. In turn these also intersect
with mens expectations of bodily ageing and the differing
social concerns within mens lives as they age. Learning out-
comes include promoting greater empirical engagement with
Innovation in Aging, 2017, Vol. 1, No. S1
how gender and ageing intersect within mens experience of
chronic illness.
WHEN BEING AN OLD MAN BECOMES AN
ADVANTAGE: PROSTATE CANCER SURVIVORS
PERCEPTIONS OF MASCULINITY
I.Pietil, H.Ojala, University of Tampere, Tampere, Finland
Both old age and prostate cancer have been thought to
threaten mens masculine identities. Our qualitative analysis
of interviews with 40 Finnish men with prostate cancer (50
70years) shows that younger interviewees indeed expressed
fears of losing their masculinity due to sexual dysfunctions
caused by radical cancer treatments. However, the older inter-
viewees often referred to their age as a factor, which made it
easier for them to cope with such effects. Reaching a higher
age set the interviewees free from masculine norms revolving
around sexual prowess. They attached such norms to younger
mens lives and underlined economic balance and stability in
their families as bedrocks of an older mans good life. Old
age thus became a positive resource for the men in coping
with chronic illness and maintaining a masculine identity. The
study highlights how cultural images of masculinity and age-
ing are intertwined in mens interpretations of chronic illness.
MEN WITH BREAST CANCER: MARGINALIZING OR
THREATENING TO BEING AMAN?
E.H.Thompson, 1. Sociology & Anthropology, College of
the Holy Cross, Broadview Heights, Ohio, 2. Case Western
Reserve University, Cleveland, Ohio
This research explores how men experience being a breast
cancer patient in the US, and how their experiences are sanc-
tioned by the nations rendering of breast cancer as a womans
disease. Based on the sociological tradition of investigating
the marginal man who is destined to live in two, not merely
different but antagonistic cultures, mens encounters with
breast cancers pink ribbon culture and hegemonic masculin-
ity are ideal for better understanding how gender does affect
mens chronic illness experience. Interviews with 17 men
with breast cancer revealed that they are seen first by them-
selves as much as others in terms of their gender rather than
their illness. Being diagnosed with and needing to be treated
for breast cancer was unmistakably challenging. Distinct
themes were deeply rooted throughout the mens narratives
and conspicuous within nearly every interview: (1) surviving
personal marginalization, (2) embodiment of (their breast)
cancer, and (3) gendered agency.
GENDER AND OSTEOPOROSIS SELF-EFFICACY
AMONG OLDER ADULTS PRESENTING FOR BONE
DENSITY TESTING
S.Solimeo1,2, T.Nguyen3, S.Edmonds2,4,5, Y.Lou9,
D.W.Roblin6,7, K.G.Saag8, P.Cram10,11, F.D.Wolinsky2,4,12,
1. Department of Veterans Affairs, Center for
Comprehensive Access & Delivery Research and Evlaution
(CADRE), Iowa City VA Health Care System, Iowa City,
Iowa, 2. Division of General Internal Medicine, Department
of Internal Medicine, University of Iowa Carver College of
Medicine, Iowa City, Iowa, 3. Department of Epidemiology,
University of Iowa College of Public Health, Iowa City,
Iowa, 4. University of Iowa College of Nursing, Iowa
City, Iowa, 5. Department of Veterans Affairs, Iowa City
VA HCS, Iowa City, Iowa, 6. Kaiser Permanente, Atlanta,
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Innovation in Aging, 2017, Vol. 1, No. S1
Georgia, 7. Department of Health Management and
Policy School of Public Health, Georgia State University,
Atlanta, Georgia, 8. Division of Clinical Immunology
and Rheumatology, Department of Medicine, University
of Alabama at Birmingham, Birmingham, Georgia, 9.
Department of Biostatistics, University of Iowa College
of Public Health, Iowa City, Iowa, 10. Department of
Medicine, University of Toronto, Toronto, Ontario, Canada,
11. Division of General Internal Medicine, Mt. Sinai/UHN
Hospitals, Toronto, Ontario, Canada, 12. Department of
Health Management and Policy, University of Iowa College
of Public Health, Iowa City, Iowa
A number of studies have shown gender differences in
osteoporosis care such that men have lower rates of diag-
nosis, treatment, and poorer outcomes than women. In our
analysis, we evaluated gender differences in self-reported
confidence in ones ability to engage in bone health behav-
iors (i.e. consuming adequate dietary calcium and engaging
in exercise), as measured by the Osteoporosis Self-Efficacy
Scale (OSES). OSES was measured in 7,749 older adults pre-
senting for bone densitometry at three U.S.medical centers.
Overall, the calcium and exercise sub-scale scores are gen-
erally high and do not significantly differ by gender. OSES,
however, has poor measurement model fit both overall and
within gender groups, although the gender differences in the
measurement model are minor, reflecting factorial invari-
ance across genders. Given their generally high OSES sub-
scale scores, greater attention to mens barriers to preventive
care as an underlying factor in their poorer outcomes may
be warranted.
EPIDEMIOLOGY OF FRAILTY AND GERIATRIC
SYNDROMES IN OLDER AUSTRALIAN MEN
R.Cumming, N.Noguchi, V.Naganathan, F.Blyth, ADULTS WITH CHRONIC CONDITIONS AND
University of Sydney, Sydney, New South Wales, Australia
The geriatric syndromes (cognitive impairment, falls,
incontinence and poor mobility) and frailty are major causes
of loss of independence among older people. The aim of this
paper is to describe the prevalence and incidence of these con-
ditions among men participating in the Concord Health and
Ageing in Men Project (CHAMP), an epidemiological cohort
(panel) study of a representative sample of 1705 community-
dwelling Australian men aged 70years and over. At baseline,
only 21% of men had one or more of the geriatric syndromes
and only 10% were frail (based on Cardiovascular Health
Study criteria). After five years, 59% of men were still alive
and had not developed any of the geriatric syndromes. The
geriatric syndromes and frailty only became common after
age 85years. These data support the concept of the old old
(those aged 85years and over) as a distinct group requiring
specialised health and aged care services.
SESSION 720 (SYMPOSIUM)
GSA SRPP SECTION: DEFINITION, BUSINESS CASE,
AND IMPLEMENTATION OF PERSON-CENTERED
CARE
Chair: A.Coulourides Kogan, Keck School of Medicine of
USC, Claremont, California
Co-Chair: L.Mosqueda, Keck School of Medicine of USC
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289
Discussant: B.Chernof, The SCAN Foundation, Long
Beach, California
Person-Centered Care (PCC) is considered the gold
standard of health care and has recently been highlighted
in policy and practice. Previously, PCC has been limited by a
lack of single definition and confusing language (i.e. patient-
centered care, person-directed care, etc.) resulting in incon-
sistent operationalization in health and social service settings
serving older adults. Through a recent collaboration between
the American Geriatrics Society and a research team at the
University of Southern California and the Keck School of
Medicine of USC, a single, expert-informed definition of PCC
and eight essential elements has been developed for older
adults with chronic conditions and functional impairment.
This session will present the consensus definition, essential
elements, and research that lead to developing these pieces:
large systematic literature review, qualitative study of how
PCC is operationalized in a sample of outpatient health care
and social services organizations serving older adults, and
expert-panel conference. The next phase of this project was
to develop the business case for PCC upon the foundation
set by establishing the definition and common language for
PCC. This work will be presented along with an interactive
return on investment (ROI) calculator that we developed to
help organizations estimate their financial risks and benefits
of implementing PCC. Finally, the clinical perspective of
implementing PCC in a primary care geriatricians practice
will be presented. Discussing the challenges and benefits to
providing PCC for older adults is important to shed light on
the ideal vs. realistic provision of person-centered health care
and social service support.
DEFINING PERSON-CENTERED CARE FOR OLDER
FUNCTIONAL IMPAIRMENT
A.Coulourides Kogan1, K.H.Wilber2, L.Mosqueda1, 1.
Family Medicine and Geriatrics, Keck School of Medicine
of USC, Claremont, California, 2. University of Southern
California, Leonard Davis School of Gerontology, Los
Angeles, California
A single definition of person-centered care (PCC) is
needed to provide clarity and a consistent point of reference
for providing care, social services, conducting research, and
developing policy for older adults with chronic conditions
and functional impairment. Therefore, the purpose of this
study was to develop the clinical case for PCCrooted in
researchresulting in a single, agreed-upon definition and
essential elements for PCC. This presentation will discuss
the quantitative (large, systematic literature review) and
qualitative (study of outpatient health care and social service
organizations serving older adults) research methods used to
inform a single definition of PCC and essential elements, as
well as the interdisciplinary expert-panel process that devel-
oped the final version of these items. The final definition
and eight essential elements of PCC will be presented and
discussed, highlighting a newly established foundation for
future research, policy, and business analyses.
PERSON-CENTERED CARE: THE BUSINESS CASE
V.Tabbush, UCLA Anderson School of Management, Los
Angeles, California
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Evidence shows that person-centered care (PCC) can
improve care and quality of life for patients; often resulting
in fewer hospitalizations and ER visits, shorter hospital stays,
and other service use reductions leading to lower expendi-
tures. PCC is a recent health care priority (e.g. WHO, IOM,
and ACA), and given payment reforms for providing care to
older adults, creating a business case for PCC is imperative to
inform policy and highlight incentives beyond patient-level
outcomes for organizations to implement PCC. Therefore, the
project was conceived to develop a business case for PCC and
an interactive return-on-investment (ROI) calculator. These
two products can equip and encourage organizations consid-
ering adopting or expanding PCC with the requisite tools,
data, and motivation to systematically assess the business case
in their own circumstances. They highlight the factors that
affect the strength of the case, and shares encouraging evi-
dence suggesting that PCC can be financially beneficial.
OPERATIONALIZING PERSON-CENTERED CARE IN
PRIMARY CARE: AGERIATRICIANS PERSPECTIVE
L.Mosqueda, Keck School of Medicine of USC, Alhambra,
California
Person-centered care (PCC) is a holistic approach to
health care and social service provision that incorporates the
persons values, preferences, and beliefs and holds them (and
those close to them) at the center of all decision-making. This
type of care represents an important departure from tradi-
tional health care that has been characterized as paternalis-
tic, silloed, and marked by poor or a lack of communication
between providers and care sites. With the newly established
definition of PCC and essential elements, health care pro-
viders now have a clear point of reference from which to
provide individualized PCC to their patients. However, sys-
tematic, environmental, and patient/family-level barriers and
facilitators remain that may help or hinder the provision of
PCC. The purpose of this presentation is to highlight the
ideal vs. realistic practice of implementing PCC into a pri-
mary care setting serving older adults. Multiple case studies
will be presented to support discussion.
SESSION 725 (SYMPOSIUM)
STANDARDISATION OF HEALTH OUTCOME
MEASURES AND VALUE-BASED HEALTHCARE
Chair: J.Banerjee, University Hospitals of Leicester NHS
Trust, Leicester, United Kingdom
The International Consortium for Health Outcomes
Measurement (ICHOM) was founded in 2012 with the
aim to propose consensus-based measurement tools and
documentation for different conditions and populations.
Variation in outcomes of healthcare is a global challenge and
to date there are no comprehensive globally relevant out-
come measures for older persons. Measuring and reporting
meaningful outcomes matter because they are more likely to
identify what is deficient in a care pathway across organisa-
tional boundaries and lead to better collaborative care provi-
sion. It also provides opportunities for different localities or
organisations to compare variations in outcome and learn
from each other. There is paucity of standardized clinical out-
comes data beyond basic mortality and morbidity measures.
Innovation in Aging, 2017, Vol. 1, No. S1
There is also a paucity of balancing measures with a systemic
inability to measure unanticipated harm. The deficiency in
outcome measurements that matter most to patients repre-
sents a global barrier to driving health care improvement and
means providers have little information on which to judge
the effectiveness of interventions. Where available, outcomes
are not standardized and therefore hard to compare leading
to a slow pace of change and inability to learn from others.
More commonly there has been more emphasis placed on
process measures with the assumption that changing pro-
cesses improves outcomes for persons accessing healthcare.
ICHOMs Working Groups (WG) follow a structured
consensus-driven modified Delphi technique to recommend
a core battery of measures that reflect multiple outcomes
that matter to patients. This international standard of health
outcomes assessment has the potential to improve clinical
decision-making, to enable better commissioning and service
integration, to facilitate the exchange of scientific knowledge,
and overall to enhance the care of patients internationally
across different conditions. ICHOM has to date developed
19 standard sets and by 2017 at least 50% of the global dis-
ease burden (as defined by the WHO) will have been covered.
Anumber of national registries and organisations across the
world are already utilising ICHOM standard sets as their
outcome measures.
DEFINING ASTANDARD SET OF PATIENT-
CENTERED OUTCOMES FOR PATIENTS WITH
DEMENTIA
E.Reynish2,1, A.Burns1, C.Roberts1, 1. ICHOM Dementia
Working Group, London, United Kingdom, 2. Stirling
University, Stirling, United Kingdom
Materials and methods: ICHOM convened an interna-
tional, multi-disciplinary working group of patient represent-
atives, psychiatrists, carer, social worker, specialist nurses,
methodologists, psychologists, and registry experts to review
existing data and practices. Using a modified Delphi method,
the group developed a consensus Standard Set of outcomes
that were felt to matter most to patients, along with case-mix
variables for risk adjustment, that we recommend collecting
for all dementia patients.
Results: The recommended Standard Set covers all types
and stages of dementia. The outcomes include all-cause
survival, cognition, neuropsychiatric behaviour, patient-
reported domains of health-related quality of life and carer
health-related quality of life. Baseline demographic, clinical,
and condition information are included to improve interpre-
tation of comparisons.
Conclusion: We defined a Standard Set of outcomes for
people with dementia. The Set provides a universal rubric for
outcome comparisons, with the ultimate goal of improving
the value of care.
DEFINING ASTANDARD SET OF PATIENT-
CENTERED OUTCOMES FOR OLDER PERSONS
A.Akpan2,1, J.Banerjee3,1, C.Roberts1, 1. ICHOM Older
Person Working Group, London, United Kingdom, 2.
Aintree University Hospitals NHS Foundation Trust,
Aintree, United Kingdom, 3. University Hospitals of
Leicester NHS Trust, Leicester, United Kingdom
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Innovation in Aging, 2017, Vol. 1, No. S1
Materials and methods: ICHOM convened an interna-
tional, multi-disciplinary working group of patient repre-
sentatives, geriatricians, acute physicians, carers, community
specialists, specialist nurses, methodologists, psychologists,
and registry experts to review existing data and practices.
Using a modified Delphi method, the group developed a
consensus Standard Set of outcomes that were felt to matter
most to older persons, along with case-mix variables for risk
adjustment, that we recommend collecting for older persons.
Results: The recommended Standard Set is aimed at
covering on average, the last 10 years of life calculated by
life expectancy at age 60. The outcomes include all-cause
survival, falls, polypharmacy, patient-reported domains
of health-related quality of life and carer burden. Baseline
demographic, clinical, and comorbidity information are
included to improve interpretation of comparisons.
Conclusion: We defined a Standard Set of outcomes for
older persons. The Set provides a universal rubric for out-
come comparisons, with the ultimate goal of improving the
value of care.
THE IMPLEMENTATION OF ICHOM STANDARD SET
OF OUTCOMES
J.Banerjee, A.Akpan, E.Reynish, C.Roberts, ICHOM,
London, United Kingdom
The ICHOM Dementia Standard Set of outcomes is being
piloted across a variety of provider settings and health econo-
mies, within `Implementation Communities` in England and
Scotland, supported by ICHOM. Dementia is a high priority
issue for NHS England and the UK Government and cur-
rent data metrics for dementia care tend to capture processes
and costs, and do not measure whether they achieve the out-
comes that matter most to those with dementia.
The Dementia Implementation Community will enable
providers to capture the ICHOM Dementia Standard Set in a
manner that is scalable nationally, and will ultimately include
every patient with dementia who enters each participating
health economy. The systematic measurement of Standard
Sets of outcomes will enable global outcome comparisons,
leading to improvements in the quality of care and the out-
comes. The broader scope will aim to take the lessons learnt
and extend this towards outcomes measurement for more
patients internationally.
SESSION 730 (SYMPOSIUM)
IAGG INTERNATIONAL COUNCIL OF THE
GERONTOLOGY STUDENT ORGANIZATION:
COLLABORATIVE NETWORKS FOR EMERGING
SCHOLARS: LOCAL, REGIONAL, AND
INTERNATIONAL PERSPECTIVES
Chair: K.S.Hall, Veterans Affairs/Duke University Medical
Centers, Durham, North Carolina
Co-Chair: C.Meyer, Royal District Nursing Service
Institute, St Kilda, Victoria, Australia
There is growing interest in aging research internationally,
yet many students and emerging scholars are uncertain of
the process of establishing, building, and maintaining local,
regional, and international connections. To address this need,
the IAGG Council of Student Organizations (IAGG-CSO)
IAGG 2017 World Congress
291
offers a symposium of several presentations and a structured
discussion bringing a multidisciplinary and multicultural
perspective to the topic of engaging in gerontological net-
works. Emerging scholars are pursuing, more than ever, pro-
fessional networking opportunities spanning local, regional,
and international borders. As access to quality information
and communication technology increases across the globe,
the field of Gerontology is approaching a new frontier, with
emerging scholars looking to establish collaborative research
networks unrestricted by geographical boundaries. This sym-
posium explores the why and how of engaging locally
and internationally. This symposium includes paper presen-
tations reflecting an international perspective (IAGG-CSO
Executive Committee members who are emerging scholars
from Australia, Canada, and the United States); a regional
perspective on the challenges of networking across vast dis-
tances where there may be few student organizations; and
the local perspective by the Emerging Scholars Professional
Organization of the United States, on the establishment and
momentum of a successful student organization. To conclude
the session, the audience will be engaged in an interactive
discussion of how to foster engagement at a local, regional
and international level.
THE MISSION OF IAGG-CSO TO FACILITATE
NETWORKS AMONG STUDENT ORGANIZATIONS
C.Meyer, 1. Royal District Nursing Service Institute,
St. Kilda, Victoria, Australia, 2. Centre for Health
Communication and Participation, La Trobe University,
Bundoora, Victoria, Australia
The IAGG-CSO is a standing committee of the IAGG,
represented currently by three executive members from
Australia, Canada and the United States. The IAGG-CSO
works to support its members (student and emerging scholar
sections within IAGG member sections, international geron-
tology/geriatric student and emerging scholar networks, and
individuals working to create student sections) and foster
participation and networking opportunities across the globe,
particularly focused on the Regional and World Congresses.
The IAGG-CSO is well placed to facilitate networking
through regular newsletter contributions, commencement
of a webinar series, development of a social media group
(LinkedIn), and a vibrant student and emerging scholar pro-
gram at the Regional and World Congresses. The symposium
audience will be used to garner ideas regarding capacity
building and local and international engagement for mem-
bers, together with understanding how the IAGG-CSO can
better meet the needs of members moving forward into the
next 4year cycle of IAGG secretariat.
MAKING MENTORING MEANINGFUL
S.Freeman, University of Northern British Columbia,
Prince George, British Columbia, Canada
Mentorship plays an important role to support students
and emerging scholars as they progress through their careers.
Yet, it can be difficult to forge successful relationships as
a mentee receiving guidance and support from established
senior persons in ones field and as a mentor to other stu-
dents and emerging scholars. This symposium will provide
practical advice on how to start and sustain effective and
mutually beneficial mentor and mentee relationships. We will
292
share examples of successes and failures experienced by men-
tors and mentees and share tips and strategies to support
development and sustainability of positive relationships. We
will address the role of mentorship in a virtual world and
opportunities for international collaboration and network-
ing. We will also share how the IAGG CSO is working to
support students and emerging scholars to build these rela-
tionships through our experiences leading national organiza-
tions (Canadian Association on Gerontology and Australian
Association of Gerontology).
THE CHALLENGES OF FORMING MEANINGFUL
COLLABORATIVE NETWORKS ACROSS VAST
DISTANCES
K.S.Hall1, K.James2, 1. Medicine-Geriatrics, Veterans
Affairs/Duke University Medical Centers, Durham, 2.
University of Stellenbosch, Cape Town, South Africa
The global community of students and early career schol-
ars span many continents, often over vast geographic dis-
tances. Locating and connecting students and early career
scholars is challenging and relies on excellent and consistent
communication via various forms of media and technologi-
cal advances. The speakers for this presentation will share
their own insights and ideas, citing specific challenges and
opportunities by region. This session will be structured to
facilitate active discussion among the audience on the pos-
sibilities for forming and maintaining meaningful collabora-
tive networks into the future.
THE ROLE OF INDIVIDUAL COUNTRY STUDENT
SECTIONS AND THE IMPORTANCE OF
NETWORKING
J.Hughes, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina
Student sections within national gerontology and geri-
atrics societies offer a wealth of professional development
and programmatic supports to students and emerging schol-
ars in the region. However, the IAGG-CSO recognizes that
many students are training in the absence of such networks,
in regions that do not have active student sections. This ses-
sion is meant to provide important resources for individual
scholars who are interested in establishing a regional student
section as well as tips for leveraging the resources of exist-
ing regional student sections. We will discuss the importance
of establishing a regional student section and practical tools
for initiating this process, using the GSAs Emerging Scholar
and Professional Organization as a model. Best practices for
expanding personal and professional networks and how to
leverage student organizations to streamline and strengthen
this process will also be discussed. Strategies for thriving and
surviving the frenetic IAGG World Congress environment
will be presented.
SESSION 735 (SYMPOSIUM)
EXPLAINING THE PHYSICAL AND PSYCHOLOGICAL
IMPACTS OF HUMAN-ANIMAL INTERACTION ON
OLDER ADULTS
Chair: N.R.Gee, SUNY, Fredonia, Fredonia, New York
Discussant: N.Sachs-Ericsson, Florida State University,
Tallahassee, Florida
Innovation in Aging, 2017, Vol. 1, No. S1
Physical activity (PA) is a well-recognized indicator and
determinant of health while sedentary behaviour (sitting or
reclining) has been identified as an independent risk factor
for poor health. Evidence indicates that while overall PA
level decreases with age, older adults are also normally the
most sedentary section of the population.
Dog ownership, and in particular dog walking as a fea-
ture of ownership, has been shown to be positively related
to overall PA levels in a range of age groups (Christian,
Westgarth, et. al., 2013). Most of this evidence has been
drawn from studies which used self-report PA measures.
The first presentation in this symposium reports the
results from a study using an objective measure of PA in
older adult Dog Owners (DOs) and Non-Dog Owners
(NDOs). The presentation discusses the impact of physical
activity on indicators of health and sets the stage for the fol-
lowing presentation.
The second presentation in this symposium discusses a
biopsychosocial model, frequently used by researchers to
explain the effects of Human-Animal Interaction (HAI), and
presents results from the Pet Assisted Living (PAL) interven-
tion on community dwelling older adults in the context of
the model.
The biopsychosocial model provides a framework for
understanding how multiple contributors can be related to
chronic disease outcomes in older adults. Research in HAI
has demonstrated that companion animals may directly
influence physiological arousal by decreasing blood pressure
and heart rate, reducing depression or anxiety and increas-
ing social support. Each of which can affect the other realms
within the biopsychosocial model and ultimately support
health.
THE PET ASSISTED LIVING (PAL) INTERVENTION
FOR ASSISTED LIVING RESIDENTS WITH
COGNITIVE IMPAIRMENT
E.Friedmann2, B.Galik2, N.R.Gee1,3, 1. Psychology, SUNY,
Fredonia, Fredonia, New York, 2. University of Maryland,
Baltimore, Maryland, 3. WALTHAM, Waltham on the
Wolds, United Kingdom
Residents of 7 small assisted living facilities were rand-
omized by facility to either reminiscing or Pet Assisted Living
(PAL) intervention included a number of specific activities
during each session designed to encourage maintenance of
function in cognitively impaired residents (N=19) health/
function. Residents participation in behaviors such as look-
ing at, touching, brushing, talking to, walking with, and
giving treats to the dog were noted for each of the 2328 ses-
sions/participant. Physical activity (PA) and depression were
assessed monthly.
Physical activity increased and depressive symptoms
decreased more with PAL than reminiscing intervention.
Participation in looking at (r=.550), brushing (r=.555), and
walking (r=.492) the dog predicted increases in PA and
walking the dog predicted decreases in depression (r=.521)
over the 12 week intervention (all ps<.05). Participants
varied in their participation in each type of dog-related
activity. Evidence supports that the PAL program helps
preserve/enhance function of AL residents with cognitive
impairment.
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Innovation in Aging, 2017, Vol. 1, No. S1
OLDER ADULT DOG OWNERS ARE MORE
PHYSICALLY ACTIVE THAN THEIR NON-DOG-
OWNING COUNTERPARTS
N.R.Gee1,2, P.Dall3, S.Ellis4, B.Ellis5, M.Granat5,
D.Mills4, 1. Psychology, SUNY, Fredonia, Fredonia, New
York, 2. WALTHAM, Waltham on the Wolds, United
Kingdom, 3. Glasgow Caledonia University, Glasgow,
United Kingdom, 4. University of Lincoln, Lincoln, United
Kingdom, 5. University of Salford, Salford, United Kingdom
The study examined the influence of dog ownership on
physical activity (PA) in community dwelling older adults
using a longitudinal design and an objective measure of PA
(activPAL monitor).
Eighty six participants (aged 6581years) were matched
on gender, age, and socio-economic status into dog owner
(DO) and non-dog owner (NDO) pairs. Each participant
wore a waterproofed activPAL activity monitor continuously
for a week, three times over a year.
The results revealed that DOs walked significantly longer
at a moderate cadence (31vs.11min/day) and took more
steps (9,700 vs.7,200 steps/day) than NDOs. DOs also sat
for significantly less time overall (9.4 vs. 10.1 hours/day)
than NDOs.
This study provides the first objective data demonstrating
that older DOs walk more than NDOs and indicates that this
walking was undertaken at a moderate cadence. On average
DOs met recommended public health guidelines (30min/day
of moderate PA), but NDOs did not.
SESSION 740 (PAPER)
AGE-FRIENDLY INITIATIVES
USING EVIDENCE TO TRANSLATE NATIONAL
POLICY INTO LOCAL ACTION
S.Shannon, Department of Health, Dublin, Ireland
The challenge of turning national policy into actions,
implemented at a local level, is one faced by policy-mak-
ers world-wide. Irelands national policy for promoting
Positive Ageing explicitly acknowledges the role that the Age
Friendly Cities and Counties (AFCC) programme plays in
improving the lives of older people. Through a collaborative
study jointly funded by national and local governments, the
Healthy and Positive Ageing Initiative uses links established
with the WHOs Age Friendly Cities Programme to translate
knowledge into action.
Data from a random sample survey of people 55 and older
in 20 AFCC programme areas during 2015/2016 (n=10,000)
was disseminated to local AFCC alliances. Reflecting the
priorities of the National Positive Ageing Strategy and the
AFCC program, the survey covered areas such as depriva-
tion and neighbourhood social capital, preferences for hous-
ing adaptation and local area walkability. Results link the
social and built environment to the health and wellbeing of
older people and identify barriers to participation and essen-
tial health and social services.
As the AFCC program expanded to 10 new local author-
ity areas, results are used to develop a common understand-
ing of age friendly priorities, to optimise and sustain political
and social commitment and to identify areas for action in
IAGG 2017 World Congress
293
new AFCC programs. The efficacy of the dissemination prac-
tices is explored through a qualitative study using thematic
content analysis of the locally produced strategies and semi-
structured interviews with the key stakeholders responsible
for the implementation of strategies.
RECOGNIZING AGE-FRIENDLY BUSINESSES
THROUGH CONSUMER AND COMMUNITY
ENGAGEMENT
D.B.Bradley1, J.Wassel2, 1. Center for Gerontology,
Western Kentucky University, Bowling Green, Kentucky,
2. University of North Carolina Greensboro, Greensboro,
North Carolina
The World Health Organization (WHO) has established
international guidelines for age-friendly communities that
include the encouragement of active aging by optimizing
opportunities for health, participation, and security in order
to enhance peoples quality of life as they age. According to
the WHO, an age-friendly city adapts its structures and ser-
vices to be accessible to, and inclusive of, older people with
varying needs and capacities. As part of Bowling Green,
Kentuckys participation in the WHO Age Friendly Cities
and Communities Initiative, a baseline assessment identified
addressing the role businesses play in promoting the longev-
ity economy and economic inclusion for area elders. In this
paper we review the rationale for age-friendly businesses and
propose a detailed framework for incorporating elder con-
sumer and community views. In collaboration with the Over
Fifty Citizens Academy, a regularly meeting workgroup of
elders committed to building an age friendly community in
Bowling Green, we created a framework for recognizing age-
friendly businesses. These community members developed
an age friendly business values array which area businesses
agreed to work towards. This Age-Friendly Bowling Green
Business Checklist recognizes a business environment encom-
passing diversity, promoting optimal health, negating ageism/
attitudes toward older adults, and valuing ongoing employee
training on serving old adults. We conclude the paper by dis-
cussing challenges of project implementation and the role of
consumer participation in the evaluation and monitoring of
age-friendly certified practices in local businesses.
AGE-FRIENDLY COMMUNITY STRATEGIES:
ARESEARCH-BASED APPROACH ADOPTED IN
GUANGZHOU, CHINA
D.W.Lai2, Q.Zhang3, J.Hewson4, C.A.Walsh4, H.L.Tong1,
1. MacEwan University, Edmonton, Alberta, Canada, 2.
Hong Kong Polytechnic University, Hong Kong, China, 3.
Guangdong Institute of Public Administration, Guangzhou,
Guangdong, China, 4. University of Calgary, Calgary,
Alberta, Canada
Making communities more age-friendly has been an
ongoing trend since the WHO launched its global Age-
Friendly Cities project. However, research on how to assess
and implement age-friendly communities in China is scarce
even though China has the largest number of older adults in
the world. The international research collaboration between
the Faculty of Social Work, University of Calgary in Canada
and Guangdong Institute of Public Administration in China
aims to develop an age-friendly community strategy for
Guangzhou, China using a multi-method, community-based
294
approach. We developed a quantitative baseline survey
instrument using the WHO age-friendly framework, which
was modified to be locally and culturally relevant. Trained
interviewers administered the survey to adults 50 years of
age and older in four distinct communities in Guangzhou
(N=400). Descriptive analysis was completed across items
in 8 domains and comparisons were made across the four
communities. Secondly, we used a series of 12 focus groups
to share the preliminary findings with key stakeholders rep-
resenting policy developers, service sectors and older adults
in order to develop locally-relevant recommendations.
This presentation will describe the findings related to the
assessment of age-friendliness in Guangzhou, contribute to
an increased understanding the cultural relevance of age-
friendly communities, and identify strategies of developing
age-friendly communities that are locally and culturally
relevant.
A NEIGHBOURHOODS AND DEMENTIA STUDY:
WHAT IS IMPORTANT TO PEOPLE WITH DEMENTIA
VERSUS TRIAL OUTCOMES
S.Reilly1, C.Opdebeeck1, H.Morbey1, F.Ahmed1, leadership.
P.Williamson3, I.Leroi4, J.Keady2, 1. Division of Health
Research, Lancaster University, Lancaster, Lancashire,
United Kingdom, 2. School of Nursing, Midwifery and
Social Work,University of Manchester, Manchester, United
Kingdom, 3. Institute of Translational Medicine, University
of Liverpool, Liverpool, United Kingdom, 4. Institute
of Brain Behaviour and Mental Health, University of
Manchester, Manchester, United Kingdom
Many systematic reviews of effectiveness of non-phar-
macological interventions for people with dementia have
highlighted the variability in the outcomes assessed. This
prevents comparisons of effectiveness across studies. This
study, embedded in the Neighbourhoods and Dementia
programme http://www.neighbourhoodsanddementia.org/
work-programme-summary/, seeks to create a core outcome
set for use within intervention studies aimed at people living
with dementia. The 4-phase study design includes: qualita-
tive interviews/focus groups and literature review; Delphi
survey; systematic review; and stated preference survey.
This presentation focuses on Phase 1, comparing outcomes
identified through the qualitative work with those meas-
ured in previous and ongoing intervention trials. Thirty-five
interviews and four focus groups were conducted with peo-
ple with dementia, care partners, health/social care profes-
sionals, policy makers, service commissioners and research
leaders. Outcome measures were also extracted from 129
international intervention trials. The qualitative data were
analysed using a thematic framework to identify outcomes
considered important to people with dementia. There were
key differences in the emphasis of the outcomes in the litera-
ture compared to the qualitative data, indicating that many
trials may not be measuring what is important to people with
dementia. For example, activities were assessed in terms of
frequency within previous studies; however, the meaningful-
ness of activities rather than the frequency were highlighted
as important in the interviews. This core outcome set will
help to ensure that the outcomes measured in evaluations
of interventions are those that are considered the most
Innovation in Aging, 2017, Vol. 1, No. S1
important to people living with dementia and will aide com-
parability and consistency in future studies.
SESSION 745 (SYMPOSIUM)
KEYNOTE: PALLIATIVE CARE IN THE
MAINSTREAMSTEPPING UP TO THE PLATE:
THE CASE FOR INTEGRATED GERIATRIC AND
PALLIATIVE CARE STRATEGIES
Chair: D.E.Meier, Icahn School of Medicine at Mount
Sinai, New York, New York
Discussant: L.Deliens, VUB and Ghent University, Ghent,
Belgium
I.Higginson, Kings College, London, United Kingdom
This session will present the case for integrating geriatric
and palliative care to deliver optimal care, improve quality
and reduce costs. The speakers will outline palliative care
issues common in elderly patients and integrative approaches
that focus on quality of life, support for functional independ-
ence, and the patients values and experiences. They will also
identify the needs of policy makers, payers and health system
PALLIATIVE CARE IN THE MAINSTREAM: THE CASE
FOR INTEGRATED GERIATRIC AND PALLIATIVE
CARE STRATEGIES
D.E.Meier, Geriatrics and Palliative Medicine, Icahn School
of Medicine at Mount Sinai, New York, New York
This session will present the case for integrating geri-
atric and palliative care to deliver optimal care, improve
quality and reduce costs. The speakers will outline pallia-
tive care issues common in elderly patients and integrative
approaches that focus on quality of life for both patient and
family caregivers, support for functional independence, and
the patients values and experiences. The data on the needs
and numbers of older persons with multiple chronic condi-
tions and functional impairment as well as the outcomes of
community-based integrative palliative care models on this
group will be discussed.
PALLIATIVE CARE FOR ELDERLY (PACE) PEOPLE IN
LONG-TERM CARE FACILITIES IN EUROPE
L.Deliens2, D.E.Meier1, 1. Geriatrics and Palliative
Medicine, Icahn School of Medicine at Mount Sinai, New
York, New York, 2. VUB and Ghent University, Ghent,
Belgium
The main strategic scientific aims of omparing the
Effectiveness of PAlliative Care for Elderly (PACE) People
in Long-Term Care Facilities in Europe are trifold. The
PACE consortium consists of 8 research institutes, span-
ning 6 European countries, and 4 European organizations
responsible for impact and dissemination. PACE has mapped
palliative care systems in care or nursing homes in Europe;
performed a large-scale representative study to examine qual-
ity of dying and palliative care in care or nursing homes in six
European countries, including Poland, Finland, Netherlands,
Italy, UK and Belgium; and is studying the impact of an inno-
vative trial PACE Steps to Success which aims to improve
the quality of palliative care.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
PALLIATIVE CARE NEEDS AMONG PERSONS WITH
NON-CANCER CHRONIC ILLNESSES AND THEIR
CARERS
I.Higginson2, D.E.Meier1, 1. Geriatrics and Palliative
Medicine, Icahn School of Medicine at Mount Sinai,
New York, New York, 2. Kings College, London, United
Kingdom
Palliative care has traditionally been limited to persons
predictably approaching death, especially those with cancer.
The needs of the larger population of older persons with
non cancer chronic illnesses and functional impairment in
whom prognosis is unrpedictable will be reviewed with spe-
cial attention to caregiver role, symptom burden, and the
mismatch of existing service delivery to the needs of this
population.
SESSION 750 (SYMPOSIUM)
KEYNOTE: BEYOND RHETORICTAKING GLOBAL
ACTION ON AGEING
Chair: N.C.Keating, Global Social Initiative on Ageing,
Seoul, Korea (the Republic of)
Co-Chair: J.Beard, World Health Organization
Population ageing is now part of our global conscious-
ness. Yet actions to address issues that arise from these
demographic shifts have lagged behind. Among the many
challenges/impediments to creating global action are: diverse
patterns of ageing across countries and regions; different
family, community and policy contexts that influence ageing
experiences; and considerable inequities both between and
within countries. The purpose of this session is to create an
agenda and advocate for global action to improve quality of
life of older populations.
The session has 3 main elements:
Contextualizing the agenda for global action.
Norah KEATING, will introduce the session, setting
parameters around thinking and hence acting differently in
response to population ageing.
John BEARD will provide an overview of global pat-
terns of ageing, emphasizing how a global response requires
understanding how these patterns are expressed in very dif-
ferent contexts around the world.
Delineating challenges from two developing countries.
Two prominent social gerontologists, Peng DU (China)
and Isabella ABODERIN (Kenya), will each describe the
3 biggest challenges in population ageing in their country.
Each will discuss which contexts (policy, community, fam-
ily) should be the main focus for addressing these challenges;
why this is the case; and what would be ideal outcomes.
3. Establishing principles for action. A substantial por-
tion of the session will be a moderated discussion. The goal
is to lead to strategies for action across countries- with local
solutions for global issues. Session moderator is Norah
KEATING.
CONTEXTUALIZING THE AGENDA FOR GLOBAL
ACTION
N.C.Keating1,2,3, J.Beard4, 1. Swansea University, Swansea,
United Kingdom, 2. North West University, Potchefstroom,
South Africa, 3. University of Alberta, Edmonton,
IAGG 2017 World Congress
295
Alberta, Canada, 4. World Health Organization, Geneva,
Switzerland
Population ageing has created an urgent need for socie-
ties to think strategically about what constitutes a good old
age for its citizen--and to formulate actions toward achiev-
ing this goal. We present a template for global action that
requires challenging cultural norms of old age as an inevita-
ble period of decline; and fostering supportive environments
to enable wellbeing. Keating sets parameters around thinking
and acting differently: focusing on physical, social and policy
environments and on the importance of creating congruence
between resources of older persons and these environments.
Beard presents global patterns of ageing, emphasizing that
global responses require understanding how these patterns
are expressed across world regions. He speaks to strategic
objectives adopted by WHO and its country constituents to
embrace a commitment to action on healthy ageing and to
develop age-friendly environments to address the multiple
and intersectoral influences that affect quality of life in older
age.
CHALLENGES IN POPULATION AGING AND POLICY
PRIORITIES IN CHINA
P.Du, Institute of Gerontology, Renmin University of
China, Beijing, Beijing, China
China has 220 million older persons aged 60 and over,
expected to increase to about 490 million by 2050. Despite
the new population policy encouraging couples to have two
children, the proportion of the older persons will double from
16.1% in 2015 to 34% by 2050. Thus the 3 biggest chal-
lenges in population ageing in China are: creating a universal
social security system that narrows the gap between urban
and rural areas; developing the social care system, includ-
ing LTC insurance and services, to meet rising needs of care
needs; and promoting intergenerational solidarity. The main
focus for policy is the integration of efforts and resources; for
community is the establishment of multi-functional service
centers in age-friendly environments; for families is enhanc-
ing caring capacity. The ideal outcomes would balance fam-
ily and social care, improve life quality of older persons and
strengthen intergenerational solidarity.
IDENTIFYING PRIORITIES FOR ACTION ON AGEING
IN SUB-SAHARAN AFRICA: LENSES AND LINES OF
INQUIRY
I.Aboderin, 1. African Population and Health Research
Center, Nairobi, Kenya, 2. Centre for Research on Ageing,
University of Southampton, Southampton, United Kingdom
A point of departure for delineating the major challenges
in population ageing in sub-Saharan African (SSA) countries
such as Kenya, is to appreciate the recent expansion in of the
national, regional and global policy and legal architecture
that commits African countries to action on older popula-
tions. The comprehensive and multilayered nature of the
responses required brings to the fore what may be viewed
as a most urgent challenge of ageing for Africa: meaningful
prioritisation. What action is most needed where? - within
contexts of severe resource constraints and multiple other
pressing agendas? This presentation delineates two principal
lenses and lines of inquiry that SSA countries might pursue
to pinpoint answers to this question, and highlights the two
296
chief associated challenges for research and debate on ageing
in the region.
SESSION 755 (SYMPOSIUM)
KEYNOTE: HOW EARLY CAN WE DETECT
COGNITIVE DISORDERS
Chair: R.Petersen, Mayo Clinic, Rochester, Minnesota
Cognitive changes in aging evolve gradually over the lifes-
pan. Most individuals will experience very gradual changes
in speed of processing, cognitive flexibility and recent mem-
ory. However, an increasing number of persons will develop
cognitive impairment due to underlying degenerative dis-
eases. We are learning about the development of subtle
clinical and biomarker features of persons as they age. This
symposium will focus on typical cognitive changes of aging
and compare them to the early cognitive features of incipient
diseases. Similarly, an emphasis has been placed on the role
of subjective concern of persons as they age and the implica-
tion of these measures for the prediction of cognitive decline.
Patient-reported outcomes are becoming an increasingly
important aspect of characterizing cognitive aging. Finally,
we are learning about the evolution of various imaging and
fluid biomarkers of incipient diseases trying to detect pat-
terns that will predict a subsequent cognitive decline. Profiles
of the accumulation of amyloid, tau and vascular changes
will be discussed in the setting of cognitive and subjective
decline. The ultimate goal of this work is to detect patterns
of impairment that may allow one to intervene with disease-
modifying therapies when they become available.
BIOMARKERS OF AGING AND ALZHEIMERS
DISEASE
R.Petersen, Mayo Clinic, Rochester, Minnesota
Most individuals experience a cognitive decline as they
age. Some of the cognitive decline is due to known pathologic
entities occurring in the brain leading to degenerative dis-
eases of aging, but others are less well explained. The Mayo
Clinic Study of Aging (MCSA) is a population-based study of
cognitive aging in the community. Approximately 3,000 par-
ticipants are followed actively on an annual basis with exten-
sive clinical and biomarker characterization. Biomarkers
include imaging and biofluid serial markers. Our work has
demonstrated that amyloid accumulates in the brain across
the age spectrum. Tau distribution begins early in life and
tends to spread outside the medial temporal lobe as amy-
loid accumulation increases. Vascular disease is a common
feature of aging and contributes to the overall pathological
burden. The combination of these markers lends to cognitive
changes with aging, and the implication of these biomarkers
for neurodegenerative diseases will be discussed.
THE ROLE OF SUBJECTIVE COGNITIVE CONCERN
IN AGING
F.Jessen, University of Cologne, Cologne, Germany
Aging is associated with decline in cognitive performance.
The majority of aging people experience this decline sub-
jectively. In a subgroup this subjective experience of decline
indicates the first manifestation of Alzheimers disease (AD)
Innovation in Aging, 2017, Vol. 1, No. S1
at a stage where the objective performance is still unim-
paired. In the framework of very early detection of AD, sub-
jective cognitive decline without objective impairment (SCD)
has become a condition of great interest. Increasing data
suggest that individuals with SCD, who have biomarker evi-
dence of AD are at increased risk of progression to mild cog-
nitive impairment (MCI) and dementia. Those with evidence
of amyloid deposition and SCD are at greater risk of cogni-
tive decline than those with amyloid deposition, but without
SCD. Current research aims at identifying features of SCD,
which are particularly associated with AD pathology. The
presentation will give an overview on the developing topic of
SCD in relation to AD.
SEPARATING THE EARLIEST PHASE OF
ALZHEIMERS DISEASE FROM AGE-RELATED
COGNITIVE DECLINE
M.Albert, Johns Hopkins University, Baltimore, Maryland
Cognitive changes with age occur in the absence of dis-
ease. Several neurobiological mechanisms appear to underly
these age-related changes in cognition in optimally healthy
individuals. There is, however, considerable recent evidence
that a subset of individuals whose cognitive performance
falls within the normal range have evidence of Alzheimers
disease (AD) pathology in their brain. This has led to the cur-
rent emphasis on initiating treatment trials for AD as early
as possible in the disease course. The challenge for the field is
to identify those changes which are associated with cognitive
aging versus those that are a harbinger of progressive cog-
nitive decline related to disease. This presentation will give
an overview of these issues, and provide data from ongoing
research aimed at separating age-related cognitive decline
from the earliest phases of AD.
SESSION 760 (SYMPOSIUM)
KEYNOTE: GENES, ENVIRONMENT, AND
BEHAVIORS THAT PREDICT HEALTHY LONGEVITY
Chair: L.Ferrucci, National Institute on Aging, Baltimore,
Maryland
Co-Chair: D.Kuh, MRC Unit for Lifelong Health and
Ageing at UCL
S.Olshansky, University of Illinois at Chicago, Chicago,
Illinois
Over the last few years research on factors that affect
longevity and healthspan has made substantial progress.
Apicture is emergeing where the match between the genetic
background and the enviromental challenges produces an
array of possible responses that are meant to be adaptive
but in some cases result in the emergence of diseases and
accelerated aging. In this symposium, three speakers address
factors that affect healthy longevity from complementary
prospectives.
Luigi Ferrucci uses the paradigm of geroscience to pro-
pose that the biology of aging is at the root of both chronic
disease and aging phenotypes. Different genetic, environmen-
tal and behavioral backgrounds promote specific physiologi-
cal impairments that in young age are compensated but in
old age are causative of and heterogeneous phenotypes.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Diana Kuh argues that a life course perspective will
improve our understanding of human responses to environ-
mental challenges with long-term impact on health span and
longevity. Understanding how humans adapt to the environ-
ment during development affect how well they age and how
long they live.
S Jay Olshansky discusses scientific theories about maxi-
mum life span. In the 20th century, life expectancy forecast-
ers consistently underestimated duration of life because they
assumed a biological limit to life. On the contrary more
recent assumptions propose life expectancies exceeding 100
to 150years.
BIOLOGICAL MECHANISMS UNDERLYING THE
AGING PHENOTYPES
L.Ferrucci, National Institute on Aging, Baltimore,
Maryland
Mechanisms of aging phenotypes such as the decline in
muscle mass and strength are unknown. In the Baltimore
Longitudinal Study of Aging (BLSA), adiposity was the
strongest correlate of low muscle quality both cross-
sectionally and longitudinally. Fat in muscle may cause
problems to: 1) mitochondria oxidative phosphorylation;
2) energetic metabolism; 3) muscle fibers structural integ-
rity. Mitochondrial muscle bioenergetics assessed by phos-
phorus MRS was associated with walking performance
and such association was mediated by impaired strength.
Participants with impaired mitochondria energetics had
experienced larger weight gain over previous 20 years.
Low muscle quality was associated with higher levels of
circulating leucine, isoleucine, tryptophan, serotonin, and
methionine. In MRI and EM analysis, the architecture of
muscle fibers were distorted with fractures in the continuity
of serial sarcomeres in older individuals. Increasing adipos-
ity may lead to impaired mitochondrial function, reduced
protein homeostasis, with negative consequence on muscle
structure and function.
HUMAN RESPONSES TO ENVIRONMENTAL
CHALLENGES: ALIFE COURSE APPROACH
D.Kuh, MRC Unit for Lifelong Health and Ageing at UCL,
London, United Kingdom
The MRC National Survey of Health and Development
(NSHD), the oldest of the British birth cohort studies, was
70years old in 2016. Since the 1970s, the NSHD has pro-
vided evidence that environmental challenges early in life,
and human responses to those challenges during develop-
ment and growth, have long-term effects on adult health,
aging and survival. Neural, metabolic, inflammatory and
endocrine pathways have been suggested as the main
mediators of biological embedding of childhood adversity,
and as common mechanisms driving the rate of ageing and
chance of survival; and epigenetic processes that underlie
these mechanisms are being investigated. Key and recent
evidence is presented from the NSHD and the other British
birth cohorts, of the long shadow of childhood, and of
these common underlying mechanisms. It is argued that
a life course perspective enhances our understanding of
aging, at the societal, individual, body system and cellular
levels.
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297
THE FUTURE OF PREDICTING HEALTHY LIFESPAN
HAS ARRIVED
S.Olshansky, University of Illinois at Chicago, Chicago,
Illinois
Estimating duration of life has been the purview of actuar-
ies for nearly two centuries, but estimating how healthy people
are likely to be when they reach older ages is a recent advance
of epidemiology, public health, and the availability of requisite
data. Yet, even these methods of measuring healthy life expec-
tancy rely on survey data that, while the current gold standard,
will be supplanted by a new source of longitudinal health data
drawn from wearable sensors. We can now peer into the func-
tioning of our bodies in ways never before thought possible, and
discover how we are driving our bodies in much the same
way we can already determine how well we drive our cars. Add
to this the fact that genetic epidemiology is leading to a greater
understanding of the inherited factors that influence duration
and quality of life, and together with wearable sensors, a new
technology has arrived that will revolutionize our concepts and
methods of measuring and predicting healthy longevity. Here
Iwill discuss this nascent health data economy and provide an
example of what it will look like and how it is likely to function
in the coming years.
SESSION 765 (POSTER)
ACUTE CARE II
FUNCTIONAL STATUS CHANGE AS AMORTALITY
PROGNOSTIC FACTOR IN HOSPITALIZED ELDERS:
CASE-CONTROL STUDY
G.Fasce, F.Crispi, C.Muoz, M.Zavala, C.Briceo,
N.Castillo, N.Araya, Geriatrics Section, Hospital Clinico
de la Universidad de Chile, Santiago, Chile
Background: Lower functionality has been associated to
negative outcomes, such as worse quality of life and higher
risk of mortality. Hospitalization is associated with a reduc-
tion of 50% of the previous functionality. On hospitalized
elders, the impact of acute loss of basal functionality at
discharge (delta functionality or DF) on mortality one year
later hasnt been determined. Methods: Acase-control study
was developed. Case: Elders older than 60 years hospital-
ized between January 2013 and December 2014 in the Acute
Geriatrics Unit of the University of Chile Clinical Hospital,
deceased within 1year of discharge. Control: Alive patients
within 1year of discharge. Exclusion criteria: Basal Barthel
15. The functionality loss between basal and discharge
Barthel was determined, identifying the cut-off point associ-
ated with a worst survival to one year, adjusted by other rel-
evant variables. Ap value <0.05 was considered statistically
significant. Results: 105 cases and 153 controls. The mean
age was 81. Median Basal Barthel: 85. There were no differ-
ences among groups on age, basal or admission functional-
ity, or frequency of geriatrics syndromes. ADF higher than
45% was associated with almost double mortality risk: OR:
1.7619 (CI:1.0394/2.9866; p= 0.0354). With a DF higher
than 50%, the mortality risk becomes higher (OR: 1.8846 -
CI:1.0680/3.3255; p=0.0287). Conclusions: Afunctionality
298
loss higher than 45% doubles the risk of death within
1 year of discharge. The risk becomes higher at higher DF.
Therefore, interventions that preserve basal functionality
should be promoted.
SURVEY OF AUSTRALIAN AND NEW ZEALAND
PUBLIC ON CRITERIA TO TRIAGE PATIENTS IN AN
INFLUENZA PANDEMIC
V.Naganathan1,2, W.Cheung3, J.Myburgh4, 1. Centre for
Education and Research in Ageing, University of Sydney,
Concord, New South Wales, Australia, 2. Ageing and
Alzheimers Institute, Concord Hospital, Sydney, New South
Wales, Australia, 3. Intensive Care Unit, Concord Hospital,
Sydney, New South Wales, Australia, 4. Critical Care and
Trauma Division, The George Institute for Global Health,
Sydney, New South Wales, Australia
To determine Australian and New Zealand (NZ) publics
view on how intensive care (IC) beds should be allocated in
a major influenza pandemic. Postal questionnaire was sent to
4000 registered voters randomly selected from the Australian
and NZ Electoral rolls. Respondents chose from 6 methods
to triage patients: use a first in, first served approach; allow
a senior doctor to decide; use predetermined health depart-
ment criteria; use random selection; use the patients abil-
ity to pay; or use the societal importance of the patient to
decide. Respondents also rated the fairness of the six triage
methods as well as 3 additional questions on the use of age,
predicted mortality, and chronic comorbidity as selection cri-
teria. The overall response rate was 15.1% in Australia and
27.0% in NZ. Australian respondents preferred that patients
be triaged to the IC unit either by a senior doctor (43.2%)
or by predetermined health department criteria (38.7%). NZ
respondents preferred that triage by a senior doctor (45.9%).
Respondents from both countries perceived triage by these
two criteria to be fair, and the other 4 methods of triage
to be unfair. A large proportion of respondents considered
using a persons chance of survival to base triage decisions
to be fair (80%) and the majority also considered treating
younger people ahead of older people (66%) and on the
basis of chronic comorbidity (60%) to be fair. In preparation
for future pandemic planning there may be value in knowing
the views of the public on how resources should be allocated.
PREVALENCE OF PIMS AMONG HOSPITALIZED
ELDERLY PATIENTS BASED ON BEERS AND STOPP/
START CRITERIA
T.Suansanae1, W.Chivapricha2, 1. Pharmacy, Faculty of
Pharmacy, Mahidol University, Ratcchathewi, Bangkok,
Thailand, 2. Faculty of Pharmacy, Rangsit University,
Muang Ake, Pathumthani, Thailand
This was a cross-sectional study to determine preva-
lence of PIMs in hospitalized elderly patients. All patients
who admitted at medical ward of Siriraj Hospital during
May 2015 to February 2016 were recruited. All PIMs were
identified at admission date by geriatric specialty pharmacist
by using Beers 2012 and STOPP/START Version 2 criteria.
Descriptive statistic were used throughout data analysis.
Atotal of 187 patients were entered the study. Mean age was
74.4years (SD 8.70) and half of them were male (51.3%).
The mean number of medications at admission is 8.24 (SD
4.77) items/patient. Commonly admission reasons were
Innovation in Aging, 2017, Vol. 1, No. S1
pneumonia, heart failure, NSTEMI, COPD with acute
exacerbation and UGIB. At date of admission, 43.3% and
44.92% of patients had at least one Beer-listed PIMs and
STOPP-listed PIMs, respectively. The most common Beers
listed PIMs were related to alpha-blockers, benzodiazepines
and anticholinergics. While, the most common STOPPlisted
PIMs were related to benzodiazepines, anticholinergics and
PIMs induced ADEs in some specific condition such as dos-
age too high, drug interaction, and duplicate drug class. In
conclusion, we found a high prevalence of PIMs among hos-
pitalized elderly patients which could be detected by using
either Beers or STOPP/START criteria.
RECOMMENDATIONS FOR THE MANAGEMENT
OF OLDER PATIENTS VISITING EMERGENCY
DEPARTMENT AND RISK OF DEATH
C.Launay1, G.Duval2, O.Beauchet3, C.Annweiler2, 1.
CHUV, Lausanne, Switzerland, 2. CHU Angers, Angers,
France, 3. Mc Gill University, Montral, Quebec, Canada
Objective: To examine the effects of geriatric and geron-
tological recommendations for the management of geriatric
patients visiting an emergency department (ED) on risk of
death in the first year following the ED visit.
Methods: A total of 131 geriatric patients who visited
Angers University hospital ED were prospectively included
in this pre-post quasi-experimental study. They were sepa-
rated in three groups matched on age and gender: two inter-
vention groups (11 patients with geriatric recommendations
and 23 patients with gerontological recommendations) and
one control group (97 patients without any recommenda-
tions). Intervention was provided upon the participants ED
admission. Incident mortality was collected via the admin-
istrative registry of Hospital before patients discharge and
via a systematic phone call 12 months after the ED visit.
Age, gender, place of living, number of daily drugs taken,
cognitive decline, and reason for ED admission were used as
covariates.
Results: Multiple Cox regression model showed that
gerontological recommendations were associated with a
lower rate of mortality (adjusted Hazard Ratio [HR]=0.12,
P=0.038) but not geriatric recommendations (adjusted
HR=9.94, P=0.905). Living at home was associated with
a greater risk of death (adjusted HR=2.55 with P=0.020).
Kaplan-Meier distributions of mortality confirmed that
patients who received gerontological recommendations had a
lower mortality rate compared to those who did no received
recommendations (P=0.005) and those who received geriat-
ric recommendations (P=0.015).
Conclusions: Our findings show that gerontological but
not geriatric recommendations were associated with a lower
risk of mortality after an ED visit in geriatric patients.
FURTHER ENABLING CARE AT HOME HOSPITAL
OUTREACH PROGRAM: OUTCOMES FOR OLDER
PATIENTS FAMILY CARERS
C.Toye3,2, S.Slatyer3,2, S.Aoun3, R.Moorin1, R.Parsons4,
M.Bronson6, R.Osseiran-Moisson3, K.D.Hill5, 1. School of
Public Health, Curtin University, Perth, Western Australia,
Australia, 2. Centre for Nursing Research, Sir Charles
Gairdner Hospital, Perth, Western Australia, Australia, 3.
School of Nursing, Midwifery and Paramedicine, Curtin
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
University, Perth, Western Australia, Australia, 4. School
of Pharmacy, Curtin University, Perth, Western Australia,
Australia, 5. School of Physiotherapy and Exercise Science,
Curtin University, Perth, Western Australia, Australia, 6.
Medical Division, Sir Charles Gairdner Hospital, Perth,
Western Australia, Australia
When an older person who receives family care at home
is discharged from hospital, an opportunity exists to identify
and address the family carers support needs. Home caregiv-
ing sustainability may then be supported. Health outcomes
for care recipients may also be improved. This study tested
the hypothesis that family carers inclusion in the Furthering
Enabling Care at Home program, immediately following
care recipients hospital discharges, would improve carers
self-reported preparedness for caregiving. The single-blind
randomized controlled trial compared outcomes from usual
discharge processes with those obtained when the new pro-
gram was added. The program, costed during the study, was
delivered by a nurse over the telephone. The nurse guided
carers to seek any required clarification of discharge infor-
mation and then implemented a systematic, carer-led, car-
egiving support needs assessment. Carers prioritized their
needs and the nurse guided access to appropriate supports.
Patients aged over seventy years, and their family carers,
were recruited from the short-stay, medical assessment unit
of a Western Australian public hospital. Data were obtained
from sixty-two family carers in the intervention group and
seventy-nine in the control group on three occasions: at
the time of the care recipients hospital discharge, and at
approximately three and six weeks later. Compared to the
control group, preparedness to care significantly improved
in intervention group carers (moderate effect size). Small
but statistically significant positive impacts from this low
cost intervention were also observed in these carers levels
of strain and distress. The programs implementation in this
and other similar settings merits consideration.
EFFECTS OF NURSING PATIENT EDUCATION ON
QOL IN ELDERLY INPATIENTS: ASYSTEMATIC
REVIEW
S.Strupeit, A.Buss, Nursing Science, Munich University of
Applied Sciences, Munich, Germany
The aim of this study was to evaluate the effectiveness of
nurse-delivered education interventions compared to usual
care with regard to the quality of life in elders in the hospital.
A systematic review was performed to identify rand-
omized controlled trials examining the effects of nurse-
delivered educational interventions on the quality of life
in elders in the hospital. The search was performed in
December 2012 in the MEDLINE (via PubMed), EMBASE
(via Ovid), and CINAHL (via EBSCO) databases and was
limited with regard to publication time and language. The
studies were appraised according to methodological quality,
and p-values were extracted to determine the effectiveness of
the interventions.
Four studies were included in the review. One study test-
ing multicomponent interventions showed positive effects on
quality of life. Two studies showed no effect, and one study
showed a negative effect of the intervention on quality of
IAGG 2017 World Congress
299
life. Methodological appraisal revealed single biases in most
of the studies.
Because of methodological issues and heterogeneity
between studies, this review could not provide evidence
of the effectiveness of nurse-delivered education interven-
tions in elders in the hospital for improving quality of life.
Nurse-delivered education may be more effective as a part
of multifactorial interventions. Further studies should exam-
ine interventions that focus on quality of life using validated
measures.
HOSPITAL-WIDE COMPREHENSIVE GERIATRIC
ASSESSMENT (CGA) FOR OLDER PEOPLE: ASURVEY
OF UK HOSPITALS.
P.McCue1, S.G.Parker1, H.Roberts2, S.Kennedy3,
S.Conroy4, 1. Newcastle University, Newcastle upon Tyne,
United Kingdom, 2. Southampton University, Southampton,
United Kingdom, 3. Sheffield University, Sheffield, United
Kingdom, 4. Leicester University, Leicester, United
Kingdom
CGA is widely recommended for older hospital inpatients.
The UK National Institute for Health Research (NIHR)
recently called for more research on the delivery of hospital
wide CGA.
We carried out a survey of acute hospitals in the UK with
the assistance of the British Geriatrics Society, The Royal
College of Physicians of London and the NIHR Ageing
Clinical Research Network.
We asked hospitals to identify services which provided
CGA: A multidimensional, multidisciplinary process which
identifies medical, social and functional needs, and the devel-
opment of an integrated / co-ordinated care plan to meet
those needs.
45 hospitals participated in the survey. All hospitals
described the provision of CGA and returned descriptions of
82 services. The majority (78/82, 95%) of the services were
led (60) or supported (18) by a consultant geriatrician. Teams
were generally staffed by physiotherapists (81/82, 99%) and
occupational therapists (80/82, 98%), with nurses (76/82,
93%) and health care assistants (73/82, 89%).
The majority (73/82, 89%) used clinical assessment pro-
cesses (such as consultant or specialist nurse review) to iden-
tify appropriate patients, in preference to screening tools
(36/82, 44%) or admission criteria (38/82, 46%). Most ser-
vices (58/82, 71%) did not use standard methods for meas-
uring frailty, with little consistency of choice of instruments
among those who did.
Multidisciplinary team based CGA was available in all
hospitals surveyed, generally led by geriatricians and staffed
with therapists and nurses. These teams make extensive
use of clinical assessment to select patients for their care.
Relatively few measure or target frailty explicitly.
COMPREHENSIVE GERIATRIC ASSESSMENT
PROCEDURE ONLINE, INCORPORATING INTERRAI
ACUTE CARE ASSESSMENT
M.Martin-Khan2, L.C.Gray1, H.Edwards3, R.Wootton1,
P.Varghese4, K.Lim5, P.Darzins6, L.Dakin4, 1. Centre
for Research in Geriatric Medicine, The University of
Queensland, Woolloongabba, Queensland, Australia, 2. The
University of Queensland, Brisbane, Queensland, Australia,
300
3. Queensland University of Technology, Kelvin Grove,
Queensland, Australia, 4. Queensland Health, Brisbane,
Queensland, Australia, 5. University of Melbourne,
Melbourne, Victoria, Australia, 6. Eastern Health, Box Hill,
Victoria, Australia
Nurse administered comprehensive geriatric assessment
(CGA), based on the interRAI Acute Care assessment system,
accessed online, enables geriatricians to review patients and
provide input into care at a distance. This study was designed
to determine whether geriatric triage decisions made using
CGA performed online are less reliable than face-to-face
decisions. This was a multi-site non-inferiority prospective
cohort study. Patients referred for an acute care geriatric con-
sultation were assessed sequentially by two specialist geria-
tricians. Patients allocated one face-to-face (FTF) assessment
and an additional assessment (either FTF or online (OL)),
creating two groups paired FTF (FTF-FTF) or paired online
face-to-face (OL-FTF). Case preparation was conducted by
a trained nurse assessor using a web-enabled clinical deci-
sion support system. Geriatricians allocated to perform an
online assessment had access to this information only.
Geriatricians allocated FTF reviewed this data, as well as the
paper-based medical file and then consulted directly with the
patient and attending staff. The primary decision was refer-
ral for permanent residential care. Overall percentage agree-
ment (PO) for the FTF-FTF group was 88% (n=71/81) (95%
CI: 0.7847, 0.9392), with a Cohens kappa of 0.6432 (95%
CI: 0.4411, 0.8452). Overall agreement for the OL FTF
group was 91% (n=77/85) (95% CI: 0.8229, 0.9585), with a
Cohens kappa of 0.7291 (95% CI: 0.5529, 0.9053). The dif-
ference in agreement between the two groups was -3% (95%
CI: -13%, 7%) indicating that was no difference. Geriatric
assessment performed online using a nurse administered
structured CGA system was no less reliable than conven-
tional assessment for triage decisions.
FREEDOM OF MOVEMENT: AMULTILEVEL
INTERVENTION TO REDUCE PHYSICAL
RESTRAINTS USE IN ACUTE CARE
D.Zekry, A.Mendes, L.Mieiro, A.Maringue, P.Layat- (1.04 %), S. parasanguinis 4 (1.04 %), S. hominis 4 (1.04
Jacquier, F.R.Herrmann, G.Gold, Internal Medicine,
Rehabilitation and Geriatrics of Geneva University
Hospitals, Geneva, Switzerland
Physical restraints are frequently used in elderly care and
justified to prevent falls, control disruptive behavior and
allow interventions. Physical restraints do not bring benefit,
being associated with poor outcomes like direct injuries,
reduced mobility and mortality.
We have implemented an intervention multilevel program
involving all the health care team of an acute care Alzheimer
unit (SOMADEM) to reduce the use of physical restraints
and to promote methods for achieving safety.
SOMADEM (SOMAtic and DEMentia) is an 18-bed unit
in a geriatric hospital. Patients admitted in this unit have
dementia and at the same time behavioral and psychological
symptoms of dementia (BPSD) due to a concomitant acute
somatic disease. The intervention model has a longitudinal
design in 3 phases: education, specialized consultation and
physical restraints alternatives. The educational part con-
sists in a 4-hour training of all unit staff taught by a special-
ized interdisciplinary team. The content covers risk of falls,
Innovation in Aging, 2017, Vol. 1, No. S1
management of disruptive behavior, legal issues regarding
physical restraints prescription, alternatives to its use and
discussion of clinical vignettes. Aweekly specialized consul-
tation by the same team proposes alternative ways.
Prevalence of physical restraints after the intervention
program is the primary outcome; evaluation of types of
physical restraints, falls and fall-related injuries, psycho-
active drugs prescription, disruptive behavior, functional
independence status and destination after discharge are
secondary outcomes. Data during the 12 months after the
start of intervention will be compared to a 15-month period
before the intervention used as baseline. Encouraging results
will be discussed.
POSITIVE BLOOD CULTURE IN ACUTE CARE
HOSPITAL FOR MATURE PATIENTS IN JAPAN
Y.Kitagawa, Department of Infection Control, National
Center for Geriatrics and Gerontology, Obu, Japan
Blood culture is one of the most important clinical exami-
nations for infectious diseases. In this report, we review our
blood culture test in recent a couple of years.
From April 2014 to June 2016, 4482 blood culture
test were ordered in National Center for Geriatrics and
Gerontology in Obu, Japan. In these cases, 611 teste were
positive result (positive rate 13.6 %). The percentage for
obtaining multiple blood culture sets was 76.6 % during
study period.
There were 217 male and 144 female with age 80.4years
old. The cultured bacteria were Escherichia coli 68 cases
(17.75 %), S.aureus 32 (8.36), S.epidermidis (MRS) 28 (7.31
%), Klebsiella pneumoniae 24 (6.27), Escherichia coli (ESBL)
22 (5.74), S.aureus (MRSA) 16 (4.18 %), -Streptococcus
(group-G) 11 (2.87 %), Enterococcus faecalis 9 (2.35 %),
Serratia marcescens 8 (2.09), Corynebacterium spp. 8
(2.09), St.pneumoniae 6 (1.57), St.agalactiae (B) 6 (1.57
%), S.epidermidis 6 (1.57 %), S.homins (MRS) 6 (1.57 %),
Prop.acnes 6 (1.57 %), E.aerogenes 6 (1.57 %), Proteus
mirabilis 5 (1.31 %), Enterococcus faecium 5 (1.31 %),
E.cloacae 5 (1.31 %), Bacillus spp. 5 (1.31 %), St.bovis 4
%), Corynebacterium striatum 4 (1.04 %), Bacillus cereus 4
(1.04 %), A.baumannii 4 (1.04 %) and others 77 (20.1 %),
respectively.
In our institute, reasonable blood culture test was per-
formed as acute care hospital. However we try to obtain
more multiple blood culture sets.
SEVERE HYPERTENSION ON ADMISSION AND
ACUTE PNEUMONIA IN THE ELDERLY WITH ACUTE
CEREBRAL HEMORRHAGE
M.Okuro, T.Okuno, T.Himeno, T.Morita, O.Iritani,
H.Yano, K.Iwai, S.Morimoto, Department of Geriatric
Medicine, Kanazawa Medical University, Ishikawa
Prefecture, Japan
Objective: Cerebral hemorrhage is frequent condition
in the elderly, and acute complications such as pneumonia
increases the risk of mortality rate. However, there are few
studies about the association with blood pressure on admis-
sion. We studied the association between the incidence of
pneumonia and blood pressure on admission.
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Innovation in Aging, 2017, Vol. 1, No. S1
Methods: Elderly patients admitted to the Geriatric
Emergency Ward of Kanazawa Medical University Hospital
with a diagnosis of acute cerebral hemorrhage during 2002
2012 were recruited into the study.(59 men, 58 women, mean
ages 808years, range 6598years). All patients underwent ened with multiorgan failure, metabolic acidosis, and pancy-
brain magnetic resonance imaging and magnetic resonance
angiography on the first day of admission. The patients were
divided into three groups according to the record of the
highest mean SBP and/or DBP of two measurements every
2h during the first 24h after admission; 21 control patients
with normotension to mild hypertension (SBP<160mmHg
and DBP<100mmHg), 37 patients with moderate hyperten-
sion (SBP 160179mmHg and/or DBP 100109mmHg), 30
patients with severe hypertension (SBP 180199mmHg and/
or DBP 110119mmHg), 29 with very severe hypertension
(SBP200mmHg and/or DBP120mmHg). CT images
were classified as 37 subcortical, 37 thalamus, 28 basal gan-
glia, 4 pons brainstem, 11 cerebellum and stratified analy-
ses were performed. The definition of pneumonia includes
clinical finding of rales, fever onset, purulent sputum, chest
radiograph showing evidence of an infiltrate/ consolidation /
cavitation, necessity of medical treatment and antibiotic
course.
Results: After admission, developed acute pneumonia
occurred one out of 21 normotensive(4.8%), 7 out of 37
moderate hypertensive(18.9%), 6 out of 30 severe hyperten-
sive(20.0%), 16 out of very sever hypertensive(55.2%). After
adjustment by potential confounding factors such as age,
sex, JSC, midline shift, hemorrhage volume, diabetes, white
blood cell count, CRP, serum albumin, incidence of pneumo-
nia was significantly associated with very sever hypertension
comparing with other hypertension groups (OR:4.89, 95%
CI:1.3742.5, p=0.014).
Conclusion: We conclude that very severe hypertension
on admission is a risk factor for acute pneumonia in elderly
patients with acute cerebral hemorrhage.
EBV-POSITIVE DIFFUSE LARGE B-CELL LYMPHOMA
OF THE ELDERLY: ADIFFERENTIAL DIAGNOSIS FOR
SEPSIS.
R.Orts Gmez1, G.Lozano Pino1, E.Villalba Lancho1,
G.Martn Nez2, 1. Geriatric Unit. Virgen del Puerto vention, Intervention and Post-intervention. Key planning
Hospital, Plasencia, Cceres, Spain, 2. Hematology Service,
Plasencia, Cceres, Spain
Epstein-Barr virus (EBV)-positive diffuse large B-cell lym-
phoma (DLBCL) of the elderly is an uncommon aggressive
lymphoma subtype arising in immunocompetent patients
>50years. Disease in elderly could have an atypical presenta-
tion and compromised functioning. We report a fatal case of
EBV-positive DLBCL of the elderly in an 84-year-old man
presenting as a respiratory sepsis and multiorgan failure.
Mr. E., an 84-year-old man, was admitted to hospital with
a 3-days history of asthenia, functional decline, fever, unin-
telligible speech, and delusions. It was associated since two
months ago with anorexia, weight loss, and an exertional
dyspnea. Imaging demonstrated pulmonary infiltrate at right
lower lobe. Mr. E. was transferred to Acute Geriatric Unit
with diagnosis of pneumonia and delirium. Empirical treat-
ment with antibiotics was started despite which we observed
persistent fever, elevated bilirubin and cholestasis. CT-scan
IAGG 2017 World Congress
301
showed pulmonary patched consolidation and retroperito-
neal and mediastinal lymphadenopathy.
He developed renal and liver failure, and shock, and he
was referred to Intensive Care Unit. Nevertheless he wors-
topenia, and, accordingly, it was done bone marrow aspirate.
He died sixteen days after his hospital admission. Bone mar-
row aspirate showed a neoplastic polymorphous lymphoid
population composed of Reed-Sternberg (HSR)-like cells
which expressed CD20, CD30, EBV/LMP and MUM-1 and
the diagnosis of EBV-positive DLBCL of the elderly was
made.
Disease in elderly could have an atypical presentation
and compromised functioning. EBV-positive DLBCL is an
uncommon aggressive lymphoma subtype and has a worse
survival than would be expected in patients with EBV-
negative DLBCL.
MOVE (MOBILIZATION OF VULNERABLE ELDERS)
AB INITIATIVE FOR INPATIENTS IN ALBERTA
COMMUNITY HOSPITALS
J.Holroyd-Leduc1, K.Osiowy1, J.Quirk2, C.Harris2,
J.E.Moore2, S.E.Straus2,3, 1. Medicine, University
of Calgary, Calgary, Alberta, Canada, 2. Li Ka Shing
Knowledge Institute, St. Michaels Hospital, Toronto,
Ontario, Canada, 3. University of Toronto, Toronto,
Ontario, Canada
The objective of MOVE AB was to disseminate, imple-
ment and evaluate in community hospitals in Alberta,
Canada an evidence based strategy that had been successful
in promoting early mobilization in older patients admitted
to academic hospitals in Ontario, Canada. Early mobiliza-
tion strategies have been shown to improve both patient and
system outcomes.
Four community-based hospitals in Alberta participated.
The multi-disciplinary approach focused on three key mes-
sages: 1.encourage mobility three times a day, 2.progressive
and scaled mobilization, and 3.mobility assessments should
be implemented within 24 hours of admission.
MOVE AB was delivered in phases: Planning/pre-inter-
activities included a Readiness assessment and Barriers and
Facilitators survey, which allowed for tailored interventions
to each unit participating. Interventions included coaching,
fairs, huddles, educational materials, e-modules as well as
focusing on natural opportunities.
The primary outcome was the proportion of patients
aged 65 and older who were mobilized during their hospital
stay. Audits were conducted though all study phases, twice a
week, 3 times a day.
Average mobilization rates increased over time (pre-inter-
vention= 42.5%, intervention= 43.4%, post-intervention=
45.6%). Average mobility rates were highest during lunch
(57.4%) and increased by 8% from pre-intervention to post-
intervention. The majority of mobile activity consisted of
sitting in a chair; sitting in bed with legs dangling or stand-
ing/walking in room independently. Additional analyses will
include examining impact on length of stay and discharge
location. However, we were able to successfully disseminate
302
the MOVE initiative from academic hospitals into smaller
community hospitals.
EFFICACY OF DYSPHAGIA REHABILITATION AND
NUTRITIONAL MANAGEMENT IN THE ACUTE
CARE HOSPITAL
M.Yamori1, H.Higashiyama2, 1. Prefectural University of
Hiroshima, Mihara, Hiroshima Pref., Japan, 2. Onomichi
municipal hospital, Onomichi, Hiroshima Pref., Japan
We have experienced dysphagia rehabilitation by Speech-
Language-Hearing Therapists (SLHTs) under nutritional
management (nutrition support team, NST) which has been
effective for patients recovery especially in the acute stage.
However, available information on the relation among recov-
ery status, rehabilitation by SLHTs, and NST in the acute
stage is limited. Hospitals where are not any or are only a
few SLHTs, even in some urban areas of Japan still exist.
Our aim of this study is to clarify the efficacy of dyspha-
gia rehabilitation under nutritional management in an acute
care hospital. The data of 750 patients admitted in a tertiary
care hospital provided for this study. They were divided into
four groups; SLHT group who were rehabilitated by SLHTs,
both SLHT and NST (Abreast) group who were rehabilitated
by SLHTs under NST, NST only (NST) group and Non-
intervention (NI) group. The patients in SHLT and Abreast
groups were older, more demented and with lower scores of
FIM on average than the other two groups. 55.4% of SLHT
group and 46.7% of Abreast group showed moderate to
severe dysarthria. The percentage of tube fed patients was
significantly higher in SLHT and Abreast group than oth-
ers. However their inpatient periods and FIM score improve-
ments did not show significant differences from others. The
rate of their secession from tube feeding was significantly
higher than others. We concluded that Dysphagia rehabilita-
tion by SLHTs under nutritional management is effective for
patients recovery not only in convalescent stage but also in
the acute stage.
DEVELOPMENT OF AN OUTPATIENT
TRANSFUSION PROTOCOL TO REDUCE AVOIDABLE
HOSPITALIZATIONS
Z.J.Palace, Medicine, Hebrew Home at Riverdale, Bronx,
New York
Improving the quality of care to the elderly is a funda-
mental cornerstone of the practice of geriatric medicine.
Reducing the frequency of avoidable hospitalizations is an
area of particular focus. Inpatient hospitalizations in the
elderly population are often also associated with the devel-
opment of multiple complications, which, in turn, increase
lengths-of-stay. These include hospital-acquired infections,
development of new decubiti, physical declines resulting
from prolonged immobility, and the untoward effects of
acute adjustment reaction from an unfamiliar hospital envi-
ronment. The development of well-designed interventions
in the nursing home can significantly reduce the number of
potentially avoidable hospitalizations in this population.
Development of an Outpatient Transfusion Protocol to
Reduce Avoidable Hospitalizations is a quality improve-
ment initiative that was implemented at The Hebrew
Home at Riverdale, a skilled nursing facility in Bronx, NY.
The objective of this program was to develop a favorable
Innovation in Aging, 2017, Vol. 1, No. S1
alternative to the hospitalization of postacute and long-term
care patients requiring blood transfusion. In our experience,
all patients being sent to the hospital for blood transfusion
were being admitted as an inpatient, irrespective of the goals
of care. This program is being successfully utilized for the
patient who is evaluated for anemia at the skilled nursing
facility and a clinical decision is made to order a blood trans-
fusion without pursuing further workup. Through a clinical
collaboration with a local hospital blood bank, a transfusion
protocol was developed. The hospital physician coordinates
the transfusion with the hospitals blood bank for the follow-
ing day, to be done as an outpatient procedure.
SESSION 770 (POSTER)
AVENUES FOR AGING IN PLACE I
CHALLENGES IN ELDERLY NIGHT-TIME CARE:
DIGNITY 24 HOURS ADAY IN SWEDISH ELDERLY
HOME CARE SERVICES?
K.E.Andersson1,2, M.Sjlund1,2, 1. Department of social
work, Ume University, Ume, Sweden, 2. Department of
social work, Ume, Sweden
The research study explores a large knowledge gap within
Swedish elderly care namely the challenges of within home
care services at night. Despite that home care services is the
most common support given to the elderly in Sweden. The
few National and International studies that exist on night-
time care, have focused on residential care facilities for the
elderly. Therefore, focus here is on night-time care in their
own homes, given by the night patrol which we know very
little about.
In the last decades, organizational transformation has
taken place within elderly care towards increased rationaliza-
tion and marketization. Along with demographical changes,
this raises questions of dignified care, equal social rights and
access to care. As the elderly are living longer and living in
their own homes with severe disability and vulnerability,
the pressure on home care services will increase including
at night. Dignity in care has been legislated in the Swedish
Social Services Act, but is vaguely implemented, specifically
at night.
Discussed are results of an interview survey with man-
agers responsible for night-time home care services in 50
Swedish municipalities. How night-time care is organized
varies depending on local governance, location and size of
municipalities. This indicates challenges for equal access to
care, depending on where you live. Care workers experience
time pressure at night with many fragile elderly in need of
care. How efforts to secure dignity and safety for older peo-
ple varies over night is therefore important to reveal, not the
least from a social equality perspective.
ACTIVITY ENGAGEMENT AMONG OLDER ADULTS
LIVING IN THE COMMUNITY
S.Herbers, N.L.Morrow-Howell, C.Baum, B.Widener,
Y.Wang, Harvey A.Friedman Center for Aging,
Washington University in St. Louis, Saint Louis, Missouri
Activity is central to theories and frameworks regarding
healthy aging. In this pilot study we sought to 1)understand
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
past and current activity engagement among older adults and
2)identify challenges and opportunities for re-engagement.
We completed structured, in-person interviews with 110
older adults living in two community-based settings; 1) a
low-income senior apartment community and 2)single-fam-
ily homes or apartments located within the boundaries of a
local NORC. Interviews included completion of the Activity
Card Sort, a tool where past and present activity levels for
89 activitiesclassified as instrumental, low-demand leisure,
high-demand leisure, or socialwere reviewed. Interviews
also included a series questions that assessed reasons for
reducing activities, facilitators to re-engaging in activities,
and willingness to re-engage. Findings indicate that partici-
pants remained most engaged in instrumental (e.g., doctor
visits, grocery shopping) and low-demand leisure (e.g., read-
ing, using a computer) activities. There was no significant dif-
ference in current activity engagement across ages, however
there was significant difference depending on where older
adults lived. Participants living in senior apartments reported
lower activity engagement for both instrumental and social
activities. The most common barriers reported for activities
were no opportunity (83%), no one to do it with (82%),
and being physically difficult (73%). The top activities resi-
dents would like to re-engage in were social or low-demand
leisure. In terms of starting new activities, interest in high-
demand leisure (e.g., yoga, biking) was high. These findings
can help inform the development of interventions to engage
older adults living in the community.
LONELINESS AS AMEDIATOR BETWEEN SOCIAL
SUPPORT AND LIFE SATISFACTION AMONG
SOLITARY OLDER ADULTS
X.Bai1, S.Yang2, C.Liu1, M.Knapp3, 1. The Hong
Kong Polytechnic University, Hong Kong, China, 2. The
Education University of Hong Kong, Hong Kong, China, 3.
London School of Economics and Political Science, London,
United Kingdom
Despite the importance of optimal life satisfaction in
later life, the varied pathways through different sources
and directions of social support to older adults life satis-
faction remain unclear. Using a sample of a sample of 151
community-dwelling solitary Chinese older adults (65 and
older) in Hong Kong, the present study used path analysis
within the structural equation modelling (SEM) framework
to examine the mediating effect of the sense of loneliness
in the relationship between different sources and directions
of social support and life satisfaction. Bootstrap approach
was employed. Goodness-of-fit indices were obtained for
the final model, with SRMR=0.045, RMSEA=0.039, and
CFI=0.987. The results showed that the sense of loneliness
partially mediated the effect of family support (standardiz
edfamily-LS=0.213; standardizedfamily-loneliness-LS=0.110) on life
satisfaction and fully mediated the effect of friends support
(standardizedfriend-loneliness-LS=0.084). It seemed that confidante
relationships and formal sources of social support represented
by community services did not affect solitary older adults
life satisfaction, but helping others can directly influence
life satisfaction of solitary older adults (standardizedhelping
-LS
=0.123). The findings pointed out the importance of
enhancing awareness among ageing service providers about
the negative effect of insufficient social support on the sense
IAGG 2017 World Congress
303
of loneliness and life satisfaction in older adults. Familial and
friendship networks should be expanded for solitary older
adults, and more volunteer programmes could be developed
for them to join.
AGING IN PLACE WITH INTELLECTUAL DISABILITY:
CARE TRANSITIONS AMONG OLDER TWO-
GENERATION FAMILIES
C.Yueh-Ching1, T.Krger2, W.Wang3, W.Lee4, 1. Institute
of Health & Welfare Policy, National Yang-Ming University,
Taipei, Taiwan, 2. University of Jyvskyl, Jyvskyl,
Finland, 3. Tzu Chi University, Hualien, Taiwan, 4.
National Chi-Nan University, Nanto, Taiwan
Little is known of transitions in care and housing of old
two-generation families that include aging (40) adults with
intellectual disability (ID) and their older (65) parents. This
study employed the housing pathways theory in order to
explore the experiences of these families of such transitions.
All potential old two-generation families from two local
authorities in Taiwan were recruited; 237 families completed
our survey and 61 our in-depth interviews between May
2015 and July 2016. Different models and types of transi-
tions in care and housing of these families were identified
and found to be connected with changes in their care respon-
sibilities and living arrangements. Old parents are concerned
with transferring their care responsibility to others, often to
their other children. The lifecycles and social/financial con-
texts of older parents and aging adults with ID, and those of
the siblings of adults with ID, are linked together and need
to be considered in the process of making moving decisions.
Concerning the transitions in care and housing, kin relations,
living geography and ethnic culture seem to be more impor-
tant factors than social/health care needs/use of older parents
and aging adults with ID. Aging in place was more popu-
lar than moving in old age among these families; hiring a
migrant care worker strengthened families choice of ageing
in the old place. Care transitions, aging with disability and
kin relations are linked together for these families and should
be taken into account and addressed by aging, housing and
disability policies.
TOBACCO CONSUMPTION AND INPATIENT
HOSPITAL SERVICE USE AMONG AN OLDER ADULT
POPULATION IN CHINA
A.C.Mui1, Y.Zhang1, H.Chen2, N.Jiang1, Y.Li3, 1. Social
Work, Columbia University, New York City, New York, 2.
Washington University at St. Louis, St. Louis, Missouri, 3.
Tsinghua University, Beijing, China
This secondary research is based on the WAVE I(2010)
of the WHO Study on Global AGEing and Adult Health
(SAGE). Based on the Andersen- Newman Behavioral Model
of Health Services Utilization, this study examined the role
of tobacco use in predicting utilization of inpatient hospi-
tal service among older adult tobacco users (self-identified)
in China (n = 2,467; age 55 or older). Tobacco consump-
tion was assessed in terms of whether elders at the time of
interview were using tobacco products (including cigarettes,
cigars, pipes, chewing tobacco or snuff) daily. The mean
age of the sample is 65.54 (SD= 8.11), with 91% male
and 86% married. Results showed that 23% of the sample
had received at least one overnight hospital stay in the last
304
12months. Other things being equal, tobacco consumption
was a significant need factor to inpatient hospital use. Data
suggest that heavy smokers were more likely to use inpatient
services. Among the predisposing factors, rural residency was
associated with hospital use. Rural elders may prefer to stay
in the hospital when needed because of the distance between
villages and hospital facilities. In addition, the two enabling
factors (having more financial resources and a higher level
of social participation) were associated with increased likeli-
hood of using hospital inpatient services. Consistent with the
literature, having poor health status was a need factor asso-
ciated with the increased likelihood of hospital service use.
Tobacco use has been identified as a key preventable mor-
bidity, and culturally meaningful tobacco cessation programs
will be discussed.
LONG-TERM OUTCOMES OF HOME
MODIFICATIONS FOR PERSONS AGING WITH
ADISABILITY: ASURVEY
D.Pal, March of Dimes Canada, Toronto, Ontario, Canada
The Home and Vehicle Modification Program (HVMP)
of the Ontario Ministry of Community and Social Services
currently funds modifications to the homes and vehicles of
eligible Ontarians to help them: continue living in their own
homes, avoid job loss, and participate in their communities.
(Ministry of Community and Social Services, 2015).
The program is administered by March of Dimes Canada,
which in 2014 conducted a survey of consumers of the pro-
gram to determine whether the homes whose modifications
the program has subsidized are still occupied by the recipi-
ent of the subsidy, and to assess consumers opinions of the
effectiveness of the modifications of their homes.
495 consumers or their designates were surveyed by tel-
ephone, by mail, or online to evaluate the long-term benefits
of home modifications funded under the program. They were
sampled from consumers who had received funding between
2007 and 2010.
Results showed that 75% were still living in their modi-
fied home and the most frequent unexpected benefits were
greater independence, improved personal care, improved
mobility indoors, and improved quality of life. Median cost
of modifications per day of use was less than $8. In 2008 the
cost for a long-term care home placement was approximately
$135 a day -- since 2013, the costs have increased to $158.36
a day.
WE TAKE CARE OF OUR ELDERLY ON OUR OWN:
OBSERVATIONS ON AN AMIS COMMUNITY SENIOR
CENTER IN TAIWAN
H.Cheng1, S.Lo2, S.Y.Chen3, 1. Anthropology, National approach to measure collaborative functioning through the
Taiwan University, Taipei, Taiwan, 2. National Taiwan
University, Taipei, Taiwan, 3. National Chung-Cheng
University, Taipei, Taiwan
Faced with population aging in Taiwanese society, the
government has promulgated the Long-term Care Services
Act as the principal legal basis for developing a compre-
hensive long-term care system for improving the quality
of life of the elderly. Resources, however, are distributed
unevenly between urban and rural areas. To compensate
for this, scholars have recently introduced the concept of
Innovation in Aging, 2017, Vol. 1, No. S1
Culture Care, and called on locals to build up their own
care network through cultural knowledge that integrates
interpersonal relationships and the social resource of the
community. This study was conducted from January 23rd to
31st in 2016, under the course Field Methods of Cultural
Anthropology (with Practices), with assistance of the pro-
fessor in arranging research area and connecting informants.
The study describes how the concept of culture care works in
a Taiwanese indigenous communitys senior center through
participant observation and in-depth interviews. By under-
standing how the project was initiated, the organization of
members, member interaction and local viewpoints on care
of the elderly, it is found that clan-based caring boundaries,
member interaction following the pattern of the Amis finaw-
lan (age-set organization), curriculums focusing on member
empowerment, and concerns of cultural heritage make the
center not only a caring organization but also a social sup-
port network. In addition, the center enables every genera-
tion to take part in caring for the elderly and strengthens
their social identity at the same time.
RURAL SYSTEMS CHANGE COLLABORATIONS
TO IMPROVE COORDINATION OF SERVICES
SUPPORTING AGING IN PLACE
D.Wihry1, L.W.Kaye1, J.Crittenden1, M.Callaway2,
D.Walsh3, 1. Center on Aging, University of Maine, Bangor,
Maine, 2. Charlotte White Center, Dover-Foxcroft, Maine,
3. Eastern Area Agency on Aging, Bangor, Maine
In rural and resource-poor regions, strategies to support
aging-in-place focusing efforts on improving coordination of
existing services represent a low cost strategy for improv-
ing older adult health and wellbeing. This poster presents
findings from an ongoing evaluation of a multi-site systems
change collaboration to improve service coordination in two
rural US counties. Pilot interventions targeting community
needs such as transportation or home-based services are
paired with meetings of providers to improve service inte-
gration and build understanding of the spectrum of commu-
nity resources available. Needs assessment findings indicate
that among adults 65+ surveyed in the region (N=280), the
most prevalent challenges for aging-in-place included get-
ting household repairs (30%), understanding government
benefits (21.5%), isolation (18.9%), falls (18.7%), and
help with homemaking activities (18.2%). Among partners
(N=15) involved in one of these collaborations, a limited
history of cooperation in the community was rated as the
most significant challenge to collaboration (Mean=3.2) of
the 20 factors measured by the Wilder Collaborative Factors
Inventory. The project evaluation utilizes a mixed method
Wilder instrument and uncovers systems changes through
the Ripple Effects Mapping (REM) qualitative method. Early
REM results indicate successes in increasing knowledge of
the spectrum of services in the targeted regions among part-
ners and supporting interactions between sectors that have
normally not worked together. Findings also highlight the
need for a dual approach educating consumers and provid-
ers about the range of available resources. Barriers to systems
change will also be examined.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
A LONGITUDINAL STUDY AT AN ELDER
COHOUSING COMMUNITY: AFTER 10 YEARS, WHO
LEFT AND WHOS LEFT?
A.P.Glass, Gerontology, University of North Carolina
Wilmington, Wilmington, North Carolina
Long common in Europe, the first senior cohousing com-
munities opened in the USA in the last decade. These com-
munities are run by the residents themselves and offer the
potential for mutual peer support and a strong sense of
community. A longitudinal mixed methods study has been
conducted by annual data collection at one such community
since it opened in 2006. One outcome explored is retention,
which is important to sustainability and future-proofing. The
cohousing community is comprised of both owned units and
income-subsidized apartments, with 31 units in total. Of the
original 39 first charter residents, 38 were white, 8 were
male, and the mean age at move-in was 70.4 (range=6384).
Thirteen (33%) of these charter residents were still living
in the community in 2016: 11 were females, all were white,
with a mean age of 79.5 (range=7394). Reasons why they
have stayed included friends, the location, liking the com-
munity and the mutual support, and pride in their creation
of a new model of housing for older adults. Six (15%) char-
ter residents died locally. The remainder (projected mean
age in 2016=79.7, range=7388) moved due to health issues
and the need for greater care, to be near family, because of
the income-subsidized housing regulations, or because they
found that living in community was not a good fit for them
or was too much work. Lessons learned about sustainability
and the value of cohousing for older adults will be shared
and suggestions for similar housing models will be discussed.
DESIGNING AGE-INTEGRATED COMMUNITIES:
LESSONS FROM ANATURALLY OCCURRING
RETIREMENT COMMUNITY
D.A.Fitzsimmons1, M.Kloseck1, S.Kuhn2, 1. Western dences or living in the community. These data suggest that
University, London, Ontario, Canada, 2. University of
Cambridge, Cambridge, United Kingdom
Urban environments are an essential determinant of
health and quality of life for older adults. Architecture can-
not force people to participate in society, or create commu-
nity cohesion; it does, however, have the potential to lay the
foundation of social infrastructure necessary to encourage
and support social relations. This in turn has the potential
to influence behavior in a positive way. The purpose of this
study was to learn from a highly successful naturally occur-
ring retirement community (NORC) the different design
characteristics of the built environment that make this such
a desirable place to live. This study employed a hermeneu-
tic phenomenological methodology to explore, describe and
interpret the lived experiences of 12 independent, interde-
pendent and dependent residents living in the Cherryhill
NORC in London, Ontario, Canada. Participants identi-
fied the criteria that attracted them to this NORC initially
and encouraged them to remain within the community.
Participants also identified a number of elements within their
apartment buildings, the transitional threshold areas, and
external spaces that would further enhance their experience
of living within this NORC. Issues included airflow, tem-
perature control, exposure, balcony design, pet ownership,
accessibility, community transportation, amenities and more.
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305
Many design and planning guidelines for age-friendly com-
munities describe elements that improve safety, mobility and
access. This study revealed that social opportunity spaces
play a key role in the life of older individuals and provides
further evidence of how seniors within this NORC leverage
social capital to provide an invaluable support network for
each other.
COMMUNITY-BASED SERVICES AND RESOURCES IN
ARESIDENTIAL SETTING: LOCATION MATTERS
K.G.Emerson, T.Washington, M.Smith, A.Carswell,
H.H.Ewen, University of Georgia, Athens, Georgia
One key component to facilitate an older adults ability to
remain in the community is provision of formal services in
their residence. However, service-accessible housing options
are often limited to those with financial means, and many
older adults remain in housing that is considered service-
poor. The study examines the disparity of services avail-
ability by types of residence. Using cross-sectional data from
Wave 2 of the Pathways to Life Quality dataset, we exam-
ined the sociodemographic characteristics, health status, and
social support by residence for adults aged 50 and older.
Data were categorized by elders living in their own home
in the community (N=347), independent elders living in ser-
vice-rich housing (Continuing Care Retirement Community
residents; N=188) and elders living in service-poor housing
(government subsidized housing; N=137). Data were ana-
lyzed across groups using ANOVA. The sample was a major-
ity female, with an average age of 76 (range 50101). Older
adults living in the service poor residences had lower socioec-
onomic resources (lower education levels, less income; p-val-
ues<.000), worse health (higher functional limitations, more
chronic conditions; p-values<.000), and less social resources
(less social integration, less social support, lower marriage
rates; p-values<.000) compared to those in service-rich resi-
elders living in service-poor areas are not only vulnerable due
to lower service availability, but also have high social, eco-
nomic, and health vulnerability. It is particularly important
to identify groups that are most vulnerable in order to target
interventions efficiently. Recommendations for policy and
practice will be discussed.
PLACE ATTACHMENT AND PLACE IDENTITY
AMONG OLDER ITALIAN MIGRANTS IN
NEWCASTLE UPON TYNE
S.Palladino, Newcastle University, Newcastle upon Tyne,
United Kingdom
This paper aims to gain a critical understanding of affec-
tive bonds established with and through places in later life,
from the perspective of members of a migrant population.
Whilst place attachment in older age has been investigated
from a wide range of scholarly angles, the ways in which it
might be experienced by people who are ageing away from
their home countries is a neglected area of research. Older
migrants processes of identification and belonging to spe-
cific places contributes significantly to active ageing and
wellbeing in later life. In order to better understand this,
I focus on how older Italian migrants in Newcastle upon
Tyne, UK, interpret a sense of attachment and identification
with significant places. This paper explores their experiences
306
of private and public places and the meanings they attribute
to them. Ibuild from ethnographic research on the ways in
which private and public spheres are physical but also oper-
ate on social and symbolic levels (Wiles, 2011). Drawing on
the social gerontology literature (Rowles 1978; 2003; Peace,
2005). I explore how individual make sense of the role of
the home - and its embodied practices- plays in sustaining
a sense of identity for themselves and others. This reflec-
tion offers a broader perspective on the migration status, of
both appropriation and expropriation even many years after
the process of migration (Basu and Coleman, 2008). Home,
the experiences and meanings associated with it, need to be
addressed as an expressive site to understand the perspective
of a migrant population.
FACTORS INFLUENCING HUMAN-PET
INTERACTION AMONG OLDER ADULTS
C.Hoffman1, A.Glicksman1, M.H.Kleban2, K.Clark1,
1. Philadelphia Corporation for Aging, Philadelphia,
Pennsylvania, 2. Abramson Center for Jewish Life, North
Wales, Pennsylvania
As more attention is paid to the role of pets in the lives of
older adults, we need to better understand who is more likely
to have a pet at home. Studies that recruit pet owners do not
allow us to estimate either the proportion of older adults
with a pet, identify the socio-demographic characteristics of
persons more likely to own a pet, or whether different char-
acteristics are more strongly associated with ownership of a
particular type of pet. The 2012 Public Health Management
Corporations Household Health Survey asked a representa-
tive sample of older adults in Philadelphia and the four sur-
rounding counties about pet ownership. Of the 3,042 persons
age 60+ interviewed, almost 40% had a pet in their home.
Our analyses compared persons 1)with no pet (n=1,864)
to 2)persons with a dog only (n=406) and 3)persons with
a cat only (n=476). We found statistically significant differ-
ences in regard to sex, age, size of the household, income,
renting or owning their home and whether the older adult
had experienced depressive symptoms in the previous week.
Interestingly there were no differences on measures of self-
rated health, frequency of social interaction, or feelings
regarding neighbors. Our findings suggest that research on
the human-pet interaction in old age needs to consider sev-
eral contextual issues (including the type of pet and the com-
position of the household) to better understand the impact of
pet ownership on health and other outcomes for older adults.
FROM UNDERSTANDING OUR AGEING BODIES TO
SAFETY IN AGEING IN PLACE
K.Lee3, Y.Lee1, Y.Lee2, S.Kwok2, 1. Hong Kong Design
Institute, Hong Kong, Hong Kong, 2. Vocational Training
Council, Hong Kong, Hong Kong, 3. Pro-Act Training and
Development Centre, Hong Kong, Hong Kong
This paper aims to discuss a cross-disciplinary col-
laborative project conducted by researchers from design
and engineering. The project adopted the Action Research
(AR) Methodology which intended to involve active senior
citizens throughout the research process. The collabora-
tion kick-started by the Aging Bodies Study with the goal to
develop the 1st Hong Kong ageing population profile includ-
ing an ergonomic database animated by visual records of
Innovation in Aging, 2017, Vol. 1, No. S1
peoples everyday behaviors. This part was led by a group of
design researchers working with design students to develop
innovative ways to engage senior citizens. Through partici-
pating interactive activities, senior citizens were invited to
co-investigate their bodies and lifestyle changes in the city.
Additionally, ethnographic study including interviews at their
homes was conducted to further inspect issues associated
with independent living in their confined spaces in typical
social housing projects in Hong Kong. Using the ergonomic
and ethnographic results of the Ageing Bodies Study, engi-
neering researcher took the led to develop a series of low-
cost devices for confined bathroom to prevent accidents and
improve safety at home. All the solutions were prototyped
with local manufacturers and sent back to peoples homes for
testing and develop creative conversations on issues regard-
ing their Ageing In Place. This people-centered process
documented a cohesion creation might form a good platform
in rapid ageing society to bring both researchers, communi-
ties and developers together to address wicked problems of
ageing for our future.
STATE OF COLLABORATION BETWEEN SELF-HELP
AND PROFESSIONAL SERVICE NECESSARY FOR
AGING IN COMMUNITY
M.Kinukawa, T.Inoue, T.Hashimoto, Research Dept.,
Institution of Elderly Housing Sciences, Kyoto, Kita-ku,
Japan
Due to the necessity to cut down social security expenses
in many aging societies,
frail older adults are directed to enhance self-help in their
home-based lives. The development of self-help or mutual
help has been also focused to substitute professional services.
At the same time, difficulty to involve informal carers has
been emerging due to the change in family relation, and the
rapid increase of one-person households.
A new inclusive service to support home-based older
adults has been launched in super-aged society, Tokyo. The
users can select necessary services from a comprehensive care
preparation consisted of meals, living assistance, nursing,
condultation, social work, 24-hour regular home visitation,
and as-needed visitation services. This initiative takes fami-
lies and informal carers as effective environmental factors in
supporting the users to involve their spontaneous participa-
tion in providing services.
Service records of 30 users of the service for one year were
analyzed to capture the emergence of self-help. This study
aimed to clarify how self-help could function and collaborate
with professional supports.
Many of the users used the service under family supervi-
sion. Family living nearby modified and adjusted the service
according to the changes of the users needs especially on
occasion of bad health condition, and also played an inter-
mediate role between doctors/nurses and care professionals.
Distant families or families with jobs received information
from care staff. Based on the information, they advised the
staff for future support.
The results indicate systemizing effective communica-
tion between self-help and care professionals needs to be
considered in aging societies, and, in case raising self-help
is difficult, professional staff needs to carry out thorough
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
information gathering, or an intermediate position between
an older adult and care staff need to be prepared.
SESSION 775 (POSTER)
BIO-BEHAVIORAL RISK FACTORS OF HEALTH
USE, INTENTION TO USE, AND PERCEPTIONS OF
RISK ACROSS TOBACCO PRODUCTS AMONG OLDER
SMOKERS
J.K.Cataldo, J.Wang, K.Delucchi, C.Dankiewicz,
Physiological Nursing, UCSF, San Francisco, California
Recently there was an eight-fold increase for e-cigarette
use among older smokers with nearly a 20-fold increase
among former smokers. The purposes of this national survey
study were to explore the perceptions of benefits and risks of
tobacco product use among older current and former smok-
ers. The sample (N=549) had a mean age of 56.9 (SD= 7.3)
and included 92% current smokers, 56% females and 83%
Non-Hispanic Caucasians. Dual use for e-cigarettes with cig-
arettes at 30 and 7-days was (24.3 and 16.6 %, respectively).
When asked about the risk of harm on a 05 scale across
products (cigarettes, cigars, e-cigarettes, and dip/chew), from
least to greatest for self, others, and environment; cigarettes
and cigars were seen as most harmful (4.3 and 4.1) and
e-cigarettes as least harmful (2.5). For the risk of addiction
across products, cigarettes had the highest mean score across
three addiction measures: overall rating of addiction (4.6),
ever tried to quit and couldnt (3. 8), and felt addicted to the
product (3.7). Among those who had never tried e-cigarettes,
almost 12% said they were likely to try a flavored e-cigarette
with nicotine for the first time in the next six months and
among current smokers when asked about their next cessa-
tion attempt, over 50% thought they would try/use e-cig-
arettes. These findings suggest that older smokers perceive
e-cigarettes as least harmful of all tobacco products and are
increasingly using e-cigarettes to circumvent no smoking pol-
icies and for cessation attempts that are largely unsuccessful.
HEALTH AND RELIGIOUS CHANGE IN LATER LIFE
M.Silverstein2, V.L.Bengtson1, 1. Roybal Institute on
Agingl, University of Southern California, Santa Barbara,
California, 2. Syracuse University, Syracuse, New York
Recent research has demonstrated a positive relation-
ship between religion and health in later life. However, no
research to date has examined how changes in religiosity,
shifts upward or downward in spiritual or religious life,
might have an impact on physical or emotional health. In
this research we examine trajectories of later life religios-
ity and their relation to health in a mixed-methods longi-
tudinal study based on the 45-year Longitudinal Study of
Generations. The survey data were collected from some 400
individuals now 6090 between 1971 and 2016. Qualitative
data come from 100 interviews collected in 2016. Results
indicate that most individuals who are religious report they
have increased their religious or spiritual involvement since
retiring; for those who are not religious a similar increase in
spiritual and contemplative activities is reported. The quan-
titative data provide limited support for the linkage between
increased religiosity and health or well-being.
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307
REEXAMINING THE EFFECTS OF RESIDENTIAL
MOBILITY ON WELL-BEING IN NULLPARENT
WOMEN. FINDINGS FROM THE DUTCH NUN STUDY
E.Stitzinger, VU University, Amsterdam, Netherlands
In the 1980s The Nun Study by David Snowdon showed
us new insights on the influence of ageing, lifestyle and
Alzheimers. However, since then we have been struggling
to find the significance of lifestyle versus biological factors
and healthy ageing of the brain. In an effort to find new
answers Dutch Nun Study included 200 Dutch Nuns living
in Netherlands between 70 and 104years of age and stud-
ied the relationship between biological factors, ageing and
lifestyle. Abetter understanding of the interactions between
genetics, individuality of functionality of neurons and life-
style may change our view on the role and importance of
cognitive functioning and help prevent cognitive decline in
late life. Lifestyles of Contemplative, Active and Missionary
Nuns were included. Findings are presented.
SOCIOECONOMIC ADVERSITY AND ALLOSTATIC
LOAD: ATWIN ANALYSIS
J.K.Robinette1, C.Beam1, T.L.Gruenewald2, 1. Leonard
Davis School of Gerontology, University of Southern
California, Long Beach, California, 2. California State
University, Long Beach, Long Beach, California
Childhood socioeconomic status (SES) is related to health
concurrently and into adulthood, and is associated with adult-
hood SES. Given these far-reaching relationships, some ques-
tion whether adulthood SES associates with health beyond
childhood SES. Biometric twin (ACE) models partition the
predictor variables into additive genetic (A), shared environ-
mental (C), and nonshared (unique) environmental (E) vari-
ance components. Researchers can control for latent genetic
and shared environmental factors that may confound con-
clusions about the causal effects of adulthood SES on health.
We used family data from the second wave of the national
Midlife in the United States (MIDUS) Study (128 MZ pairs,
99 DZ pairs, 119 Sibling pairs) to examine this question.
Health was assessed with a measure of multi-system physi-
ological dysregulation posited to confer risk for the develop-
ment of physical health problems. Adult SES was calculated
with education, family-adjusted poverty to income ratio, cur-
rent financial situation, enough money to meet needs, and
difficulty paying bills. Results of ACE models suggested that
male twins with lower adult SES had higher allostatic load,
indicating greater physiological risk, than their co-twins with
higher SES (b=0.19), adjusting for genetic and shared envi-
ronmental correlations between allostatic load and SES, and
observed childhood SES, health status, and perceived support
from family and friends. This relationship was not observed
among female twins. These results add to a growing litera-
ture indicating that lower adult SES is associated with poorer
multi-system physiological health, even after accounting for
shared genetic and early environmental influences.
SOCIO-ECONOMIC DIFFERENCES IN THE SPEED
OF HEART RATE RECOVERY FOLLOWING
ORTHOSTATIC CHALLENGE
C.McCrory1, P.V.Moore1, L.F.Berkman2, R.Kenny1,
1. Department of Medical Gerontology, Trinity College
308
Dublin, Dublin, Ireland, 2. Harvard University, Boston,
Massachusetts
Much recent work has focused on the prognostic value of
heart rate recovery (HRR) as a risk factor for cardiovascu-
lar disease and cardiovascular mortality. This paper explores
socio-economic variation in HRR following exposure to a
potent physiological stressor. The sample involves a nation-
ally representative cohort of 4475 community-dwelling older
persons aged 50years+ participating in the Irish Longitudinal
Study on Ageing (TILDA). Participants completed an active
stand (i.e. vertical stand from a supine position) as part of a
clinic-based cardiovascular health assessment and heart rate
and blood pressure responses to the stand were monitored
over a two-minute time horizon using a finometer. Highest
level of educational achievement served as our measure of
socio-economic status. Mediation analysis was undertaken
to explore the pathways through which social inequality
comes to affect the speed of HRR using the extensive array of
covariates available in the TILDA dataset. Participants with
a primary level education were characterised by a signifi-
cantly slower HRR following the stand compared with those
with tertiary level education (B= -1.16 bpm, CI95%=-1.78,
-0.55; p<0.001). Mediation analysis revealed that lifetime
smoking history accounted for a sizeable proportion (~50%)
of the educational differential. Additional adjustment for
other objectively measured markers of lifestyle measured
during the clinic-visit rendered the educational differential
non-significant.
INTENT TO AVOID FAT FOOD CONSUMPTION
AND PERCEIVED STRESS IN MIDLIIFE AND OLDER
AFRICAN AMERICANS
E.Iheanacho-Dike1, P.A.Ralston1, I.Young-Clark1,
C.C.Coccia2, 1. Center on Better Health and Life for
Underserved Populations, Florida State University,
Tallahassee, Florida, 2. Florida International University,
Miami, Florida
Cardiovascular disease (CVD) is the leading cause of
death for African Americans (AAs) in the USA, with diet and
perceived stress identified as two key factors. Fat consump-
tion has been identified as a key contributor to poor dietary
health in AAs and stress may lead to increased fat consump-
tion. However, few studies have examined the extent to
which perceived stress and intent to avoid high fat consump-
tion are related to fat consumption in mid-life and older
AAs. Thus, the purpose of this study was to examine the
relationship between intent to avoid high fat food consump-
tion (intention to change fat behaviors, consistency of avoid-
ing high fat foods), fat consumption (NCI Fat Screener) and
perceived stress (Cohens Perceived Stress Scale). Guided by
the planned behavior and social cognitive theories, this study
uses baseline data from a broader longitudinal church-based
project to reduce CVD risk conducted with mid-life and
older AAs (n=221) in six churches across a two county area
of North Florida, USA. Age, gender, educational level and
marital status were controlled in the analysis. Preliminary
results showed perceived stress had an inverse relationship
with consistency of avoiding high fat foods (p <.01), In addi-
tion, consistency of avoiding high fat foods was negatively
related to general fat consumption (p < .01). Findings suggest
participants with higher stress have less ability to consistently
Innovation in Aging, 2017, Vol. 1, No. S1
avoid fat, and participants with higher ability to consistently
avoid consuming high fat foods had lower reports of general
fat consumption in their diets. Implications for practice will
be discussed.
HEALTHFUL DIET PATTERNS ARE POSITIVELY
ASSOCIATED WITH LEUKOCYTE TELOMERE
LENGTH IN HEALTHY ADULTS
C.Leung, E.Epel, Center for Health and Community,
University of California, San Francisco, San Francisco,
California
Studies examining associations with healthful diet pat-
terns and leukocyte telomere length (LTL) have been incon-
clusive. Using data from the 19992002 National Health
and Nutrition Examination Surveys (NHANES), we exam-
ined four evidence-based measures of healthful dietary pat-
terns in relation to LTL the Healthy Eating Index-2010, the
Alternate Healthy Eating Index-2010, Dietary Approaches
to Stop Hypertension (DASH) Index, and the Alternate
Mediterranean Diet Index. The NHANES study popula-
tion included 4,758 US adults, aged 20 to 65 years, with
no prior history of coronary heart disease, diabetes, stroke,
or cancer. LTL was assayed from DNA specimens. Dietary
patterns were estimated from 24-hour dietary recall data
for each pattern, a higher score signified better diet quality.
Associations were examined using multivariate linear regres-
sion models, adjusting for sociodemographic characteristics,
health behaviors, and total energy intake. Pearson correla-
tion coefficients between the four dietary patterns ranged
from 0.609 to 0.730. One-standard-deviation increases in the
Healthy Eating Index-2010 (B=0.015, 95% CI 0.003, 0.028)
and the DASH index (B=0.016, 95% CI 0.003, 0.029) were
both associated with longer LTL. A marginally significant
association was also observed with the Alternate Healthy
Eating Index-2010 (B=0.009, 95% CI -0.000, 0.018). Further
adjustment for body mass index and waist circumference did
not alter these associations. The Alternate Mediterranean
Diet Index was not associated with LTL (B=0.002, 95% CI
-0.009, 0.013). In this nationally representative sample of US
adults, several healthful diet patterns were associated with
longer LTL. These results may provide insight on the com-
plex associations between optimal nutrition and longevity.
HEALTH BEHAVIOR PROFILES OF KOREAN BABY
BOOMERS: EFFECTS OF PERCEIVED HEALTH
CONCERNS AND MASTERY
B.Kim1, K.Kim1, G.Han2, 1. University of Massachusetts
Boston, Boston, Massachusetts, 2. Seoul National
University, Seoul, Korea (the Republic of)
Health behaviors including health-risk and preven-
tive behaviors are closely linked to various health out-
comes and longevity. This study aimed to identify distinct
profiles of health behaviors among Korean Baby Boomers
(born between 1955 and 1963) and examine factors (e.g.,
demographic characteristics, perceived health and illness,
and mastery) distinguishing health behavior profiles. We
analyzed a sample of 4,053 respondents from the Korean
Baby Boomer Panel Study in 2014. Latent class analysis was
applied to six health-risk (smoking, drinking) and preven-
tive (exercise, health check-up, and supplement and herbal
medicine intake) behaviors to classify profiles. We identified
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
five different combinations of health-risk and preventive
behaviors: a) moderate risk and low preventive (34%), b)
low risk and high preventive (22%), c) high risk and high
preventive (16%), d) moderate risk and moderate preven-
tive (14%), and e) high risk and low preventive (13%).
Multinomial regression analyses for the pattern member-
ship indicated that respondents who reported higher levels
of health concerns were more likely to belong to the high
risk and high preventive pattern, compared to the moderate
risk and moderate preventive pattern. Also, respondents with
a stronger sense of mastery were less likely to be in the low
risk and high preventive pattern. Our findings suggest that
different levels of health concerns and sense of mastery are
reported by individuals who engaged in certain patterns of
health behaviors among Korean Baby Boomers, which may
highlight the potential importance of examining different
types of health behaviors as patterns.
HEALTHY LIFESTYLE HABITS AND HEALTH-
RELATED QUALITY OF LIFE AMONG OLDER
ADULTS WITH DIABETES
W.Qin, A.L.Townsend, Case Western Reserve University,
Cleveland, Ohio
Health-related quality of life (HRQOL) is impaired
among people with diabetes. This study aims to examine
the relationship between having at least one healthy lifestyle
habit (no smoking, physical exercise, or both) and HRQOL
among older adults with diabetes.
Adults age 65 or older with diabetes were selected
from the 2014 Behavioral Risk Factor Surveillance System.
HRQOL measures are general health (excellent, very good,
or good=1) and less than 14days physical health not good,
mental health not good, and impaired activity. Healthy life-
style habits included not smoking and engaging in physical
activity in past 30 days. Covariates were age, gender, race,
education and body mass index. Binary logistic regression
is employed to examine the relationship between having at
least one healthy lifestyle habit and HRQOL.
In total 30,917 participants age 65 or older with diabe-
tes were selected for this study. Just over half (56.2%) were
female (n=17,373), 71.4% were non-smokers and 60.1%
had physical exercise during past 30days (n=18,578). Having
at least one healthy lifestyle habit is associated with signifi-
cantly better general health (odds ratio=2.78, p<0.001), less
than 14 days physical health not good (odds ratio=2.68,
p<0.001), less than 14 days mental health not good (odds
ratio=2.11, p<0.001) and less than 14days impaired activity
(odds ratio=2.95, p<0.001).
Overall, study findings imply that to help older adults
with diabetes have better health and reduce impaired activi-
ties, prevention could encourage them not to smoke and to
engage in more physical activity.
DRINK WISE AGE WELL: AUK-WIDE MULTILEVEL
PROGRAMME TO REDUCE ALCOHOL-RELATED
HARM IN OLDER ADULTS
S.Wadd1, J.Breslin3, G.McDougall, L.Elliott4, I.Madoc- ent social era impact their current risk-taking sexual behav-
Jones5, A.Whittaker6, M.Donnelly7, 1. University of
Bedfordshire, Luton, Bedfordshire, United Kingdom,
3. Addaction, Glasgow, United Kingdom, 4. Glasgow
Caledonian University, Glasgow, United Kingdom, 5.
IAGG 2017 World Congress
309
Glyndwr University, Wrexham, United Kingdom, 6.
Edinburgh Napier University, Edinburgh, United Kingdom,
7. Queens University Belfast, Belfast, United Kingdom
Alcohol use can have a detrimental impact on health,
physical and mental functioning, social wellbeing and qual-
ity of life in older adults. The World Health Organisation
has identified alcohol-related harm among older adults as an
increasing concern. With funding from the National Lottery,
a five-year multilevel programme to reduce alcohol-related
harm in older adults (50+) is being implemented and evalu-
ated across the UK. The programme, known as Drink Wise
Age Well, is being delivered in five demonstration areas
in England, Wales, Scotland and Northern Ireland. The
programme is evidence-based and designed specifically for
older adults. Activities include delivering community-level
public awareness campaigns, providing a telephone helpline,
a peer education project, a group resilience intervention, a
programme of diversionary activities, alcohol training for
professionals working in older adults services and a range
of age-appropriate interventions for those with existing alco-
hol problems. Importantly, the programme is also engaging
with national and local policy makers to increase the profile
of the issue and ensure that the needs of older adults are
considered and highlighted in relevant strategy. Early find-
ings suggest that the programme is reducing at-risk drinking,
decreasing symptoms of depression and anxiety, increasing
resilience, raising awareness of the issue, increasing profes-
sional capacity and improving positioning of the issue on the
policy agenda. Multilevel programmes such as Drink Wise,
Age Well could be key to reducing alcohol-related harm in
ageing populations worldwide.
SIXTY AND SEXY: FACTORS INFLUENCING
HIV RISK-TAKING BEHAVIORS AMONG OLDER
AFRICAN-AMERICAN WOMEN
J.T.Richardson, M.A.Pyles, Kinesiology and Health
Sciences, Virginia Commonwealth University, Richmond,
Virginia
Despite myths and stereotypes, many older women are
sexually active. Among older African American women,
rates are increasing for newly-diagnosed HIV infection, for
those living with HIV and for HIV/AIDS-related mortality.
While African American women represent only 14% of the
U.S. female population, they account for nearly two-thirds
of all new HIV infections in women and for over half with
AIDS. Although many health promotion/disease prevention
(HP/DP) efforts are directed toward HIV risk-reduction for
younger African-American women, less notice is directed
toward their sexually active, older counterparts. Yet, the pri-
mary mode of transmission for both is high risk heterosexual
exposure. Does a one-size-fits-all prevention approach work
for all African American women? Or, is it necessary to custom-
ize interventions for older African-American women because
of unique factors influencing their risky sexual behaviors?
This inquiry explored whether early gender socialization and
the establishment of gender norms and roles in a very differ-
iors. Surveys and focus groups were used to elicit values,
beliefs, attitudes, gender role expectations and knowledge in
relationship to high risk sexual behaviors. The results high-
lighted the need to tailor HIV prevention interventions that
310
are socially- and culturally-relevant and appropriate for the
priority population of older African American women. The
resulting intervention design takes into account overcoming
long-held gender roles/norms and positively impacts their
knowledge, attitudes and behaviors that in turn empowers
them to protect their health, practice healthy sexual behav-
iors and to improve their overall quality of life.
PROTECTIVE FACTORS IN VULNERABLE, RURAL
OLDER ADULTS: LINKS WITH SALIVARY MARKERS
OF INFLAMMATION
N.E.Schoenberg, R.L.Brown, A.Hansen, S.Bi, P.Keller, tiple linear regression was used to assess whether diabetes,
Behavioral Science, University of Kentucky, Lexington,
Kentucky
Numerous social determinants-- individual, interpersonal,
community, policy- converge to increase stress among older
rural adults. This stress, which can manifest itself physically
in potentially harmful inflammatory response, frequently
erodes health and undermines social relations. Yet, over
the life course, individuals tend to become more effective
at identifying efficacious coping strategies. To improve our
understanding of how this vulnerable population copes with
stress, we conducted semi-structured and structured inter-
views with 21 rural residents, aged 65+ about physical and
mental health, stress, and protective factors, including social
support, religiosity, and exercise. Additionally, we collected
saliva samples which were assayed for markers (pro-inflam-
matory molecules C reactive protein (CRP), tumor necrosis
factor alpha (TNF), and interleukin-6 (IL-6) of stress and
inflammation. This sample was 65.6% female and com-
prised predominantly lower class families: 50% indicated
they struggled to make ends meet and maintained numer-
ous physical health problems: 53.1% reported at least one
chronic disease, including heart disease, diabetes, high blood
pressure, high blood cholesterol and etc. Of the three focal
protective factors, only social support was significantly asso-
ciated with lower levels of salivary inflammation markers.
However, both exercise and religiosity demonstrated non-
significant associations with inflammatory parameters that
were in the predicted direction and may emerge as significant
with additional participants. In addition, all three protective
factors were significantly related to lower self-reported stress.
Religiosity was most consistently associated with lower risk
for health problems. Drawing on these protective strategies
may be helpful for designing future interventions and policy
for this and other vulnerable populations.
ASSOCIATIONS OF BIOBEHAVIORAL FACTORS AND
SELF-RATED HEALTH IN BLACK MEN: NHANES
2009 2010
L.T.Lee1, P.Bowen1, G.McCaskill2, O.J.Clay3, 1. Acute,
Chronic and Continuing Care, The University of Alabama
at Birmingham, Birmingham, Alabama, 2. Birmingham/
Atlanta Geriatric Research, Education, and Clinical Center,
Birmingham, Alabama, 3. Department of Psychology,
The University of Alabama at Birmingham, Birmingham,
Alabama
Background: Self-rated health is a strong predictor of
health outcomes including mortality in the general popula-
tion. Men with low self-rated health, living with diabetes or
psychological distress have an increased risk of mortality
Innovation in Aging, 2017, Vol. 1, No. S1
compared to women. Few studies have examined the relation-
ship between physical activity and self-rated health within
older African American men. The purpose of this study was
to assess the relationships of diabetes, depression, and physi-
cal activity with self-rated health.
Methods: Investigators used 2009 2010 National Health
and Nutrition Examination Survey data and participants
were African American men age 45years or older. They com-
pleted survey measures of demographic and socioeconomic
factors, physical activity engagement, mental and physical
health, and perceived health status. Covariate-adjusted mul-
depressive symptoms, and physical activity were indepen-
dently associated with self-rated health.
Results: The mean age of the analytic sample of 270
African American men was 60.179.36years. Thirty percent
(n=81) had poor or fair self-rated health and 27% had diabe-
tes. Results revealed that fewer days of vigorous recreational
activities, reporting high levels of depressive symptoms, and
having diabetes were each individually associated with lower
levels of self-rated health, ps < .05.
Conclusion: Findings from this investigation identified
subsets of African American men who are at-risk for low lev-
els of self-rated health. These results also suggest the potential
importance of developing interventions that target diabetes
and depression management as well as physical inactivity for
this population in order to improve perceived health status.
SESSION 780 (POSTER)
CANCER AND AGING
A MULTI-MODAL INTERVENTION TO MANAGE
PROSTATE CANCER SYMPTOMS
D.M.Kresevic1,2, A.Zhang3, 1. Louis Stokes Cleveland VA
Medical Center, Cleveland, Ohio, 2. University Hospitals
Of Cleveland, Cleveland, Ohio, 3. Case Western Reserve
University, Cleveland, Ohio
There are nearly 3 million prostate cancer survivors in
the U.S., with many reporting urinary incontinence UI and
decreased quality of life QOL. While post treatment recom-
mendation include referral for Pelvic Floor Muscle PFM
rehabilitation including Kegel exercises, timed voiding and
medications it does not appear that this recommendation is
consistently being done and evaluated. (ACS, 2015). In this
study 279 eligible participants who consented were rand-
omized to 1)a biofeedback and peer support group, (2) bio-
feedback group and individual phone calls and 3)usual care
which included printed instructions. Biofeedback included a
60 minute session on pelvic exercises. Support groups and
telephone groups included 6 biweekly sessions led by either
a psychologist or nurse using a problem solving approach
to address urinary symptoms. Measures included: a urinary
diary to track frequency of urine leakage, the University of
California Prostate Cancer QOL Index, a visual analogue
scale to measure severity of UI and SF-36V2 to measure
overall physical well-being. Mean age was 64.8years, 63.6%
where white, 25.5% were high school graduates, 64.9%
were married, 30.5% employed, 67.6% had stage II can-
cer, 56.1% were treated with surgery, 50% with radiation
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
therapy. The biofeedback plus support and plus telephone
groups reported less symptom severity (p 0.001) and fewer
incontinence problems (p 0.01) than the usual care group
at 6months. Study findings show that PFM exercise practice
plus peer and individual problem solving support can sig-
nificantly improve urinary continence and quality of life in
patients following prostate cancer treatment.
PREDICTORS OF ADJUSTMENT TO AGING AMONG
OLDER WOMEN IN BREAST CANCER REMISSION
S.Vonhumboldt, I.Leal, F.Carneiro, Instituto Superior de
Psicologia Aplicada (ISPA), Almada, Portugal
Objectives: To build a structural model to explore the
predictors of adjustment to aging (AtA) reported by older
women in breast cancer remission.
Methods: 214 older women in breast cancer remission
participated in this study. Aquestionnaire to determine socio-
demographic (age, income, professional and marital status,
education, household, living setting and self-reported spir-
ituality), lifestyle and health-related characteristics (physical
activity, leisure, perceived health, recent disease and medica-
tion), and measures to assess AtA, sense of coherence and
subjective well-being, were employed. Structural equation
modeling was used to explore a structural model of the self-
reported AtA, encompassing all variables.
Results: Preliminary results indicated that self-reported
spirituality (=.397; p < .001), leisure (=.383; p < .001), problems in daily life. Breast cancer survivors (n=38, age:
physical activity ( = .267; p < .001), perceived health
( = .211; p < .001), marital status ( = .173; p < .001), from a cancer center in the United States. Neuropsychological
professional status (=.156; p=.009), sense of coherence tests were administered during a lab visit. Participants car-
(=.138; p < .001), and living setting (=.129; p=.007), ried study smartphones for 14 days; five times daily the
predicted AtA. The variables accounted for 79.2% of the
variability of AtA.
Conclusion: Self-reported spirituality and leisure were the
strongest predictors of AtA. Our preliminary findings suggest
that health care interventions with older women in breast
cancer remission still living in the community may benefit
from clearly including predictors of AtA, as these are essen-
tial for promoting older women s aging well.
INCIDENCE OF AND RISK FACTORS FOR FALLS IN
CANCER PATIENTS RECEIVING CHEMOTHERAPY
R.Yang, K.Mooney, University of Utah, Salt Lake City,
Utah
Falls are complex in nature, causing physical injuries and
emotional trauma. Certain medications, muscle weakness of
lower extremity and sensory loss are reported as significant
risk factors for falls in the elderly population. Frequently
most of these risk factors can exist in cancer patients receiv-
ing chemotherapy. However, few studies have explored falls
and fall risk factors in this population. In this secondary
analysis of a longitudinal study, 85 patients with breast,
ovarian, or lung cancer receiving chemotherapy at risk for
falling were closely monitored using a novel automated tele-
phone system (SymptomCare@Home). Fall events, defined as
actual falls and near falls were ascertained during about three
months of follow-ups. The mean of 1.05 falls (SD=2.09) with
a 35.3% fall rate and a 16.7% injury rate were reported.
Gender (t(5)=1.31, p=.25), ethnicity (t(76)=-.08, p=.93), and
comorbidity (t(69)=.86, p=.39) were not associated with the
IAGG 2017 World Congress
311
number of falls. Among fallers (n=30, 35.3%), about one-
third had their shoes on, one-fourth fell in a dark area, and
most fell onto a flat floor and inside the house. About 17%
of patients had their medication regimens changed due to
falls and fall related injuries. The main precipitating reason
for the falls were faintness, the sudden loss of balance, and
tripping, indicating falls were often unanticipated, leaving
patients no time to avoid the fall. These findings suggested
that the overall rate of falls in cancer patients is similar to
that of the elderly population. However, due to the small
sample size, risk factors for falls need further study.
DAILY FATIGUE AND COGNITION AMONG BREAST
CANCER SURVIVORS
S.Eisel1, S.B.Scott2, B.J.Small1, J.A.Mogle3, H.Jim4,
P.Jacobsen4, 1. University of South Florida, Tampa, Florida,
2. Stony Brook University, Stony Brook, New York, 3.
Pennsylvania State University, State College, Pennsylvania,
4. Moffitt Cancer Center, Tampa, Florida
According to the World Health Organization over the
next 20 years new cases of cancer will increase by 70%.
Because of increased cancer risk with age and improved sur-
vival rates, individuals over age 65 make up 2/3 of cancer
survivors. Memory and attention difficulties (e.g., chemo-
brain) and fatigue are common quality of life concerns for
survivors but little is known regarding prevalence of these
4064), 636 months post-chemotherapy, were recruited
phones prompted them to complete brief surveys and to play
brain games. Each night, participants reported on that days
memory problems. Survivors completed 91% of smartphone
cognitive tasks and 92% of daily memory failure surveys.
Multilevel models were conducted to determine if survivors
report more daily fatigue on days when memory failures were
reported. Results indicated that differences between people
accounted for 69% of the variation in daily fatigue. Contrary
to predictions, survivors did not report more fatigue on days
when memory failures were reported. However, survivors
who reported more memory failures across the two weeks
also reported higher levels of daily fatigue. In sum, ecological
cognitive assessments can inform which and when survivors
are affected and which domains are impacted, essential infor-
mation for developing interventions targeted to survivors
most impacted by decreased quality of life and situations in
which they are most at-risk.
MEANING-MAKING COPING STRATEGIES AMONG
JAPANESE OLDER ADULTS WITH CANCER
X.Yi1, F.Ahmadi2, H.Kase1, 1. Health Sciences and
Welfare, Waseda University, Tokorozawa, Saitama, Japan, 2.
University of Gavle, Gavle, Sweden
With the rapid expansion of aging population in Japan,
the number of older adults with cancer has been increasing
too. For example, a research conducted in 2008 shows that
by the age of 70years old, 20% of male and 16% of female
are likely to be afflicted by cancer. And by the age of 80years
old, 39% of male and 26% of female are at risk. Besides
312
medical treatment, people with cancer tend to choose differ-
ent methods to cope with their current situation. In recent
years, some studies have drawn their attention on the role
of religiosity and spirituality in coping strategies of disease.
One significant problem is that many studies in this field
have neglected non-religious populations.
This presentation will discuss the meaning-making cop-
ing strategies among older adults with cancer in Japan
and what impact culture has on the coping methods they
choose. The presentation will also draw attention on which
meaning-making strategies are chosen by cancer patients in
a non-religious country like Japan, and to discuss whether
meaning-making coping methods can be used in the treat-
ment of cancer.
PSYCHOSOCIAL FACTORS THAT INFLUENCE
MOTIVATION TO SCREEN FOR CANCER AMONG
ADULT BLACK MALES
D.Atakere, T.A.Baker, Psychology, University of Kansas,
Lawrence, Kansas
There are significant disparities in morbidity and mortal-
ity rates among minority populations in general and among
Black males in particular. Cancer, for example, is the 2nd
leading cause of death among Black males. Yet, there exists
prevalence of imminent and aggressive stage of diagno-
sis among this gendered population. An individuals moti-
vation to screen for cancer is influenced by knowledge of
cancer prevalence and perceived likelihood of being diag-
nosed. While the relationships between health and masculin-
ity, identity, and attachment have been reported, much less
is known as to how these factors influence the decision to
screen for cancer. This study aimed to determine the influence
identified health and social factors have on cancer screening
among Black men. Participants were surveyed on questions
assessing cancer knowledge, belief about cancer diagnoses,
masculinity, self-esteem, attachment style, ethnic identity,
and additional social and health characteristics. Results from
the multivariate model showed that education, ethnic iden-
tity, masculinity, and attachment were significant indicators
of cancer screening. Cancer screenings among Black men
are contingent upon a myriad of psychological, social, and
behavioral factors that are not exclusive, but rather coex-
isting determinants of health. Focusing exclusively on Black
men enhances our understanding of this adult population,
and data from this study holds promise in informing health
messages that may reduce deleterious health behaviors and
outcomes among this marginalized population, by under-
scoring factors that may impact the health needs of diverse
race and gendered populations.
DYADIC INTERDEPENDENCE ON DEPRESSION
TRAJECTORIES AMONG OLDER ADULTS WITH
CANCER AND CAREGIVERS
H.Yoon, K.Choi, Hallym University, Chuncheon,
Gangwon-do, Korea (the Republic of)
This study explores dyadic interdependence on depres-
sion for older adults with cancer and their family caregivers.
Cancer takes an emotional toll on patients and their fam-
ily caregivers. Family caregivers distress levels are similar to
patients with cancer. Based on actor-partner interdependence
model and caregiver stress process model, integrated stress
Innovation in Aging, 2017, Vol. 1, No. S1
process model was developed as a research framework.
Depression as a stress outcome was measured by Korean
version CES-D. Stressors for older adults include functional
status, physical symptoms and side effects. Stressor for fam-
ily caregivers is caregiving burden. Older adults functional
status, physical symptoms and side effects were measured
by EORTC-QLQ-C30. Stress moderators include optimism,
spirituality, and family support for both older adults and
their family caregivers.
A total of 180 older adult with cancer and family car-
egiver dyads who participated in two wave surveys in 2013
and 2015 are used for this study. Paired t-test, repeated
ANCOVA, AMOS, and Mplus were used to analyze the data.
The level of depression of older adults with cancer and
their family caregivers was not significantly different between
wave 1(T1) and wave 2(T2). However, the level of depres-
sion of older adults with cancer who were cared by their
adult children were significantly higher than their spouses.
And family caregivers level of depression was influenced by
the period of caregiving. When the period of caregiving was
under sixteen months, the level of depression of family car-
egivers was significantly increased at Time 2.
Results showed significant actor effects for the depression
of older adults with cancer and their family caregivers from
Time 1 to Time 2, and also significant partner effects for the
depression leading from older adults with cancer (Time 1)to
their family caregivers (Time 2). Spirituality, optimism, and
family support were significant mediating factors reducing
actor and partner effects between older adults with cancer
and their family caregivers.
Results revealed that spirituality of both older adults with
cancer and their family caregivers was important variable on
depression. Research on spiritual effects of cancer on patients
and caregivers show that there are positive effects of cancer
on patients and their caregivers. For the most part, findings
indicate that cancer can be a transformational experience.
Patients and family members reconsider their priorities and
refect on what is important in their lives. Patients and family
caregivers who are able to find more meaning in the illness
report better quality of life.
AGE-RELATED DIFFERENCES IN HEALTH-RELATED
QUALITY OF LIFE IN CANCER SURVIVORS
S.S.Vang1, S.Kang2, A.C.Mui1, 1. Columbia University,
New York, New York, 2. SUNY Binghamton, New York,
New York
The purpose of this study is to examine age-related dif-
ferences in health-related quality of life (HRQOL) between
younger (age 1865) and older cancer survivors (age
65+). Data used for this study were drawn from the 2014
Behavioral Risk Factor Surveillance System, a cross-sec-
tional, state-based, annual random-digit-dialed telephone
survey of non-institutionalized adults. All respondents who
had completed the core questionnaire and cancer survivor-
ship module were included (n=5,656).
Demographic data show that 60% of participants were
females and 40% were males. Approximately 55% were
married and 45% were separated, divorced, widowed, or
never married. 49% reported having a high school degree or
lower. T-tests indicate that older cancer survivors had poorer
physical HRQOL than younger cancer survivors; however,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
they were more likely to fare better mentally. Multiple regres-
sion results suggest that cancer survivors who exercised and
were married had significantly better HRQOL. Survivors
with greater co-morbidities and those who had not com-
pleted treatment reported worse HRQOL. Findings indicate
that physical activity and social support could help improve
survivors HRQOL. Special attention should be paid to sur-
vivors who have co-existing conditions and those who have
not completed treatment.
FLOURISHING DESPITE ACANCER DIAGNOSIS:
FINDINGS FROM ANATIONALLY REPRESENTATIVE
STUDY
E.R.Fuller-Thomson, K.West, Social Work, University of
Toronto, Toronto, Ontario, Canada
This study investigated the association between cancer and
complete mental health (CMH). CMH has three elements:
1)absence of mental illness, addictions and suicidal thoughts
in the past year; 2) almost daily happiness or life satisfac-
tion in the past month; 3)psychosocial well-being. Control
variables included socio-demographics, health behaviours,
current physical health and lifetime history of mental illness
and childhood maltreatment. The nationally representative
2012 Canadian Community Health Survey-Mental Health
was analyzed. This study used bivariate and logistic regres-
sion analyses to estimate the odds ratios of CMH among
community dwellers aged 50 and older with current cancer
(n=438), previous cancer (n=1,174) and no cancer history
(n=9,279). Our analyses suggested that adults aged 50 and
over with current cancer had a much lower prevalence of
CMH (66.1%) than those with previous cancer (77.5%) and
those with no cancer history (76.8%). After adjusting for 17
variables, the odds of CMH among those with current can-
cer remained substantially lower (OR=0.63; 95% CI=0.49
0.79) than those without cancer. Among those who had ever
had cancer, the odds of CMH were higher for female, White,
married, and older respondents, as well as those with higher
socioeconomic status, and no history of childhood physical
abuse, substance abuse, depression or anxiety disorder. These
findings have a hopeful message for patients and clinicians.
Two-thirds of current cancer patients have CMH. Former
cancer patients are comparable to those without a cancer
history, suggesting substantial resilience.
DECISIONAL CONFLICT AND PROSTATE CANCER
SCREENING DECISIONS AMONG RURAL AFRICAN
AMERICAN MEN
R.S.Allen1, J.Oliver1, M.K.Eichorst1,2, L.Mieskowski1, 1. by a common yet unique experience (Eisikovits & Koren,
ARIA/Psychology, The University of Alabama, Tuscaloosa,
Alabama, 2. Salem Veterans Affairs Medical Center, Salem,
Virginia
African American (AA) men have prostate cancer death
rates (47.2) that are 137% higher than non-Hispanic whites
(19.9). These numbers provide clear evidence that a signifi-
cant prostate cancer disparity exists among AA men in the
United States. Our study interviewed a sample of 33 AA
men (Mage=54.61, SD=8.30, range=4071) from three port beliefs/behaviors developed within relationships dur-
southern, rural counties about their prostate cancer screen-
ing decisions and the conflict experienced in these decisions.
Men were interviewed three times over the course of twelve
IAGG 2017 World Congress
313
months (baseline, 6 mo, 12 mo). In addition to an overall
score, the Decisional Conflict Scale (DCS) consists of 4 sub-
scales: Informed (to assess how much is known), Values (to
asses personal preferences), Support (to assess resources
available), and Uncertainty (to assess clarity of choice).
High numbers indicate greater conflict and low numbers
indicate greater ease in making decisions. Mens report of
overall decisional conflict decreased across 12months, F(2,
42)=8.983, p<.005, with a significant difference between
baseline (M=40.23) and 12-months (M=20.91). Moreover,
this predicted how likely men were to report a desire to
engage in preventive prostate cancer screening, t(29)=2.68,
p=.013. Specifically, greater perceived levels of support and
stronger values predict greater intention to engage in pros-
tate cancer screening across the course of one year. Rural AA
men benefit from having social support, such as the presence
of health care advocates (e.g., wives, mothers, siblings) to
reduce decisional conflict and facilitate engagement in pros-
tate cancer screening.
RELATIONSHIPS OF OLDER AFRICAN AMERICAN
WOMEN AND FAMILY CAREGIVERS IN THE BREAST
CANCER EXPERIENCE
E.L.Csikai1, S.S.Martin 2, C.Broussard1, 1. The University
of Alabama, Tuscaloosa, Alabama, 2. McGill University,
Montreal, Quebec, Canada
Within all human relationships, major life events, includ-
ing diagnosis of a life-threatening illness, such as cancer, will
be experienced differently by each member. African American
women and family members in cancer dyads may struggle
with adjustment in new roles as patient and caregiver
and also have multiple concerns about well-being as the com-
bination of age and ethnicity puts older African American
women at high risk for poor cancer outcomes. In this study,
experiences with breast cancer diagnosis and treatment deci-
sion experiences within the context of relationships between
older African American women and close family members/
caregivers were explored.
Utilizing a qualitative phenomenological approach, in-
depth, semi-structured, individual interviews were conducted
with 15 older African American women (ages 4667) who
were diagnosed with and received treatment for breast can-
cer and one family member (husbands, daughters, sisters,
and others) with whom they most closely shared the can-
cer experience. Data were analyzed using dyadic analysis
to identify meaning units and themes that both overlapped
and contrasted; highlighting the relationship as affected
2010). Overlapping themes included: fears/emotional reac-
tions; family concerns; protection; and support. Contrasts
included: trust/confidence in decisions; discovery and mean-
ing of diagnosis; and future care.
Older women and family caregivers may have difficulty
understanding each others changing needs and that their
relationship is affected differentially when confronted with
life-altering serious illness. The mutual protection and sup-
ing the cancer experience may be utilized to facilitate future
medical decisions or health crises.
314
ETHNIC DISPARITIES IN CANCER INCIDENCE
AND SURVIVAL AMONG THE OLDEST OLD IN THE
UNITED STATES
J.L.Krok-Schoen3,2, R.D.Baltic2, J.L.Fisher1, 1. Arthur
G.James Cancer Hospital and Richard J.Solove Research
Institute, Columbus, Ohio, 2. Comprehensive Cancer
Center, The Ohio State Univer, Columbus, Ohio, 3. School
of Health and Rehabilitation Sciences, College of Medicine,
The Ohio State University, Columbus, Ohio
Two of the fastest growing segments of the U.S.popula-
tion are the oldest old, people aged 85years, and Hispanics.
Currently, no studies have examined ethnic disparities in
cancer incidence and survival in the 85 population. This
study sought to examine potential ethnic disparities in can-
cer incidence and survival rates among the oldest old using
data from the SEER Program. Cases diagnosed with one of
the leading four cancer sites (lung and bronchus, colon and
rectum, female breast, prostate) were reported to one of 18
SEER registries. Differences in cancer incidence were exam-
ined for cases aged 85 years and diagnosed 19922013.
Five-year relative cancer survival probability was examined
for Hispanic and non-Hispanic adults aged 85years diag-
nosed 20062012. Results indicated that from 19922013,
among those aged 85years, non-Hispanics had higher inci-
dence compared to Hispanics for colon and rectum, lung
and bronchus, female breast, and prostate cancers. Five-year
survival probability for cancers of all stages combined was
higher for non-Hispanics than Hispanics in this age group.
However, Hispanics had higher survival probability of colo-
rectal cancer diagnosed at regional (67.2% vs. 60.5%) and
distant (5.4% vs. 3.8%) stages than non-Hispanics, respec-
tively. Hispanics also had higher survival probability of
lung and bronchus cancer diagnosed at regional (15.9% vs.
12.7%) and distant (2.8 % vs. 2.2%) stages than non-His-
panics, respectively. In summary, ethnic differences in can-
cer incidence and survival probability exist within the 85
population. Continued efforts are needed to understand and
reduce ethnic disparities in cancer prevention and treatment
among this population.
A MIXED METHODS APPROACH TO EXAMINING
POSTTRAUMATIC GROWTH IN OLDER CANCER
SURVIVORS
A.I.Hoogland, Moffitt Cancer Center, Tampa, Florida
A wealth of research has been conducted on cancer survi-
vorship and posttraumatic growth (PTG; defined as positive
change following the struggle associated with a trauma), but
little research has investigated PTG in older samples. This
lack of scholarship is surprising, considering cancer diagno-
ses are especially prevalent in older adults. To address this
gap in our knowledgebase, a population-based random sam-
ple of older cancer survivors (N=56) was recruited through
the Kentucky Cancer Registry. Participants mailed in ques-
tionnaires that included several validated surveys, including
the Posttraumatic Growth Inventory (PTGI). Overall, par-
ticipants reported high levels of posttraumatic growth (PTG
Mean=54.85; SD=28.31), which was positively associated
with personal significance of the cancer diagnosis (p=.04).
Normed PTGI Subscale scores were nuanced such that par-
ticipants felt more appreciation of life, but a decreased sense
of having new possibilities. Even among older adults, there
Innovation in Aging, 2017, Vol. 1, No. S1
were age trends such that older older adults reported
less PTG than younger older adults (p=.002), and were
less personally impacted by a cancer diagnosis (p < .001).
Qualitatively, a reliance on faith and a sense of acceptance
emerged as themes, consistent with previous literature iden-
tifying a shift in perspective with age that allows for embrac-
ing changes in health status. It is feasible that older adults are
better able to accept traumatic illnesses as a natural part of
the life course, as has been seen in other studies on late-life
illness.
SESSION 785 (POSTER)
CAREGIVING II
INFORMAL CAREGIVER BURDENS AND THE
SUBSEQUENT COGNITIVE STATUS OF THE CARE
RECIPIENT
D.Lloyd, M.P.Aranda, School of Social Work, University of
Southern California, Los Angeles, California
Studying factors influencing caregiver burden implies
that, in addition to the caregivers quality of life, such bur-
den may influence the health trajectory of care recipients.
Five domains of caregiver burden are analyzed in relation
to care recipients change in cognitive status one year later
using National Health and Aging Trends Study and linked
National Study on Caregiving data. A sample of 703 care
recipients whose baseline cognitive status is not prob-
able dementia, and their primary informal caregivers, are
included. Caregiver burden dimensions of social limitation,
role overload, and psychological distress are associated with
care recipients transition to probable dementia, while posi-
tive mood and financial burden are not, in separate regression
models with controls for care recipients sex, age, race/eth-
nicity, marital status, education, self-rated health, and pos-
sible dementia status. When all five domains are included
in the same model, social limitation is the sole net predictor
of cognitive status change. Determinants of caregiver bur-
den are examined as well. Simultaneous regression of all five
burden measures on care recipient and caregiver character-
istics reveals several factors. Notable predictors of specific
caregiver burdens are recipients relationship to the caregiver,
their health, and caregivers employment status, marital sta-
tus, and gender. Caregiver commitment to a set schedule of
caregiving is associated with social limitation, role overload,
and psychological distress. Distress is greater among sons
who are primary caregivers, compared with those who are
the care recipients spouse, while being married (but not the
recipients spouse), is protective. Additional findings will be
reported, and their implications discussed.
PARTICIPATORY ARTS IN THE HOME TO SUPPORT
WELLNESS IN DEMENTIA CAREGIVER AND CARE
RECIPIENT DYADS
R.Poulos2, D.Harkin1, E.R.Beattie3, C.Cunningham1,4,
C.Poulos1,2, 1. HammondCare, Sydney, New South Wales,
Australia, 2. University of New South Wales, Sydney,
New South Wales, Australia, 3. Queensland University of
Technology, Brisbane, Queensland, Australia, 4. University
of Edinburgh, Edinburgh, Scotland, United Kingdom
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
There is growing evidence that participatory art has a
positive role in promoting the health and wellness of older
people with a range of conditions, including people with
dementia and caregivers. This pilot project trialled an eight
week, two hours per week, participatory arts program (e.g.
visual arts including mixed media, painting and clay) deliv-
ered in participants homes by one of four professional art-
ists (n=6 caregiver and care recipient dyads). The evaluation
employed mixed methods.
Caregiver interviews found that caregivers were over-
whelmingly surprised by their own creative output and that
of their care recipient. They indicated the program provided
time away from the caring role, describing feeling relaxed
and less stressed. The artists visits provided an opportunity
for caregivers to learn new skills, enjoy much-appreciated
social interaction and reduce monotony. Several caregiv-
ers learned novel ways of engaging with their care recipi-
ent from artist-care recipient interactions. Some dyads were
able to use their creative output for inter-generational family
engagement; and five dyads expressed an interest in pursu-
ing art in some form post-program. Improvement in scores
on the Warwick-Edinburgh Mental Well-being Scale and the
Zarit Burden Interview were also found for some carers.
This pilot suggests that participatory arts delivered by
professional artists in the home can equip family caregivers
with new skills in shared creative activities that bring joy
and emotional interaction and may counteract agitation and
stasis. The model of program delivery can be readily scaled
up and tested in a larger study.
IF IGOTTA DO IT: EXAMINING COUPLES age of 45, serving as a primary caregiver, and not receiving
CAREGIVING TRAJECTORIES FOLLOWING SPINAL
CORD INJURY
A.A.Bender1, E.O.Burgess2, 1. Emory University, Atlanta,
Georgia, 2. Georgia State University, Atlanta, Georgia
Sustaining a Spinal Cord Injury at any point in time is
life altering physically, emotionally, and financially for
all persons affected by the injury, but it can place unique
challenges on younger married couples. This presentation
uses data from individual interviews with 18 couples (ages
2155) at three time points (96 interviews) following injury,
as well as extensive observation in the rehabilitation set-
ting. Using a combination of the life course perspective and
cognitive sociology as guiding theoretical frameworks and
grounded theory analysis, we examined how the health care
institution influenced marital relationships during their reha-
bilitation stay and the subsequent transition home. We found
staff and couples accepted and reinforced the dominant
cultural narrative that women are natural caregivers, but
larger social structures of class, gender, and the division of
paid and unpaid labor work together to push some women
into caregiving or prevent other women from engaging in
caregiving. In contrast, male caregivers were excused from
the expectations of caregiving and actively resisted taking on
the caregiving role. Expanding on Aneshensel etal.s (1995)
caregiving career, we identified three main types of caregiv-
ers, each with their own path of caregiving Naturalized,
Constrained, and Resistant. Overall, the transition to injury
is complex for patients and partners and this presentation
highlights how the marital relationship is affected by a non-
normative, unexpected transition. This research extends the
IAGG 2017 World Congress
315
understanding of caregiving careers by emphasizing how
gendered expectations are further modified by the rehabilita-
tion context and additional structural factors such as work
and family.
DOES CAREGIVING INFLUENCE MARITAL AND
COHABITING UNION STABILITY IN MIDDLE AND
LATER LIFE?
M.J.Penning, Sociology, University of Victoria, Victoria,
British Columbia, Canada
Family and other informal caregivers provide the vast
majority of long-term care to older adults as well as others
with chronic illnesses and disabilities. Although they report
some positive aspects of caregiving, in general, research sug-
gests that caregiving is stressful and has negative implica-
tions for the health and well-being of caregivers. Yet, little
is known regarding its impact on related outcomes such as
union stability in middle and later life. To address this gap,
we drew on retrospective data on union histories drawn from
the 2007 Canadian General Social Survey for a national sam-
ple of adults aged 45 and older who were in a marital union
or a cohabiting union a union at age 45 (n=17,194). Cox
proportional hazard models revealed that being involved in
caregiving activities was associated with a reduced likelihood
of separation or divorce in middle and later life, particularly
when the respondent was a primary caregiver and the care
recipient was a current or former spouse/partner. However,
this was primarily the case for men and those in marital
unions. For women as well as those in cohabiting unions,
caregiving activities (i.e., having been a caregiver before the
professional assistance) enhanced the risk of subsequent
union dissolution. These findings suggest that caregiving
both contributes to and undermines union stability. This, in
turn, has important implications for theory, research, and the
provision of support to informal caregivers.
DO FAMILY MEMBERS MOST IMPORTANT
CONCERNS ABOUT CAREGIVING VARY ACROSS
THE CAREGIVING CAREER?
M.Y.Savundranayagam1, S.Basque1, A.Roberts2,
J.B.Orange1, K.Johnson3, 1. Western University, London,
Ontario, Canada, 2. Northwestern University, Evanston,
Illinois, 3. McCormick Dementia Services, London,
Ontario, Canada
Caregiver identity theory posits that family caregivers
relationship identity changes across the caregiving career.
Family caregivers initial relationship identity is one based on
a familial dimension. As caregiving unfolds, however, their
evolving roles help shape a new relationship identity involv-
ing the caregiver role. This study investigated whether fam-
ily members most important concerns about caregiving vary
across the caregiving career and by kinship status. Participants
included 10 adult-child and 18 spousal/partner caregivers to
the persons with dementia. Participants identified their car-
egiving concerns prior to engaging in an enhanced dementia
education and training program. Thematic analyses of their
concerns yielded the following themes from most to least fre-
quent: positive approaches to care, health status, vigilance,
addressing dementia-related changes, safety, happiness of
person with dementia, caregiver stress, and time for self and
316
others. Differences were found by relationship identity and
by kinship status. With regard to positive approaches to care,
adult-children viewed themselves primarily in terms of the
familial role whereas spouses/partners viewed themselves
primarily as caregivers. The same pattern was observed for
health status. However, adult-childrens health concerns
focused on their relative with dementias health whereas
spouses/partners were concerned about their own health.
Caregiver stress and addressing dementia-related changes
were major concerns for spouses/partners whose relationship
identity consisted primarily of the caregiver role. Happiness
of the person with dementia, vigilance, and time for self and
others did not vary across the caregiving career or by kin-
ship. Findings reveal the differential needs of spouses/part-
ners versus adult-children across the caregiving career.
A MULTI-COMPONENT CAREGIVER TRAINING
PROGRAM FOR MANAGING BEHAVIORAL
SYMPTOMS OF DEMENTIA
B.Karlin1,2,3, D.Young4, K.Dash1, M.K.Landon1, 1. pants when companions lived with participants (OR=1.38),
Education Development Center, Waltham, Massachusetts,
2. Johns Hopkins University, Baltimore, Maryland, 3.
Northeastern University, Boston, Massachusetts, 4.
Seniorlink, Boston, Massachusetts
Behavioral symtoms, including agittation, aggression,
vocalization, and care refusal, are nearly universal among
individuals with dementia. Despite the availability of effec-
tive psychosical approaches for managing these behavioral
symptoms, these approaches remain widely under-utilized
among professional, and especially family, caregivers, due
in large part to limited training in these approaches. This
paper will examine the development, core components, and
outcomes of an evidence-informed, competency-based train-
ing program in the prevention and management of behavio-
ral symptoms of dementia among aging services providers
and family caregivers within a system of home-based care
and support. The Vital Outcomes Inspired by Caregiver
Engagement (VOICE) Dementia Care Training Program
was developed based on identification of state-of-the-art
approaches to managing behaviors through expert review of
the literature and structured needs assessment. Results from
mixed-method evaluation design reveal significant improve-
ments in knowledge, attitudes, and self-efficacy among train-
ing participants, with largest effect sizes (d=1.8) on domains
of knowledge and self-efficacy to manage behaviors. In addi-
tion, the training of aging services staff and family caregiv-
ers led to signifiant increases in engagement, self-care, and
personal development among many participants. Findings
underscore the need and opportunity for training in improv-
ing the abilities and confidence of aging services providers
and family caregivers in the nonpharmacological manage-
ment of behavioral symptoms of dementia.
THE PARADOXICAL IMPACT OF COMPANIONSHIP
ON THE BIOPSYCHOSOCIAL HEALTH OF OLDER
AFRICAN AMERICAN MEN
J.Mitchell1, T.Cadet2, S.Burke3, E.Williams1, D.Alvarez3,
1. Social Work, University of Michigan-Ann Arbor,
Ann Arbor, Michigan, 2. Simmons Collge, Boston,
Massachusetts, 3. Florida International University, Miami,
Florida
Innovation in Aging, 2017, Vol. 1, No. S1
Background: African Americans comprise 9% of the
approximately 46 million U.S. adults age 65 and older.
Two thirds of older African American (AA) men reside with
spouses, relatives or other companions. This study investi-
gated the assumption that living with or having frequent
contact with companions most often confers health-related
benefits for African American men. Methods: Utilizing
a secondary data analysis of the National Alzheimers
Coordinating Center Uniform Data Set, this investigation
examined the relationship between older African American
mens physical health outcomes (diabetes, hypertension, cho-
lesterol), mental health outcomes (depression, anxiety, sleep
disturbances) and caregiver characteristics, including living
arrangements and frequency of contact with the participants
for 3,423 older AA men and their 1,161 companions at base-
line. Findings: The mean age of both participants and com-
panions was 74years old and 90% of participants lived in
a private residence. Logistic regression models indicated that
the likelihood of high cholesterol was significant for partici-
called daily (OR=1.057) or visited daily (OR=1.059). Similar
increased risk for anxiety was found when companions lived
with (OR=1.66), called daily (OR=1.089), or visited daily
(OR=1.079) with participants. Finally, participants experi-
enced an increased likelihood of non-medical sleep distur-
bances when companions lived in (OR=1.67), called daily
(1.105), or visited daily (1.078). All p-values were below
.01. Conclusions: The frequency of contact with companions
may be consequential for select health outcomes for older
African American men, though the timing of contact (i.e.
before any diagnosed illness or in response to it) requires
further investigation.
INVESTIGATING THE RISK AND FUTURE NEEDS OF
OLDER CARERS IN IRELAND AND ENGLAND: TILDA
AND ELSA
C.A.McGarrigle1, S.Leahy1, R.Kenny1,2, 1. Trinity College
Dublin, the University of Dublin, Dublin, Ireland, 2.
Mercers Institute for Successful Ageing, Dublin, Ireland
Participation in leisure activities and supportive social
ties have been associated with improved physical and mental
health. These health effects work through a number of path-
ways, both behavioural and psychological, which can result
in better health behaviours, and buffering of the harmful
effects of stress. We investigate and compare the prevalence
of informal caring by the older population in Ireland and
England and investigate predictors of, and health outcomes
associated with informal caring and determine whether these
are moderated by social participation and support.
We examined measures of physical function (self-rated
and objective (hand-grip strength)), mental health (CES-D,
CASP-12), economic and social participation, associated
with provision of informal care using multivariate models
in the Irish Longitudinal Study on Ageing (TILDA) (wave 3,
2014), and the English Longitudinal Study on Ageing (ELSA)
(wave 6, 20122013).
Provision of informal care was common and was asso-
ciated with similar characteristics (younger age, female,
more education, not employed). There were similar health
outcomes for both countries. While there was no evidence
of a difference in physical function, mental health differed:
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Innovation in Aging, 2017, Vol. 1, No. S1
quality of life increased with low intensity caring hours
(<20), while depression increased with high intensity caregiv-
ing (50+ hours/week). These associations were attenuated by
active social activities and positive social relationships.
Across two separate social care systems, the older popu-
lation contribute substantially to the support and informal
care of their family and friends. Overall, informal caring was
associated with positive health outcomes, but this depended
on accessibility to both social supports and formal care
provision.
AUSTRALIAN LIVES ALTERED BY PARKINSONS
DISEASE: WORK, RETIREMENT, AND CARE
J.Brady, K.OLoughlin, Faculty of Health Sciences,
University of Sydney, Cremorne, New South Wales,
Australia
People diagnosed with Parkinsons disease cannot be
certain about when and in what way their motor and non-
motor symptoms will progress through time and how effi-
cacious their medication in managing symptoms will be on
any given day. In this context people experience fluctuations
in both disease and iatrogenic symptoms and, depending on
the stage of illness, a persons body may be abled and dis-
abled frequently with varying symptoms throughout the day.
Changes in body function, age and stage of disease influence
the type of care the person diagnosed will need in everyday
life.
An Australian qualitative study has examined narra-
tives from eighteen people living with Parkinsons disease
(age >55; n=9 people diagnosed; n=9 partner-carers) who
described how their lives have been changed by the onset of
this chronic illness. The study is also informed by data col-
lected from six focus groups (n= 31). Participants identified a
range of responses that clustered around the impact on them
physically, emotionally, socially, and financially.
Findings show that people diagnosed and their partner-
carer have to reconsider their life goals both individually and
as a couple. Adiagnosis often comes in the late stages of their
career which can influence the transition to, and planning for
retirement and, for the partner-carer, require them to manage
paid work and spousal care.
This empirical study evidences and describes how people
living with Parkinsons disease have very specific care needs,
which influence their ability to remain in paid employment
and capacity to remain financially independent.
MECHANISMS OF CHANGE IN ACAREPARTNER
MOBILE HEALTH INTERVENTION FOR VETERANS
WITH HEART FAILURE
R.Trivedi4,3, S.Scott5, E.Bouldin2, J.E.Aikens1, J.Piette1, and mood for both the caregiver and person with demen-
1. University of Michigan, Ann Arbor, Michigan, 2.
Appalachian State University, Boone, North Carolina, 3.
Stanford University, Palo Alto, California, 4. VA Palo Alto
Health Care System, Menlo Park, California, 5. Denver VA,
Denver, Colorado
Heart failure (HF) interventions have recognized that
involving an informal caregiver in disease management
can enhance outcomes. While patient-focused interventions
appear to improve self-efficacy, the mechanisms that under-
lie dyadic interventions remain largely unexplored. We used
data from a recently completed comparative effectiveness
IAGG 2017 World Congress
317
trial which examined whether involving a non-cohabitating
caregiver (CarePartner) in a mobile health (mHealth) inter-
vention benefited HF outcomes more than mHealth alone
did. The mhealth intervention involved weekly interactive
voice response (IVR) phone calls to monitor symptoms. In
the mHealth+CarePartner arm, participants CarePartners
received a summary of the participants IVR responses.
Results of the trial indicated that medication adherence
improved significantly more in the mHealth+CarePartner
condition. For this secondary analysis, we used serial media-
tion models to evaluate indirect pathways that might explain
this effect. Specifically, we tested whether improvements in
patient-reported relationship quality and self-efficacy medi-
ated the effect of intervention upon medication adherence.
Relationship quality was measured by frequency of talking
with the CarePartner, perceived difficulty of talking with the
CarePartner, and negative emotions associated with talk-
ing to the CarePartner. Indirect effects were estimated using
bias-corrected bootstrapping with 95%CI, which showed
a negative association between the intervention arm and
self-efficacy. Paired t-tests showed that the mHealth arm
was associated with improvements in self-efficacy (t=-4.27,
p<.01) while the mHealth+CarePartner arm demonstrated no
change (t =-1.59, p=0.12). Findings suggest that constructs
that explain the success of patient-focused self-management
strategies, such as self-efficacy, are unlikely to sufficiently
explain the success of dyadic interventions in HF.
CARE PREFERENCES IN DEMENTIA: THE IMPACT OF
INCONGRUENCE ON PERSONS WITH DEMENTIA
AND CARE PARTNERS
E.Shelton1,2, S.Orsulic-Jeras2, C.J.Whitlatch2, S.Szabo3, 1.
Cleveland State University, Akron, Ohio, 2. Benjamin Rose
Institute on Aging, Cleveland, Ohio, 3. Cleveland Clinic,
Cleveland, Ohio
The psychosocial impact of care preference incongru-
ence on persons with dementia and their family caregiver
remains unexplored in the literature. In-depth interviews
were conducted with 128 dyads each consisting of a person
with dementia and a family caregiver. Baseline data from
an intervention study were used to examine incongruence
between the preferences of the caregiver and the person with
dementia (actual incongruence) as well as the caregivers
own preferences and the caregivers perception of the per-
son with dementias preferences (perceived incongruence).
Preferences for three care-related domains were recorded:
personal activities of daily living (PADLs), instrumental
activities of daily living (IADLs), and socioemotional tasks.
Outcomes included dyadic relationship strain, quality of life,
tia. Results indicated that perceived incongruence of care
preferences was a better predictor of negative psychoso-
cial outcomes than actual incongruence. Actual incongru-
ence for socioemotional care preferences was a predictor of
greater relationship strain and worse mood for the person
with dementia, while perceived incongruence for socioemo-
tional care preferences was related to lower quality of life
and worse mood for the caregiver. Unexpectedly, perceived
incongruence for PADLs predicted higher quality of life and
better mood for the caregiver. Findings have implications for
communication between care partners, especially regarding
318
socioemotional care preferences. These socioemotional pref-
erences, which might be overlooked in the creation of a care
plan, may influence the person with dementias well-being.
INSTRUMENTAL AND EMOTIONAL EFFECTS OF
CARE RECIPIENTS COMPANION ANIMALS ON
CAREGIVING
J.Bibbo, C.Proulx, Human Development and Family
Science, University of Missouri, Columbia, Missouri
This study examined the impact of older adults com-
panion animals on informal caregivers instrumental and
emotional experiences. Older adults report strong emo-
tional bonds with their companion animals (CA) which
often become increasingly important as health declines and
dependence upon others increases. Individuals requiring
assistance meeting their own needs are likely to need assis-
tance in meeting the needs of their CA. The care recipients
companion animal may be an important, though presently
overlooked, factor in the caregiving experience.
This study measured the amount of care tasks/activities
informal caregivers of older adults devoted to their care
recipients CAs. Role theory was used to model the impact
of the CA (i.e., number of tasks/activities performed and
caregivers perceived costs of the CA) on the caregiving
experiences of burden, satisfaction, and mastery. Caregivers
for an individual ages 50+ who did not consider the care
recipients CA to be his/her own animal completed an online
questionnaire. Descriptive statistics and path analyses were
conducted in Stata. Preliminary results (N = 42) indicated
caregivers performed an average of 14.96 pet care tasks/
activities (n=27, SD=5.38, range: 522), increasing time in
the caregiver role by 27.19% hours per week. The number of
tasks/activities did not have direct effects on caregiver out-
comes. The perceived costs of the CAs were positively associ-
ated with caregiver burden (=0.31, p=.01) and negatively
associated with caregiving mastery (=-0.39, p <.01). Care
recipients CAs may significantly impact both the instrumen-
tal and emotional experiences of caregivers.
HOW PHYSICAL HEALTH CONCERNS AFFECT
OLDER ADULTS ABILITY TO CARE FOR THEIR PET
R.L.Mueller, E.G.Hunter, Gerontology, University of
Kentucky, Lexington, Kentucky
Research attests to the numerous physical, mental and
social health benefits for those individuals who care for a
pet. Older adults are a growing population, but care for the
smallest percentage of pets cared for in the United States.
The primary goal of this study was to identify and explore
major variables as related to an older adults present physical
health that currently affects their ability to care for their pet.
The study explored whether health constraints were present
in the older adult, and if so, if the older adult viewed them as
inhibiting their ease or ability to care for their pet.
Participants were aged 60+ and had to currently care for
a pet. Nineteen qualitative, in-depth face to face interviews
took place lasting approximately 90 minutes and included
a physical and social health assessment and demographic
information. An interview guide facilitated questions target-
ing physical and social health.
Approximately 15 of the 19 older adults interviewed,
four men and fifteen women, reported some form of physical
Innovation in Aging, 2017, Vol. 1, No. S1
health concerns; i.e. arthritis, balance concerns, immobility,
muscle atrophy, allergies etc. though not all reported these
physical health concerns as affecting their ability to care for
their pet. Concerns involved inability to pick up their dog,
large or small, difficulties with lifting and carrying 20 pounds
of litter, inability to walk their dog, allergies to the pet and
struggling to carry a cat or small dog in a carrying crate.
Strategies to overcome limitations were developed through
behavioral change and/or social support.
CAREGIVERS IN CALIFORNIA: ARE THEY
DIFFERENT FROM THE NATIONAL CAREGIVERS?
E.Ume, M.Shaheen, S.Teklehaimanot, Charles R Drew
University, Los Angeles, California
Purpose: To determine the prevalence of caregiving and
characterize the California caregivers (CGs).
Background: National reports on caregiving in the USA
revealed that 18% are CGs. Half of CGs provides care to
their parents. CGs spent24 hours/week providing care and
most provided medical/ nursing care without training. CGs
who provided higher hours of care may report their health as
fair/poor and consider caregiving as highly stressful.
Methods: We analyzed data related to demographics,
access to care, insurance, self-perceived health status, chronic
conditions and provision of care from the 2009 California
Health Interview Survey (CHIS).
Results: Of 11,321 CGs, 51% were currently CGs, 45%
were 50 years, 57% were female, 55% were white, 52%
were married. Most of CGs were US-born (76%) and live at
300% federal poverty level (54%). Most of the CGs were
insured (81%), 19% reported fair/poor health status, 60%
were overweight/obese, 75% used alcohol, and had hyper-
tension (28%), and heart failure (22%). CGs tended not to
attend the Medi-Cal training for long term CGs (3%).
Conclusions: The percentage of the Californias CGs was
higher than the national level of CGs, lower in current CGs,
and similar in reporting fair/poor health status. California
CGs were high income earners relative to the national level.
CGs utilized negative coping behaviors to manage the bur-
dens of caregiving. These results provide evidence of the neg-
ative impact of caregiving on CGs health outcomes in CA.
Efforts must be intensified to provide consistent support for
CGs to help mitigate long-term fatalistic outcomes for CGs.
SESSION 790 (POSTER)
CHRONIC CONDITIONS AND DISEASES
RACIAL-ETHNIC DIFFERENCES IN
MULTIMORBIDITY COMBINATIONS OVER TIME
A.R.Quinones1, A.Botoseneanu2, S.Markwardt1,
H.Allore3, 1. OHSU-PSU School of Public Health,
Oregon Health & Science University, Portland, Oregon, 2.
University of Michigan-Dearborn, Dearborn, Michigan, 3.
Yale University, New Haven, Connecticut
Background: Multimorbidity, defined as having multiple
chronic conditions, is common and disabling. Comparatively
little research on multimorbidity has focused on how disease
combinations progress over time and whether this differs by
race/ethnicity.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: We analyzed up to 16 years of follow-up for
7,116 participants who start at age 5160 in the Health
and Retirement Study (HRS). Participants reported having
2 of the following chronic conditions: hypertension, heart
disease, lung disease, diabetes, cancer, arthritis, stroke, cogni-
tive impairment, or high depressive symptom burden (CESD
score 4). We identify the most common disease combina-
tions that characterize white, black, and Latino adults from
middle-age forward (i.e., when they become study age-eligi-
ble until death or dropout).
Results: The racial/ethnic composition of our sample
was 56% (non-Latino) white, 26% (non-Latino) black, and
14% Latino. We find that white, black, and Latino middle-
aged adults start with relatively similar prevalent multi-
morbidity combinations: (1) hypertension + arthritis and
(2) hypertension + diabetes are the most prevalent combi-
nations across all three race/ethnic groups. However, after
24 years of follow-up, race/ethnic patterns of prevalent
multimorbidity combinations emerge. Black and Latino
adults are characterized by prevalent combinations that
include cognitive impairment earlier in the lifecourse rela-
tive to white adults.
Conclusions: These findings have implications for clini-
cians and researchers who seek to identify how multimor-
bidity combinations evolve differently for middle-aged and
older adults from white and underrepresented race/ethnic
backgrounds. It will be important to further disentangle the
competing challenges of greater morbidity and increased risk
of mortality over time in future studies.
HEALTH DISPARITIES: ARE THEY REGIONAL?
ADESCRIPTIVE ANALYSIS OF OLDER ADULTS IN
THE UNITED STATES
J.Minahan, E.Valdivieso, D.Johnson, T.A.Baker,
Psychology, University of Kansas, Lawrence, Kansas
Unequal access to social, financial and educational ser-
vices cause differences in the mental and physical health of
older adults. This study investigated health disparities of
older adults in the United States using the 2014 Behavioral
Risk Factor Surveillance System published by the CDC.
Respondents selected were 65years and older, and analyzed
variables included: general health status, BMI, physical and
mental health status, exercise, history of depression and
cognition. When compared with other regions, the south-
ern U.S. had the highest percentage of individuals endors-
ing poor perceptions of health (23.5%), a lifetime prevalence
of depression (20.2%) and trouble with cognition (13.2%).
Of those who reported a lower quality of health in last
month, individuals from the South indicated the highest
average of days of poor physical and mental health (13.1
and 12.1, respectively). With respect to health behaviors,
this same region demonstrated the lowest percentage of indi-
viduals participating in physical activities (71.2%). Obesity
was found to be highest in the Midwest (31.6%) and South
(31.4%). Difference in health indicators between U.S.regions
are interpreted using the social determinants perspective and
fundamental cause of health inequalities. According to the
2014U.S. Census, the southern region has the highest per-
centage of older adults living below the poverty line, as well
as the lowest household annual income and education rate.
Differences in social capital and unavailable resources shape
IAGG 2017 World Congress
319
older adults health behaviors by determining their lifestyle
choices, and ultimately influence their physical and mental
health.
ENTERING OLDER AGE AS LONG-TERM SURVIVORS
OF END-STAGE RENAL DISEASE: LESSONS FROM
EXPERIENCE
J.Trask1, E.L.Csikai2, 1. Social Work, Jacksonville State
University, Jacksonville, Alabama, 2. The University of
Alabama, Tuscaloosa, Alabama
The global prevalence of chronic kidney disease is grow-
ing and older adults are over-represented among dialysis
recipients. Increasing incidence of End Stage Renal Disease
(ESRD) at all ages has corresponded to the rapid growth
in the leading causes of diabetes and hypertension. Long-
term ESRD with dialysis treatment may accelerate biologi-
cal aging and result in premature vascular disease, impaired
cognitive functioning and frailty (Kooman, van der Sande,
& Leunissen, 2016), thus compromising quality of life. In
a qualitative phenomenological study, in-depth, face-to-face
interviews were conducted with ten individuals (6 male; 4
female; ages 4268) diagnosed with and managing treatment
for ESRD for twenty years or longer (currently receiving
in-center hemodialysis). The number of years since ESRD
diagnosis ranged from 2045years. Asemi-structured inter-
view guide was constructed to explore factors that facilitate
and challenge long-term survival with ESRD. The primary
themes that emerged from the data were Reactions to Initial
Diagnosis (discovery/reactions), Treatment Experiences,
Quality of Life, and Vision for the Future. Most participants
realized, through trial and error, that consequences were
severe for not adhering to the prescribed treatment regi-
mens and shared ongoing struggles with treatment adher-
ence. They attributed their current success to desire to find
a good quality of life, family, friends, faith in God and hope
for the future. The results of this study indicated that holistic
interventions are needed to facilitate adherence, self-efficacy
and social support in order to live longer and healthier well
into old age.
SOCIAL CONTROL, SELF-EFFICACY, AND
PSYCHOLOGICAL FUNCTIONING IN OLDER
PATIENTS WITH TYPE 2 DIABETES
F.Yang1, J.Pang2, 1. Shanghai University, Shanghai, China,
2. Nanyang Technological University, Singapore, Singapore
Diabetes mellitus is one of the most prevalent chronic
diseases globally. If not managed well, it would cause a
variety of severe complications that would adversely affect
patients functioning. Research shows that familys involve-
ment is beneficial to patients adjustment only when there is
a healthy interaction between family members and patients.
This cross-sectional study examined the role of persuasion-
based and pressure-based social control received from family
members in diabetes management and whether patients self-
efficacy moderated the relationship between persuasion/pres-
sure and patients psychological functioning. Participants
were 96 men and 103 women with type 2 diabetes mellitus in
Singapore, with a mean age of 63.3years. Results show that
persuasion was positively related to self-care adherence. In
addition, significant interaction effects were found. Patients
with lower self-efficacy benefited from persuasion, but were
320
adversely affected by pressure. In contrast, patients with
higher self-efficacy were adversely affected by persuasion,
but were less negatively affected by pressure. In conclusion,
findings highlight the importance of reducing pressure-based
social control, considering patients self-efficacy when family
members seek to influence patients self-care behaviors, and
targeting patient-family interaction in future interventions
with an ultimate goal of promoting patients better adjust-
ment to diabetes.
AGING WITH DIABETES AND DIABETIC FOOT:
ASSOCIATION BETWEEN ADHERENCE TO
TREATMENT AND COGNITION
R.Natovich1, I.Harman-Boehm2,3, T.Kushnir2,4, 1.
Sheeba Medical Center, Ramat-Gan, Israel, 2. Ben-Gurion
University of the Negev, Beer-Sheva, Israel, 3. Soroka
Medical Center, Beer Sheva, Israel, 4. Ariel University, Ariel,
Israel
Diabetes and aging are independent risk factors for cog-
nitive decline. Self-care is a cornerstone in diabetes manage-
ment and prevention of complications, including cognitive
decline. The presence of ulcers (diabetic foot, DF), represents
an increase in self-care burden and in cognitive demands
needed for adherence to self-care recommendations (ASC).
We examined the association between ASC and cognitive
functions in people with diabetes with (GD) and without
DF. This case control study included 99 individuals with DF
[58y6.9, diabetes duration (DD) 15.17.8, HbA1c 8.82.1, M.Mutambudzi, N.Chen, K.S.Markides, University of
76% males]; and 95 controls [(61y7, DD 13.48.5, HbA1c Texas Medical Branch, Galveston, Texas
7.41.3, 76% males]. Groups were matched for DD and
gender. ASC was determined using The Summary of Diabetes
Self-Care Activities questionnaire; Cognitive function was
assessed by Neurotrax computerized battery, Digit sym-
bol and Verbal fluency tests. Association between adherence
(high/low) and group (GD/DF) on cognitive functions was
assessed by a series of ANOVAs. Adherence to nutrition was
found to be positively associated with memory (101.511.2
vs 93.514.4**), phonemic fluency (9621.1 vs 86.319.9*), time were associated with increased risk of functional disa-
semantic fluency (99.519.9 vs 90.715.6*), psychomotor bility and mortality. We used data from 1,458 participants of
abilities (94.713.7 vs 85.218.9***). A highly significant the Hispanic Established Population for the Epidemiological
group effect was found, as DF scored significantly lower than
GD in all tested cognitive domains (p<0.0001). No interac-
tion effect was found between group and adherence levels
on cognition. Cognition was not associated with adherence
to physical activity, blood checks or medication. The results
demonstrate the importance of adherence to diet for preserv-
ing cognitive functioning in people with diabetes, with and
without DF, an issue of special relevance in older age.
NURSING INTERVENTION FOR ELDERLY HIGH-RISK
PATIENTS WITH DIABETIC FOOT ULCERATION
L.Imhof, A.Keller-Senn, Institute of Nursing, Zurich
University of Applied Sciences, Winterthur, Switzerland
Foot ulcerations is one of the most severe complications
of older patients with diabetes. The incidence rate is as high
as 62% and up to 10 % of those patients have an amputa-
tion within three years. Patient education comprising instruc-
tion on foot care and self-monitoring has been suggested as
pivotal part of treatment.
An RCT evaluating the effectiveness of a nurse-led inter-
vention for patients with existing diabetic foot ulceration
Innovation in Aging, 2017, Vol. 1, No. S1
and/or amputation was conducted. In addition to dress-
ing and wound inspection (usual care), the patients in the
intervention group received eight individualized, face-to-face
counselling sessions at patients homes over five weeks and
two telephone follow-ups.
From 254 identified high risk patients, 118 could be
enrolled (age M=64.2/11.5 years). During the 12 months
follow-up, overall hospital or ER admission was significantly
lower in the IG compared to the CG (40.0% vs. 62.5%,
RR=0.67, p=.029). Hospital/ER admission specific due to
foot ulceration was lower (18% vs 31.3%, ns), but not sta-
tistically significant, as were new wounds (42.6% vs. 56.1%,
n.s.).
Survival time in overall hospital admission was signifi-
cantly longer in the IG compared to the CG (M=280days/CI:
240, 321 vs. M=206days/CI: 164, 249, p=.021).
Although the study did not show significant effects on
wounds or hospital admission specific due to foot ulcera-
tion, the nurse-led intervention showed preventive effects
in this high risk population of older patients with diabe-
tes. Therefore, further full-powered research investigating
patient-directed, and more individually tailored interven-
tions should be conducted in this high risk patients.
EFFECTS OF SYNERGISTIC DEPRESSIVE SYMPTOMS
AND DIABETES ON MOBILITY IN OLDER MEXICAN
AMERICAN ADULTS
Current literature suggests that diabetes and depressive
symptoms are independently associated with mobility, and
that mobility in turn may predict disability and mortal-
ity. This study aimed to investigate the synergistic effect of
depressive symptoms and diabetes on mobility as measured
by performance oriented mobility assessment (POMA) scores
over a 9-year period in older Mexican Americans. Asecond-
ary objective was to examine whether mobility scores over
Study of the Elderly (H-EPESE) survey, for adults 75 years
and older for the years 20042013. Generalized linear
mixed models were used to examine the effects of syner-
gistic depressive symptoms and diabetes on mobility over
the study period, after which we examined the effect of
mobility over time on disability and mortality. Our findings
suggested that diabetes and depressive symptoms were sig-
nificantly and independently associated with mobility over
time. Synergistic depressive symptoms and diabetes however
were not significantly associated with mobility. The change
of POMA scores over time when compared to the baseline
(20042005) scores was strongly associated with functional
disability (p=<0.01) and mortality (p=<0.01). Further, syn-
ergistic depressive symptoms and diabetes showed a signifi-
cant association with functional disability (p=<0.01), but
not mortality in our models. While our preliminary analysis
did not find synergistic depressive symptoms and diabetes to
be significantly associated with mobility, further research is
warranted given the high prevalence of both functional dis-
ability and diabetes in this population.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 321

EFFECTS OF NON-PHARMACOLOGICAL Multimorbidity expresses a statistically significant beta

TREATMENTS ON QUALITY OF LIFE IN coefficient with the loneliness scale (=0.092, p<0.001) in
PARKINSONS DISEASE block 3, after controlling for age, sex, marital status, educa-
S.Ahn1, T.Bredow2, F.Yu1, 1. University of Minnesota, tion and income. The inclusion of perceived pain in block 4
Minneapolis, Minnesota, 2. Bethel University, Arden Hills, reduced the effect of multimorbidity on loneliness to =0.049
Minnesota (p<0.001). Inclusion of functional status in block 5 further
Parkinsons disease (PD) is a multifaceted neurodegen- reduced this association to =0.043 (p=0.001).
erative chronic condition with a declining trajectory over an In this study, multimorbidity modestly increases the risk
average 2030years. Health-related quality of life (HRQOL) of loneliness among older persons as hypothesized, while
is increasingly recognized as an important aspect of PD treat- perceived pain appears to slightly mediate this effect. Further
ment given the lack of cure for PD and expected life expec- study is needed to help clarify these associations using more
tancy upon diagnosis. The purpose of this systematic review refined measures and other sub-populations.
of the literature is to analyze the effects of non-pharmacolog-
ical treatments on HRQOL in persons with PD to suggest the SESSION 795 (POSTER)
best practices in PD care. Keywords, e.g., PD, QOL were used
for literature search in PubMed, CINAHL, and PsycINFO
CHRONIC DISEASE MANAGEMENT
databased up to June 15, 2016. Of the 161 articles gener-
ated, 12 met the eligibility criteria. The level and quality of
THE ASSOCIATION BETWEEN MEDICAL,
each article were determined by two authors independently
SOCIOECONOMIC, AND SELF-RATED HEALTH
using the Effective Public Health Practice Project (EPHPP)
STATUS IN KOREAN ADULTS
Quality Assessment Tool for Quantitative Studies. Our find-
J.Lee, K.Kwon, Y.Kim, Department of Rehabilitation
ings show that 58% of the 12 included studies represented
Medicine, Uijeongbu St. Marys Hospital, The Catholic
Level I (RCT) and 42% Level II (quasi-experimental
University of Korea, Uijeongbu, Korea (the Republic of)
designs). About 50% of the studies have strong quality, 8%
Method: This study sample was consisted of 3610 Korean
moderate quality and 42% weak quality. The interventions
adults aged 50 years and older which were based on data
varied tremendously across studies (e.g., music therapy, cog-
obtained from the 2009 to 2011 Korean National Health
nitive training, spa therapy, neuromuscular therapy, reflexol-
and Nutrition Examination Survey (KNHANES) IV and
ogy, acupuncture, self-management program, physiotherapy
V. Self-rated health status was measured using the visual
network, and telemedicine) with only 3 studies evaluated a
analogue scale of the EuroQol 5-dimension (EQ-VAS). The
similar intervention (i.e., exercise). About 83% of the stud-
complex sample general linear regression model for EQ-VAS
ies showed that the interventions improved HRQOL. We
was performed to determine the association with medical
conclude there is a pressing need to increase the volume of
and socioeconomic status.
high quality research in each intervention category to further
Results: The mean EQ-VAS score was 69.174.04 (mean
establish the minimally and optimally effective doses of those
standard error). The score of self-rated health status
interventions.
reported by the EQ-VAS was lower in the subjects with knee
pain (-5.46; p=0.001), hip pain (-5.17; p=0.002), and back
MULTIMORBIDITY AND LONELINESS AMONG
pain (-5.87; p<0.001) in comparison with the subjects with-
CANADIAN OLDER ADULTS: THE MEDIATING
out joints pain, male (-3.72; p =0.02) in comparison with
EFFECT OF PAIN PERCEPTION
female after adjustment for age, sex, anthropometric factors,
O.Atoyebi, A.Wister, Simon Fraser University, Vancouver,
socioeconomic factors and medical comorbidities. The lower
British Columbia, Canada
EQ-VAS score was also associated with lower education
Multimorbidity negatively affects the activities, lifestyle
level (p=0.001), lower physical activity (p=0.001) and lower
and quality of life of older persons causing complex interac-
income level (p<0.001). Interestingly, medical comorbidities
tions between physical and psychological conditions. These
including stroke, heart disease, diabetes mellitus and radio-
may make social interaction difficult, leading to potential
graphic osteoarthritis except high blood pressure were not
feelings of loneliness. However, it is not known how the
statistically associated with lower score of EQ-VAS (p>0.05).
pathways between multimorbidity and loneliness could be
Conclusion: The presence of pain or lower socioeconomic
modulated by the perception of pain. This study aimed to
status was associated with lower score of self-rated health
determine if an association exists between multimorbidity
status. Adequate pain management may be important con-
and loneliness and whether this association is mediated by
siderations in ensuring a better perceived health-related qual-
pain perception.
ity of life for aged 50years and older.
This cross-sectional study used data drawn from the
2008/2009 Canadian Community Health Survey, targeting
CAN WE IMPROVE MEDICATION USE IN OLDER
persons aged 80 (n=6,427). Loneliness scale was derived
ADULTS? AN INTERDISCIPLINARY MEDICATION
by summing up responses to questions measuring loneliness
THERAPY INTERVENTION
(Hughes etal., 2004), multimorbidity was measured using an
D.Moga, D.Rigsby, E.Abner, G.Jicha, Pharmacy Practice
additive multimorbidity scale and pain was assessed with the
and Science, University of Kentucky, Lexington, Kentucky
HUPDPAD variable in CCHS. Ordinary least square regres-
Older adults are at higher risk for experiencing medi-
sion analysis with six hierarchical blocks was used to esti-
cation side effects due to an altered metabolic profile and
mate the relationships among multimorbidity, loneliness and
higher comorbidity rates. Many of the clinical guidelines
pain variables.

IAGG 2017 World Congress

322
for optimizing pharmacotherapy in this population include
anticholinergic drugs on the list of potentially inappropriate
medications. Although several drugs exhibit anticholinergic
effects, prescribers may be unaware of such properties, thus a
team effort (pharmacist-physician) might be the key for suc-
cessfully implementing interventions to reduce inappropriate
prescribing in this population.
We conducted an interdisciplinary medication therapy
management (MTM) intervention for older patients who
were prescribed one or more anticholinergic medications.
We recruited 50 subjects 65 years with normal cognition
(n=33), mild cognitive impairment (n=12), or mild demen-
tia (n=5) enrolled in the University of Kentucky Alzheimers
Disease Center cohort. Participants were randomized to
either MTM (direct physician-pharmacist review and modi-
fication of medications) or control intervention (FDA materi-
als on inappropriate medication use). After 8 weeks, primary
outcomes included change from baseline in the number of
anticholinergic drugs and Medication Appropriateness
Index (MAI). The intervention reduced anticholinergic use
in 56% of the participants (intervention arm) vs 8% (con-
trol), p<0.0001. The intervention also improved medication
appropriateness: mean difference in MAI from baseline 4.16
(intervention) vs 1.13 (control), p=0.03.
An effective intervention to address medication appro-
priateness in a complex population is an essential first step
to improve pharmacotherapy-related outcomes. Our MTM
proved to be effective and acceptable (per patients verbal
feedback during study visits) method for reducing inappro-
priate medication use and shows promise for larger scale
interventions.
REASONS FOR CARE SEEKING IN THE EMERGENCY
DEPARTMENT BY OLDER ADULTS WITH CHRONIC
ILLNESS
B.Lutz1, A.Jones1, D.Carden2, A.Hall3, J.Schmucher4, they think is good, not worrying about disease, having
J.S.Harman5, P.Hendry2, 1. University of North Carolina-
Wilmington, Wilmington, North Carolina, 2. University
of Florida, Gainesville/Jacksonville, Florida, 3. University
of Alabama at Birmingham, Birmingham, Alabama, 4.
University of Wisconsin-Madison, Madison, Wisconsin, 5.
Florida State University, Tallahassee, Florida
Health care in the US is highly fragmented with little con-
tinuity. Poorly executed transitions result in a cycle of cri-
sis care. In this grounded theory study we identified factors
that influenced care-seeking by older patients in the emer-
gency department (ED) This study was part of a larger ran-
domized controlled trial (RCT) testing the effectiveness of
an ED-to-Home Transitional Care Intervention (TCI). The
RCT included 1004 community-living Medicare patients, >
60years who sought care in 2 EDs; 40 of these were purpo-
sively selected for in-depth interviews and were asked about
their decisions to seek care in the ED. Narratives were ana-
lyzed using comparative and dimensional analysis. Findings
suggest that care seeking decisions were well thought-out
based on perceived symptom acuity and severity, previous
experiences with similar symptoms, and advice from others.
Availability and promptness of primary care, and immedi-
acy and comprehensiveness of ED care were also taken into
account. These older patients are often resource-poor and
have complex unmet social and health-related needs. TCIs
Innovation in Aging, 2017, Vol. 1, No. S1
addressing concerns about physical and mental health, social
environment, health literacy, and availability and accessi-
bility of resources need to be considered. Facilitating ready
access to comprehensive primary care and case manage-
ment services may also be necessary to eliminate the cycle
of repeated ED visits in this population. Research is needed
to better understand the social and medical complexities of
older adults who seek care in the ED, the impact of patient
complexity on hospital-based crisis care, and key constructs
for tailoring patient-centered ED-to-home TCIs.
SELF-MANAGEMENT OF OLDER INDIVIDUALS WITH
CHRONIC HEART FAILURE IN JAPAN
A.Mitsuoka1, H.Hirata2, 1. Nagoya Medical Center,
Nagoya, Aichi, Japan, 2. University of Shiga Prefecture,
Hikone, Shiga, Japan
Background: Facing a super-aged society, the prevalence
of chronic heart failure (CHF) among older individuals
continues to grow in Japan, and this will become a social
problem in the future. Although older individuals with CHF
often repeat hospitalization, about 70% are capable of main-
taining self-management at home, without being re-hospi-
talized for more than one year. However, few studies exist
that focus on this population in Japan. Purpose: This study
aimed to explore why older individuals with CHF are capa-
ble of maintaining self-management at home. Methods: This
study was a descriptive qualitative design. Eight participants
aged 75 years or older with New York Heart Association
classIor II heart failure, who have not been re-hospitalized
for more than one year, were interviewed regarding the self-
management of their health. Results: Eight categories were
extracted, including self-management guidance by medi-
cal staff, support from caregivers, experience dealing
with CHF symptoms by themselves, understanding their
own disease, carrying out daily living in accord with what
methods to maintain good health in his/her own way, and
being aware of the disease in their function with aging.
Implications: These findings suggest that medical staff need
to provide appropriate self-management guidance for each
older individual with CHF. In order to effectively provide
such guidance, medical staff must understand and respect the
important habits and views that older individuals with CHF
have acquired over the course of their lives.
THE DIVERT-CARE CATALYST TRIAL: TARGETED
CHRONIC-DISEASE MANAGEMENT FOR HOME
CARE CLIENTS
A.P.Costa1,3, D.Haughton5, G.Heckman2, S.Bronskill4,3,
S.Sinha6,3, R.McKelvie1, 1. Dept. of Clinical Epidemiology
& Biostatistics, McMaster University, Hamilton, Ontario,
Canada, 2. University of Waterloo, Waterloo, Ontario,
Canada, 3. Univeristy of Toronto, Toronto, Ontario,
Canada, 4. Institute for Clinical Evaluative Sciences,
Toronto, Ontario, Canada, 5. Hamilton Niagara
Haldimand Brant (HNHB) Community Care Access Centre
(CCAC), Hamilton, Ontario, Canada, 6. Mount Sinai
Hospital, Toronto, Ontario, Canada
Home care patients are a large population of vulnerable
older adults living in the community. They are medically
complex, access care across settings, have very high rates
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
emergency department use, and have relatively poor access
to effective chronic disease management. We tested a multi-
disciplinary intervention deployed with a case-finding tool to
determine its real-world effectiveness.
A cardio-respiratory disease management intervention
was developed based on existing guidelines and deployed
using the validated Detection of Indicators and Vulnerabilities
of Emergency Room Trips (DIVERT) Scale. Intervention
components were refined and delivered by a multi-discipli-
nary group of geriatricians, cardiologists, primary care pro-
viders, home care coordinators, nurses, and pharmacists.
Components included: sustained self-care training, patient
self-care resources, medication review, advanced care plan-
ning, clinician communication tools, and staff education.
We conducted a non-randomized pragmatic cluster trial.
One hundred home care patients from three geographic areas
were enrolled for the intervention over 6months. The con-
trol group included patients who met the same eligibility in
the six surrounding geographic areas. A city-wide control
group was also included ad hoc. Data were analyzed based
on intent-to-treat. The absolute risk of an emergency depart-
ment visit was reduced by 20% over the 7-month follow-
up. Nursing costs increased by approximately $4 per day,
or approximately $500 over the entire follow-up period.
Results were similar with the ad hoc control group.
Targeted, multi-component cardio-respiratory disease
management interventions are feasible and effective for home
care clients. The trial received honours from provincial heath
care organizations. A large pragmatic cluster-randomized
trial is being planned.
SLEEP DISORDERS IN OLDER DEPRESSIVE PEOPLE
G.Prada1,2, R.Nacu1,2, L.Lungu1,2, A.Prada2, A.Ilie3, (r=0.36). Hypertension was more prevalent in both urban and
I.Alexa3, A.Herghelegiu1, 1. Clinical department, National
Institute of Gerontology and Geriatrics Ana Aslan,
Bucharest, Romania, 2. University of Medicine and
Pharmacy Carol Davila, Bucharest, Romania, 3. Gr.T. resources and family income both negatively associated with
Popa University of Medicine and Pharmacy, Bucharest,
Romania
Introduction: Disorders of sleep and mood disorders
occur often in elderly, have impact on quality of life and mor-
bidity, and influence each other. Objective of the study was to
identify sleep disorders in elderly and adults diagnosed with
mood disorders.
Material and method :We analyzed 2 randomly selected
groups of adults and older patients, total of 440 subjects, 110
men and 110 women in each group. Apreviously validated
questionnaire has been used to assess sleep, with a total of
23 items. Neuropsychologist evaluated mood disorders. 71%
adults and 89% elderly resided in urban area. Over 32%
adults had higher education and 64% elderly had medium
education.
Results: More elderly (21%) as compared to adults (7%)
lost their spouse. 1/3 of subjects in both groups felt tired
after waking-up; 86% adults and 63% elderly continued
to feel tired whole day. Adults had significantly more often
(p<0.001) altered sleep program. 2/3 of elderly had diffi-
culty with initiating sleep. Most elderly slept 4 hours every-
day, statistically significant difference from adults (p<0.01).
Elderly woke-up during night because of various pains and
IAGG 2017 World Congress
323
renal conditions, while adults because of depression. Women
had sleep disorders mainly due to depression in both age-
groups. Nightmares were more prevalent in elderly (p<0.05).
Elderly with mood disorders sleep less (p<0.01), wake-up
during night. Elderly describe more often poor quality of
sleep (p<0.01).
Conclusions: Women present more frequently with sleep
disorders. Older depressive people sleep less, wake-up more
often during night and take longer to sleep again than adults.
PROFILES OF MORBIDITY, DISABILITY, AND RISK
FACTORS FOR OLDER ADULTS IN TAIWAN: AGIS-
BASED APPROACH
Y.Tsai1,3, L.Chuang2,4, C.Chiu1, 1. Institute of
Gerontology, National Cheng Kung University, Tainan,
Taiwan, 2. Department of Sports Medicine, Kauhsiung
Medical University, Kauhsiung, Taiwan, 3. Sinhua Branch,
Tainan Hospital, Ministry of Health and Welfare, Tainan,
Taiwan, 4. Lees Clinic, Pingtung, Taiwan
Association of morbidity and disability in older adults
changed over time, and it has great implications informing
public health policy concerning care for the older popula-
tion. This study used Q-GIS to discern the relationship
between disease risk factors, including physical conditions,
environment, health behavior, social-economic and medi-
cal resources, and disability in older Taiwanese over time.
The data were based on nationally representative National
Health Interview Survey in 2005 and 2009. There were
2,709 and 2,914 nationally representative older adults
(65+) in 2005 and 2009, respectively. According to our
analysis, behavior such as smoking, significantly associated
with asthma (r= 0.55, p<0.05) and tends to increase stroke
resource-lacking areas than in general rural areas. Depressive
symptoms has higher self-reported rate in older adults living
in mountainous eastern Taiwan than in other areas. Medical
hospital admission rate (r= -0.38 and -0.30, respectively).
However, prevalence of chronic disease has weak association
with disability or hospital admission rate geographically. The
gap between urban and rural medical resources grew larger
in 2009 than in 2005. Our Q-GIS model shows that lack
of medical resources or family economic support, but not
chronic disease, increases hospital admission rate. Findings
from this study suggest that improving medical resources
and family income may be the most critical factors to pro-
mote health for the growing older population in Taiwan.
RELATIONSHIP BETWEEN SILENT HYPOGLYCEMIA
AND TREATMENTS, OR HBA1C IN ELDERLY
PATIENTS WITH DIABETES
M.Koshizaka1, T.Ishikawa1, Y.Maezawa1, M.Takemoto1,
Y.Tokuyama2, T.Saito2, K.Yokote1, 1. Chiba University,
Chiba, Chiba, Japan, 2. Kashiwado Hospital, Chiba, Japan
Introduction: There are few researches that studied about
the relationship among HbA1c, the diabetic treatments and
the blood glucose profile in the elderly patients with diabetes
by continuous glucose measurement system (CGM).
Methods: We compared the percentages of time estimated
as hypoglycemia (glucose level <70mg/dL on the CGMS)
324
and severe hypoglycemia (glucose level <50mg/dL on the
CGMS), and other parameters, between the patients treated
with insulin, SU, or glinides and the patients treated with-
out them. We performed the same comparison between the
group of HbA1c less than 8% and the group of HbA1c 8%
or more.
Results: The percentage of hypoglycemia time was sig-
nificantly higher in the patients treated with these 3 class
drugs than the patients treated without them (2.86.6%
vs. 0.71.7%, P=0.0011). The percentage of hypoglycemia
time was significantly higher in the patients with HbA1c
less than 8% than the patients with HbA1c 8% or more
(3.27.1% vs. 1.12.9%, P=0.0352). Compared with the Nong Hoi village housing, Muang district, Chiang Mai.
patients without hypoglycemia, the patients with hypogly-
cemia had significantly lower BMI (20.9 4.5kg/cm2 vs.
23.04.3kg/cm2, P=0.0118). The average insulin total daily
dose in the patients with hypoglycemia was more than that
of the patients without hypoglycemia (14.415.5 units vs.
9.213.0 units, P=0.0297).
Conclusion: In the 65years or more elder patients with
diabetes, the patients treated with insulin, SU or glinides had
hypoglycemic risk. It is necessary to carry out the optimal
blood glucose control comprehensively by HbA1c, CGMS
and other predictors, in order not to cause hypoglycemia in
the elderly patients with diabetes.
APPLICATION OF PEPTIDES FOR COMPLEX
TREATMENT OF AUTOIMMUNE THYROIDITIS
D.Gorgiladze, R.Pinaev, V.Aleksandrov, Scientific and
Production Center of Revitalization and Health, Saint-
Petersburg, Russian Federation
Background: Improvement the existing methods of treat-
ment of autoimmune thyroiditis by using complex applica-
tion of low molecular weight peptides.
Methods: We have conducted a study of the effectiveness
of treatment in 218 patients with autoimmune thyroiditis
aged from 39 - 51 years. All peptide preparations used in
this study, were developed by the St. Petersburg Institute
of Bioregulation and Gerontology, and are essentially com-
plexes of low molecular weight peptides with a molecular
weight up to 5000Da, isolated from thyroid and pineal
glands of young animals. We measured: indicators of the
thyroid hormones levels, indicators of the antibodies levels,
indicators of high-fidelity infrared thermography and ultra-
sonography of thyroid gland.
Results: It was revealed that application of a complex of
peptides of thyroid and pineal glands in patients with auto-
immune thyroiditis helped to improve general health and
laboratory indicators. This complex also caused an antibod-
ies level reduction and the positive changes in thyroid gland,
detected by ultrasonography.
Conclusions: It is preferable to apply the complex of
peptides of thyroid and pineal glands, as part of complex
treatment as well as for prevention of diseases in mid-
dle and senior age. The existing conventional treatment
regimens of autoimmune thyroiditis require the inclusion
of these high-performance schemes, physiological pep-
tide preparations targeted action aimed at increasing the
reserve capacity of the organs and tissues involved in the
pathological process.
Innovation in Aging, 2017, Vol. 1, No. S1
DEVELOPMENT OF CARING MODEL FOR ELDERLY
PERSONS WITH CHRONIC ILLNESS BY VOLUNTEERS
IN COMMUNITY
N.Suwankruhasn, Medical Nursing, Chiang Mai University,
Chiang Mai, Thailand
Elderly person with chronic illness need continuity and
long term care. Some elderly persons live alone or with fam-
ily members who cannot care them. Thus, they need help
from others. People in a community are a group of care pro-
vider for elderly person.
The study aimed to develop the caring model for elderly
person with chronic illness by volunteers in the community,
This research and development consisted of 5 processes:
1)surveyed and analyzed the current situation, problem and
need. 2) designed the caring model for elderly person with
chronic illness (draft version). 3)trial of the model 4)evalu-
ated and improved the model, and 5)distributed. The study
population included 24 elderly who lived alone or family
members need caring help, 264 elderly with self- help or less
dependence, and 17 caregiving volunteers.
The research finding revealed that the caring model for
elderly person with chronic illness by caregiving volunteers
covered health and social welfare (allowance elderly, disabil-
ity living allowance, and environment and safety). Elderly
were divided into 2 groups: the first group was independ-
ence/less dependence; and the second group was lack of
self-help/ high dependence. The first group received health
assessment and participated in health promotion projects in
which caring volunteers were developed to write a proposal
for funding from other agencies. The second group received
home visit, health assessment, and necessary help by caring
volunteers and health care team from the municipal hospi-
tal. In a case with health problem would be referred to the
municipal hospital, municipal service for older person, or
Chiang Mai Provincial Social Development Human Security
Office.
DETERMINANTS OF HIGH SELF-CONFIDENCE
IN DIABETES MANAGEMENT AMONG OLDER
DIABETES PATIENTS
S.Lee2, D.Lee1, S.Choun1, 1. School of Social & Behavioral
Health Sciences, Oregon State University, Corvallis,
Oregon, 2. The Roy J.and Lucille A.Carver College of
Medicine at University of Iowa, Iowa City, Iowa
Self-confidence in diabetes management is important
in initiating and maintaining diabetes self-care behaviors,
such as healthy diet, being physically active, monitoring
blood sugar, medication compliance, good problem solving
skills, risk-reduction behaviors, and healthy coping skills.
Self-confidence represents that patients are capable and
effective in achieving desired health outcomes. Patients
level of confidence in diabetes self-care is associated with
patients perception on the degree of problems present in
diabetes management, difficulties in self-care, understand-
ing of self-care methods, self-rated health, and social sup-
port. We used data from the Health and Retirement Study
(HRS) to explore the determinants of self-confidence in dia-
betes management among older diabetes patients. The sam-
ple consist of 1,888 diabetic patients (mean age=70years,
SD = 8.8, age range = 50 - 96, women = 52.4%) who
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
completed diabetes survey in 2003. We conducted regres-
sion analysis, controlling age, gender, education level,
marital status, and types of diabetes. Results revealed that
patients who reported higher confidence in diabetes man-
agement tended to experience less difficulties in self-care,
better understanding of self-care methods, and greater
social support. Additionally, those who had higher confi-
dence in self-care gave higher ratings for their self-care and
perceived higher self-rated health. Importantly, receiving
emotional and tangible support from family and friends is
significantly associated with increasing patients confidence
in self-care activities. These results indicate that improving
confidence in self-care is essential to have successful diabe-
tes management. Our findings can aid healthcare providers
in identifying patients who will potentially struggle with
self-care practices.
LONG-TERM LIFESTYLE INTERVENTIONS
IN MIDDLE-AGED AND ELDERLY MEN WITH
NONALCOHOLIC FATTY LIVER DISEASE
Z.Bao, Department of Geriatrics, Shanghai Institute of
Geriatrics and Gerontology, Shanghai, China
Nonalcoholic fatty liver disease (NAFLD), a meta-
bolic disorder related to insulin resistance and metabolic
syndrome,has become a public health concernworldwide.
Currently,principaltherapeutic modalities targeting NAFLD
are lifestyle interventions. However, the efficacy of long-term
lifestyle interventions in NAFLD management remains largely
unexplored.This study aimed to evaluate theefficacy of long-
term lifestyle interventions inmiddle-aged and elderly men
with NAFLD. All the280 eligible patients were randomizedto
control or test group. In test group,patients received coun-
seling bytwo physiciansevery 3months via phone visit. Adiet
tailored to their calorie need and increased physical activities
according to individual situations were prescribed.Patients
in control groupreceived no intervention.Afterperiodic inter-
ventions for 2years, body weight, abdominal circumference,
ALT, TCH, LDL-C and HDL-C decreased in test group.
Specially, fatty liver index (FLI) and NAFLD-fibrosis score
(NAFLD-FS) in test group reduced markedly.However, in
control group, there was only significant decrease in LDL-
C, HDL-C level and NAFLD-FS (P< 0.001), whereas other
parameters remained essentially unchanged.Liver steatosis
grade in test group decreased significantly, while the situation
aggravated in control group. In NAFLD, long-term lifestyle
interventionsexert an anti-obesity effect and attenuated liver
dysfunction and steatosis.
NUTRITIONAL PROFILE AND INTEGRATED
MODELS OF CARE TO THE AMAZONIAN ELDERLY
M.A.Faber1,4, J.Faber2, A.B.Lima3, R.P.Lima3, 1. encing significant or longstanding difficulties with physical
Postgraduation, Idaam College, Manaus, Amazonas, Brazil,
2. Hospital 28 de agosto, Manaus, Amazonas, Brazil, 3.
Universidade do Estado do Amazonas, Manaus, Amazonas,
Brazil, 4. Uninorte, Manaus, Amazonas, Brazil
The bad nutrition that occurs in the elderly may be
due to physiological changes of aging, the socio-economic
conditions, diseases and the interaction between nutrients
and drugs. The food served to the elderly should be mostly
cooked or prepared to facilitate mastication. These types
IAGG 2017 World Congress
325
of food contain less vitamins, minerals and fiber. Examine
the association between body mass index, waist-hip ratio,
waist circumference and nutritional profile in groups of
elderly relating it to their food habits and observer by
type of shelter of this population taken care of in one of
them Centers in Manaus, aiming at to know the reason
of the search of the aged, the medical attendance, types
of requested examinations. During 2015, 1076 elderly
was accompanied, amongst routine medical consultations;
inclusion revisit. Excrement and blood biochemical analy-
sis had been requested, and gauging of the arterial pressure.
The highest BMI, WHR, and WC quartiles and predefined
BMI categories were analyzed as predictive variables. The
alimentary consumption was registered during 3days and
each specific nutrient. We used a statistical analyzed by
SPSS. Was found overweight prevalences (65, 8%), 87%
hypertension, 48% intestinal parasitism; 45% high cho-
lesterol, 47% anemic and 32% diabetics. The diet com-
pared to the Dietary Reference Intakes showed inadequate.
BMI = 30,310,5 e 28,34,0 and WHR= 0,910,05 e
0,930,08.
DELIVERING TAILORED REHABILITATION
THROUGH AN ELECTRONIC PATIENT RECORD TO
PROMOTE PHYSICAL FUNCTION
J.A.Richardson, L.Letts, D.Chan, H.Siu, L.Thabane,
S.Sinclair, McMaster University, Hamilton, Ontario,
Canada
Rehabilitation has potential to exploit technology to
address changes in physical functioning associated with
chronic diseases and aging. This cohort study was designed
to determine feasibility of using an electronic patient health
record to prevent the physical functional decline in per-
sons 44years with and without chronic diseases/condi-
tions. Participants completed self-report measures including
assessments of function and preclinical disability, the Rapid
Assessment of Physical Activity (RAPA), at baseline, 6, 12,
and 18 months. Participants, 97 persons with chronic dis-
eases/conditions (CD) and 50 persons without (NCD), iden-
tified goals using the Patient Specific Functional Scale (PSFS).
Using the assessment results, physical and occupational ther-
apists tailored recommendations delivered electronically to
address the goals. A library of therapist intervention pages
(TIPs) on rehabilitation strategies was created, with topics
such as back pain, energy conservation, managing arthritis,
balance exercises etc.. Forty-two percent of persons with
CD had no difficulty or preclinical changes at baseline com-
pared to 92% without chronic disease; 35% with CD and
8% (NCD) had early changes or difficulty; while 23% (CD)
had established difficulty in physical functioning, experi-
functioning, mobility, or activities of daily living. Although
the range of health-related activities identified with the PSFS
varied, functional mobility and exercise/physical activity
items were prominent. After 6months, significant changes in
physical activities (RAPA; p=0.05) were detected in the CD
group. Findings suggest that on-line monitoring and delivery
of rehabilitation strategies support improvements in physical
activities and thus promote physical functioning for people
with chronic conditions.
326 Innovation in Aging, 2017, Vol. 1, No. S1

FUNCTIONAL GAIN OBTAINED BY ACATALAN identity, including intra-IPCP referrals, weekly Team Skype
MODEL OF INTEGRATED GERIATRIC CARE conferences, and documentation in EPIC for discrete data
S.J.Santaeugnia2, F.J.Tarazona-Santabalbina1, M.A.Mas2, abstraction. A federal HRSA grant (#UD7HP26906) and
1. Geriatric Medicine, Hospital Universitario de la Ribera 5 community partnerships support the free, non-primary
(Alzira, Valncia, Spain), Alzira, Valncia, Spain, 2. care weekly Co-Ops, in rent free store front, high traf-
Servicio Geriatra y Cuidados Paliativos. Badalona Serveis fic, locations. The project is also a part of the emerging
Assistencials, Badalona, Barcelona, Spain NEXUS network of IPCP projects, and the National Center
Background: Health systems based in the care have for Interprofessional Practice and Education (Regents of the
obtained better results in clinical care for patients with health University of Minnesota, 2013.) Outcomes after 18months
and social complex needs. In this context an integrated geri- and more than 1600 visits and home visits include improved
atric model of care could improve results in functional gain, or sustained measures of population health (e.g., SF 36;
health outcomes and patients quality of life. PROMIS 10; preventive health practices; HgbA1c; hyperten-
Methods: Quasi-experimental study was designed. During sion control), experience of care (CGCAHPS),and reduced
the years 2006 to 2012 1.309 patients were attended in this cost (number of hospital days), consistent with the IHI Triple
new catalan integrated geriatric care model (CICM) and Aim.
1.068 patients were enrolled in the usual care (Catalonian
geriatric care model). SESSION 800 (POSTER)
Results: CICM patients were significantly older (81.6
versus 78.3 years old). There were no differences for the
COGNITION II
main admission reasons in both groups. At admission time,
CICM patients had a higher degree of dependence, meas-
EFFECTS OF COMBINED PHYSICAL, SOCIAL,
ured by Barthel Index score (32.8 versus 39.9 points) and
AND INTELLECTUAL LEISURE ACTIVITIES ON
total dependence prevalence (38.4% versus 32.2%), higher
COGNITIVE STATUS
clinical complexity and more geriatric syndromes. In the
L.Lai1,2,3, L.Harkouk1, K.Z.Li1,2,3, 1. Dept. of Psychology,
ANCOVA analysis, functional gain was significantly higher
Concordia University, Montreal, Quebec, Canada, 2. Centre
in CICM group (17.2 (SD 0.8) points in Barthel Index than
for Research in Human Development, Montreal, Quebec,
control group (-5.6 (SD 1.1)), adjusting by age, gender, num-
Canada, 3. PERFORM Centre, Concordia University,
ber of geriatric syndromes and Barthel index score.
Montreal, Quebec, Canada
Conclusions: Patients enroled in CICM group obtained
This presentation describes observational work examining
a higher functional gain. The results of this study may be an
the potential benefits of combined social, physical, and intel-
useful start to design future randomized controlled studies.
lectual leisure activities on cognition. Asample of 333 recent
retirees (46 - 79 yrs.) completed questionnaires to evaluate
OUTCOMES OF AMOBILE, NURSE-LED
their engagement in everyday social, physical, and cognitive
INTERPROFESSIONAL COLLABORATIVE TEAM IN
activities. Cognitive outcomes included tests of global cogni-
UNDERSERVED RURAL AMERICA
tion (MoCA), switching (Trails B-A), and processing speed
G.A.Jensen, L.Jones, M.Kutzke, L.Lange, C.Larsen,
(Digit Symbol Coding). Multiple stepwise regression models
M.Klamm, N.Jelen, Sanford Health, Sioux Falls, South
revealed that physical and social activities were most predic-
Dakota
tive of global cognition and switching ability. Importantly,
The evolution of healthcare payment systems in the USA
high levels of physical activity protected against low MoCA
has fostered increased emphasis on health maintenance by
scores, particularly for individuals who did not engage in
patients who actively engage with providers who use evi-
high levels of social or intellectual stimulation. These findings
dence-based strategies and tactics. For those with rising risk
suggest that in training intervention designs, physical activity
or pre-existing chronic conditions, improved self-manage-
should be prioritized, but that other types of leisure activ-
ment and touch point surveillance can prevent use of high
ity confer addititional benefits when combined, above and
end health services such as emergency room visits and hospi-
beyond the individual activity types.
talizations. While cooperating with patients, primary provid-
ers, health coaches and community stakeholders, the Health
THE IMPACT OF COMBINED PHYSICAL
Co-Op pushes inter-professional care delivery beyond the
AND COGNITIVE TRAINING ON MOBILITY
traditional hospital and clinic settings, out into communities.
OUTCOMESDOES FORMAT MATTER?
This project describes early impact of an innovative
H.Bruce1,2,3, L.Lai1,2,3, K.Z.Li1,2,3, 1. Dept. of Psychology,
trial involving a person-centered, health delivery model to
Concordia University, Montreal, Quebec, Canada, 2.
improve access and outcomes for rural, frontier and diverse
PERFORM Centre, Concordia University, Montreal,
populations in the Upper Midwest. The model involves the
Quebec, Canada, 3. Centre for Research in Human
deployment of a dedicated, community-based, nurse-led,
Development, Concordia University, Montreal, Quebec,
mobile Interprofessional Collaborative Practice (IPCP) team
Canada
into small urban, rural and diverse underserved adult popu-
Researchers have demonstrated that with age, declining
lations, including ~75% older adults, non-English speaking
sensorimotor abilities are compensated for by the recruit-
Hispanics and Native Americans. The Team includes expe-
ment of higher level cognitive processes. This view was
rienced health professionals including nurses, a pharmacist,
recently supported by showing that cognitive dual-task
physical therapist, occupational therapist, dietician and social
training improved mobility and posture among older adults.
worker. Each discipline contributes to the IPCP collective

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
Moreover, preliminary evidence suggests that combined
physical and cognitive training is more effective than single
domain training in improving mobility among older adults.
However, to date there has been no investigation contrasting
sequential and simultaneous training conditions. To explore
this hypothesis, 41 older adults were assigned to either a
sequential or simultaneous training group consisting of 12
weeks of computerized divided attention training and aero-
bic training. All participants completed pre- and post-train-
ing assessments consisting of mobility (STS: Sit-to-Stand)
and cognitive (n-back working memory) tasks performed
singly and concurrently. Additionally, the sound intensity of
the cognitive stimuli was manipulated in order to increase
auditory challenge. Pre-post comparisons on the STS mobil-
ity task revealed that both groups improved under dual-task
conditions at both levels of auditory challenge. Additionally,
participants in the sequential training group demonstrated
improved dual-task performance on the cognitive task. These
results suggest that while both training protocols were suc-
cessful in improving mobility under challenging dual-task
conditions, sequential training was more effective in improv-
ing dual-task cognitive performance. Therefore, focusing on
one training intervention at a time appears to be more benefi-
cial than dual-task training where participants are required
to divide their attention between two tasks.
METAMEMORY ACCURACY FOR OLFACTORY
MEMORY IN AGING
J.Szajer1,2, C.Murphy2,3,1, 1. SDSU/UC San Diego Joint
Doctoral Program in Clinical Psychology, San Diego,
California, 2. San Diego State University, San Diego,
California, 3. University of California, San Diego, San
Diego, California
The California Verbal Learning Test (CVLT) is known to
have utility in the identification of Alzheimers disease (AD)
and other dementias. Odor memory tasks have also been
shown to have particular utility in aiding the early detection
of AD, where loss in olfactory function has been shown to
become evident prior to significant impairments in memory
functioning. However, declines in memory are heterogene-
ous. Metamemory, or the ability to monitor, judge, and
control ones memory, is one factor that has been shown to
influence trajectories of age-related declines in memory func-
tioning, even in neurodegenerative disorders like AD.
The current study investigated age differences in meta-
memory based on retrospective confidence ratings of rec-
ognition memory performance on an olfactory analogue
of the CVLT, the California Odor Learning Test (COLT).
Confidence ratings were self-reported using a bipolar visual
analog scale. Participants included 16 older (70-88yrs) and
25 younger (18-26yrs) adults. Age groups were equivalent on
demographic variables (e.g. gender, education). Odor thresh-
old was assessed and controlled for.
Across memory measures, younger performed better
than older adults (p < .05). Analysis of confidence accuracy
indicated that overall, older adults demonstrated stronger
calibration between recognition memory performance and
confidence; however, young adults demonstrated better con-
fidence resolution, rating correct responses with higher con-
fidence (p > .05).
IAGG 2017 World Congress
327
More accurate metamemory in aging has been associated
with fewer memory errors and higher quality of life, while
metamemory impairments can precipitate errors in judg-
ment, and difficulty managing responsibilities (e.g. medica-
tion adherence, finances). Thus, further research on aging
metamemory remains important.
PREMORBID PERSONALITY AND THE
OCCURRENCES OF THE RISK OF MCI AFTER 3
YEARS IN JAPANESE ELDERLY
Y.Masui1, H.Inagaki1, Y.Gondo2, T.Kurinobu1, K.Ikebe2,
K.Kamide2, Y.Arai3, T.Ishizaki1, 1. Tokyo Metropolitan
Institute of Gerontology, Itabashi, Tokyo, Japan, 2.
Osaka University, Suita, Osaka, Japan, 3. Keio University,
Shinjyuku, Tokyo, Japan
Background: Recent studies have reported that the onset
of dementia or mild cognitive impairment (MCI) in old age
has associations with personalities of individuals before
their onsets. However, it had not been confirmed in Japanese
elderly people.
Objective: To investigate the associations between per-
sonality traits and MCI risks by the prospective study on
Japanese elderly people who are cognitively intact.
Methods: Data were obtained in two waves three years
apart from 1251 community-dwelling older adults (637
women, mean age=74.64.9 years at Wave 1). Cognitive
function and 5 big five personality traits were measured
at Wave 1 by Japanese version of Montreal Cognitive
Assessment (Moca-J) and NEO Five Factor inventory. After
3years, Moca-J was conducted at Wave 2.
Result: The score of Moca-J less than 26 was judged to
have MCI risk. 325 individuals had no MCI risk at Wave
1.Three years later, 147 of 325 individuals were with risk of
MCI at Wave 2.
As a result of a binary logistic regression analysis with
whether having MCI risk or not at Wave 2 as a objective var-
iable, it was indicated that the occurrences MCI risk in three
years significantly associated with high neuroticism(OR=2.11,
95%CL:1.313.40,p<01), and with low openness(OR=.50,
95%CL:.31-.86, p<.01) at Wave 1.There were no significant
associations between other personality traits and MCI risks.
Discussion: These results suggested that, as reported by
preceding studies, the associations between personality traits
(neuroticism and openness) and MCI risks in three years on
Japanese elderly people.
SELF-REGULATED LEARNING OF MOVEMENT
SEQUENCES IN ADVANCED AGE
A.Olivay Hausmann, University of Cologne, Faculty of
Human Science, Rehabilitative Gerontology, Kln, Germany
Self-regulated learning can be defined as a self-directed
process by which learners transform their mental abilities
into a new skill. The purpose of this study was to demonstrate
a possible impact of self-regulated learning on the acquisi-
tion of movement sequences among elderly people. Earlier
studies revealed that with increasing age, sequence acquisi-
tion is more error-prone. It was hypothesised that this would
not be observed in self-regulated sequence learning: While
older subjects were expected to choose a slower pace and less
ambitious learning goals, no association between error rate
and age was expected. N=140 subjects (aged 5094) were
328
trained in a sequence of typing movements. At each trial,
participants imitated a part of the sequence presented on
a wooden plank. Participants determined the learning pace
(number of sequence elements per trial) and learning goal
(final number of elements). They were asked to acquire as
many elements as possible while remaining able to flawlessly
demonstrate the acquired sequence part later on. As hypoth-
esised, a higher age was associated with fewer elements per
trial and fewer final elements, but not with higher error rates,
which were exceptionally low in all subjects. These results
prove the potential of self-regulated learning for the compen-
sation of age-related declines in sequence learning. Further
investigations should explore how older subjects sequence
learning can be fostered so that they feel safe adopting more
ambitious learning goals without risking more errors.
EXPOSURE TO GREEN DOES NOT ALWAYS RESTORE
ATTENTION IN OLDER ADULTS
A.Setti1,2, M.Cassarino1, I.Tuohy1, 1. School of Applied
Psychology, University College Cork, Cork, Ireland, 2.
Trinity College Dublin, Dublin, Ireland
Objectives: Exposure to green scenes has been proven
restorative for directed attention (Attention restoration the-
ory, ART) in young adults, but very few studies have benefi-
cial effects of green on older adults attention. The present
study aimed to test ART on older individuals considering the
potential influence of current environment of residence.
Methods: A sample of 37 community-dwelling people
aged 60+ (mean age: 66.2, standard deviation 7.1; 48.6%
female), was divided into two groups. Each group first com-
pleted the sustained attention to response task (SART) to
fatigue directed attention, after which they viewed images of
either restorative (natural) or nonrestorative (urban) scenes,
and then completed the SART again.
Results: Participants who were currently rural and were
exposed to nonrestorative images showed a significant
increase in number of commissions between the two sessions
of the SART, t(10)=-3.01, p=.013, Cohens d=-0.912, and
significantly faster reaction times, t(10) = 3.112, p = .019,
Cohens d = 0.981; on the other hand, rural participants
exposed to restorative images became slower (t(8)=-2.614,
p=.031, Cohens d=-1.253, but did not show any signifi-
cant differences in terms of accuracy. No significant pattern
was found for urban participants. The findings held after
controlling for sex, age, education and MMSE.
Conclusions: The results did not show attention restora-
tion and suggest that the environment of residence of older
individuals, which could be considered as a form of long-
term exposure, mediates the influence of exposure to nature
on attentional skills.
MEDIATORS OF THE EFFECT OF CHILDHOOD
SOCIOECONOMIC STATUS ON COGNITIVE
PERFORMANCE
C.E.Franz1, A.Beck2, A.Yao1, W.S.Kremen1, 1. University
of California San Diego, La Jolla, California, 2. San Diego
State University, San Diego, California
Growing up in a low socioeconomic status (SES) back-
ground in childhood has been associated with lower general
cognitive ability (GCA) in childhood, adulthood, and later life.
Less examined is the extent to which childhood SES affects
Innovation in Aging, 2017, Vol. 1, No. S1
specific cognitive domains in later life and whether these
associations are mediated by other factors. Participants were
1009 Vietnam Era Twin Study of Aging (VETS) male twins
with mean age of 56 (range 5161), and 62 (range 5767)
at the adult assessments. Measures included: childhood SES
(parental occupation+education), and three mediators: age
20 GCA measured with the Armed Forces Qualification Test,
adult SES, and cognitive engagement at age 56 (e.g., self-
improvement, educational and cultural activities). Thirteen
neuropsychological tests were utilized to measure seven
specific cognitive domains at age 62. Childhood SES, age
20 GCA, cognitive engagement, adult SES, and cognitive
domains were all significantly correlated. Multiple media-
tion analyses were conducted separately for each cognitive
outcome. For abstract reasoning, there remained significant
direct effects of childhood SES (accounting for 39% of the
total effect) as well as a significant indirect effect accounting
for 61% of the total effect. Associations between childhood
SES and episodic memory, processing speed, verbal fluency,
visual-spatial ability, working memory domains as well as
age 62 GCA were fully mediated by the paths through age 20
GCA, cognitive activity, and adult SES. Thus, the long term
effect of childhood SES on cognitive performance was pre-
dominantly indirect; results suggest the importance of early
indicators of GCA when making inferences about later life
cognition.
SUBJECTIVE MEMORY COMPLAINTS, LEARNING
POTENTIAL, AND OBJECTIVE COGNITIVE
FUNCTIONING IN OLDER ADULTS
G.Rodriguez, N.M.Mendoza Ruvalcaba, Gerontology,
University of Guadalajara, Guadalajara, Jalisco, Mexico
Introduction: Subjective memory complaints in older
adults should not be considered only as an age-related phe-
nomenon or a symptom of depression. Instead, these com-
plaints deserve to be taken seriously, at least as a possible
early sign of dementia.
Methods: Cross-sectional study, n= 201 older adults
60-years and older (mean age=71.88, SD=7.07 years, 84%
women) were interviewed in a senior center. Memory com-
plaints were self-reported, learning potential was assessed
by using The Rey Auditory Verbal Learning Test (RAVLT).
For objective cognitive functioning a battery was applied,
for episodic memory (Subtest-RBNAS), working memory
(Digit Span Backward WAIS-IV), processing speed (Symbol
Digit WAIS-IV), attention (Trial Making Test-A), executive
functioning (Trial Making Test-B). Socio-demographic and
health data were also asked. Pearsons correlation test was
performed.
Results: 13. 4% reported his memory as bad, 64.7% regu-
lar, 18.4% good and only 5% excellent. Subjective memory
complaints are significantly related (p <. 01)with worse per-
formance in all cognitive test. Moreover, it was found a sta-
tistically significant difference (p <.05) in the learning curve,
between those who complain and those who have no memory
complaints. Age does not correlate with subjective memory
complaint. There was a negative correlation between subjec-
tive memory complaint and depression.
Conclusion: The results support the consideration of
memory complaints of as possible predictors of changes in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
cognitive functioning, due to its correlation with objective
assessment of cognition in older adults.
COGNITIVE FUNCTIONING IN OLDER MUSICIANS:
BENEFITS OF TRAINING WITH AMUSIC ENSEMBLE
J.V.Strong, VA Boston, Pembroke, Massachusetts
Previous research suggests that learning a musical instru-
ment during childhood may have an impact on cognitive
functioning later in life. There are many aspects of musical
training, including participating in an ensemble (e.g., band,
orchestra), or learning to improvise or compose proficiently.
Music training history of community dwelling older adult
instrumental musicians (N=45) was collected and each
participant completed a standard battery of neuropsycho-
logical tests. Analyses were run to determine if there were
differences in cognitive scores between subgroups of musi-
cians: 1) those who participated in an ensemble and those
who did not, 2) musicians who compose and those who
do not, 3)musicians who improvise and those who do not,
and 4)musicians considered competent on one vs. multiple
instruments. Results found that musicians who participated
in an ensemble showed higher performance on tests of imme-
diate memory (California Verbal Learning Test, p<0.05),
verbal fluency (Animal Naming p<0.02 and COWAT-FAS
p<0.05), visual memory (Brief Visual Memory Test-Revised
p<0.01), and a version of the Stroop Task (DKEFS Color
Word Interference Trial 3 p<0.01). There were no differ-
ences between groups of musicians who did or did not com-
pose, improvise, or play multiple instruments. These findings
suggest that there are aspects about playing in an ensemble
that may provide increased mental control and memory per-
formance later in life.
COGNITIVE-PHYSICAL-PSYCHOLOGICAL
INTERVENTION IMPROVES COGNITION AND
SOCIAL SUPPORT IN OLDER ADULTS
X.Zhu1, S.Yin2,1, J.Li1, W.Ren1, L.Huo1, Z.Zheng1, 1. After adjusting for covariates including age, sex, education,
Institute of Psychology, Chinese Academy of Sciences,
Beijing, China, 2. Hubei University, Wuhan, China
Cognitive, physical and social activities are cognitively
beneficial for older adults, but intervention has rarely been
conducted in combination of these three components. This
four-armed controlled non-randomized trial investigated the
synergistic effects of a multimodal intervention on cogni-
tion, well-being and brain plasticity in a sample of healthy
older adults. Four groups older adults respectively received
multimodal intervention (cognitive training, Taichi exer-
cise and group counseling), or cognitive plus Taichi train-
ing, or cognitive training, or lectures (active control group)
during six weeks. Seventeen participants in the multimodal
intervention group and 17 controls completed resting-state
functional magnetic resonance imaging scanning before and
after intervention. Cognitive performance and well-being
were assessed at baseline, post-intervention and 3-month
follow-up. A total of 156 participants completed interven-
tion and 134 were available at follow-up. Compare to the
control group, three intervention groups showed improve-
ments to varying degrees on cognitive function. The cognitive
plus Taichi group had largest increase with the multimodal
group as the second best at post-intervention, while both
group showed parallel maintenance effects on cognition at
IAGG 2017 World Congress
329
follow-up. Enhancement and maintenance in social support
were only found in multimodal group. Moreover, multimodal
intervention induced strengthened functional connectivity
between the medial prefrontal cortex and medial temporal
lobe, as well as regional alterations of intrinsic activity in
frontal, temporal and cerebellum regions. The results suggest
that cognitive-physical-psychological intervention is helpful
for preserving brain and cognitive function during old age,
and has advantages in comprehensive promotion of both
cognitive and emotional well-being.
DAILY LEISURE ACTIVITY AND COGNITIVE
FUNCTION IN LATER LIFE: AN 11-YEAR FOLLOW-UP
STUDY
Y.Chang1, I.Wu2, C.Hsiung2, 1. Department of Public
Health, China Medical University, Taichung City, Taiwan,
2. Institute of Population Health Sciences, National Health
Research Institutes, Miaoli County, Taiwan
Previous studies used the composite measure of leisure
activities to examine the relationship between leisure activi-
ties and cognitive function in later life. The aim of this study
was to investigate differential effects of cognitively stimu-
lating leisure activities (CSLAs) on cognitive decline in the
elderly population using four waves data (1996, 1999, 2003
and 2007) from the Taiwan Longitudinal Study on Aging
(TLSA). 2,532 Taiwanese community-dwelling elders aged
67 and older were included in analysis. In each wave, leisure
activities and cognitive performance of participants were
assessed using questionnaire-based instruments. Four CSLAs
including watching TV, radio listening, reading and gambling
were assessed in terms of weekly frequencies. The number of
error responses from a 9-item Short Portable Mental Status
Questionnaire (SPMSQ) was used to measure cognitive
performance. Generalized estimating equation models with
negative binomial distribution were employed to examine
associations between 4 CSLAs and error numbers of SPMSQ.
marital status, financial status and physical function, the low-
est frequency (< once a week) in all four CSLAs were associ-
ated with increased error numbers of SPMSQ comparing to
their counterparts who were in the highest frequency (almost
everyday) in up to 11-year follow-up. Among 4 CSLAs, the
greatest effect on cognitive performance was found in read-
ing activity, followed by watching TV and listening radio. We
conclude that daily activities in these 4 CSLAs were protec-
tive of cognitive function in later life.
SUBJECTIVE MEMORY AND ITS RELATION TO
DEPRESSION AND COGNITIVE FUNCTION IN
VIETNAMESE ADULTS
O.Meyer1, A.Leggett2, S.Liu4, S.Zarit3, 1. University
of California, Davis School of Medicine, Sacramento,
California, 2. University of Michigan, Ann Arbor,
Michigan, 3. Pennsylvania State University, University Park,
Pennsylvania, 4. University of California, Davis, Davis,
California
The population in Vietnam is aging rapidly. Subjective
memory complaints that accompany aging have been asso-
ciated with a variety of poor mental and cognitive health
outcomes for adults in the U.S. The relation of subjec-
tive memory complaints to objective measures of cognitive
330
functioning is tenuous some studies indicate that subjec-
tive memory complaints are associated with subsequent
cognitive decline, while others demonstrate that subjective
memory complaints are related more to mood. However,
little research has been done with aging Vietnamese. In this
study, we examined the relation between subjective memory
and depressive symptoms (CES-D) as well as cognitive func-
tion (MMSE). Whether subjective memory is more strongly
related to depression than it is to actual cognitive function
has implications for treatment and interventions in Vietnam.
The sample consisted of 477 adults 55years and older liv-
ing in Da Nang, Vietnam and surrounding rural areas. In
separate multivariate regression analyses, memory com-
plaints were significantly associated with depressive symp-
toms ( =.19, p < .001), controlling for several covariates;
memory complaints were also significantly associated with
MMSE score ( = -.10, p < .05), although not as strongly. and measurement of EF is often computer-based, task-
Results suggest that memory complaints are associated with
depression, possibly because one notices a decline in memory
even when objective memory measures show no evidence
of impairment. Consistent with the literature, these findings
suggest that depression may precede cognitive decline related
to dementia. However, future research should test the path-
way between subjective memory complaints, depression, and
dementia using a longitudinal sample.
LEISURE ACTIVITIES, EDUCATION, AND
COGNITIVE IMPAIRMENT: APOPULATION-BASED
LONGITUDINAL STUDY
J.Li1, X.Zhu1, C.Qiu2, Y.Zeng3, 1. Center on Aging demonstrated convergent validity (HTKS completion time rs
Psychology, Key Laboratory of Mental Health, Institute of
Psychology, Chinese Academy of Sciences, Beijing, China,
2. Aging Research Center, Department of Neurobiology,
Care Sciences and Society, Karolinska Institutet, Stockholm,
Sweden, 3. Center for Healthy Aging and Development
Studies, National School of Development, Peking University,
Beijing, China
Background: We examine the association between leisure-
time activities and the risk of developing cognitive impair-
ment among Chinese older people, and further investigate
whether the association varies by educational level.
Methods: This follow-up study included 6586 participants
(aged 79.59.8years, range 65 105years, 51.7% female) when interventions are most effective.
of the Chinese Longitudinal Healthy Longevity Survey who
were aged 65years and were free of cognitive impairment
in 2002. Incident cognitive impairment was defined at the
2005 or 2008/2009 survey following an education-based
cut-off on the adapted Chinese version of Mini-Mental State
Examination (MMSE). Participation in cognitive activities
(e.g., reading) and nonexercise physical exercise (e.g., house-
work) was assessed by a self-reported scale. Cox proportional
hazard models were employed to examine the association of
leisure activities with incident cognitive impairment.
Results: During a 5-year follow-up, 1448 participants
developed incident cognitive impairment. Overall, a high
level of participation in leisure activities was associated with
a 41% decreased risk of cognitive impairment compared to
low level engagement in leisure activities after controlling for
age, gender, education and other confounders. The benefi-
cial effect was significant in nonexercise physical activities
but not cognitive activities. Moreover, there was a significant
Innovation in Aging, 2017, Vol. 1, No. S1
interaction between leisure activity and educational level,
such that the beneficial effect of leisure activities was larger
in educated elderly than their uneducated counterparts, and
only educated elderly benefited from cognitive activities.
Conclusions: Late-life leisure activities protect against
cognitive impairment among elderly Chinese people, and the
protective effects are more profound for educated elderly.
EXECUTIVE FUNCTION IN OLDER ADULTS:
APSYCHOMETRIC EVALUATION OF THE HEAD-
TOES-KNEES-SHOULDERS TASK
E.S.Cerino, K.A.Hooker, R.S.Stawski, M.McClelland,
College of Public Health and Human Sciences, Oregon
State University, Corvallis, Oregon
Executive function (EF) abilities are recognized as compo-
nents of cognition most likely to show age-related declines,
focused and lacking ecological validity. We investigated a
new way of measuring EF in older adults by adapting a brief,
behavioral measure of EF in children, the Head-Toes-Knees-
Shoulders task (HTKS). An easy to administer measure
would allow for early detection of declines and intervention
among those at risk for mild cognitive impairment. Asample
of 150 community-dwelling older adults (Mean age=68.55,
SD = 6.34) completed the HTKS, NIH Toolbox (NIHTB):
Cognition Battery and Positive and Negative Affect Schedule.
The HTKS showed good internal consistency, = 0.84.
Significant associations between HTKS variables and meas-
ures of attention, inhibitory control, and processing speed
ranged from -0.20 to -0.30; HTKS total score rs ranged from
0.17 to 0.24). HTKS completion time exhibited the strongest
associations to NIHTB measures, suggesting that the time
it takes older adults to complete the HTKS may be a bet-
ter measure of EF than the total score. Non-significant asso-
ciations between HTKS variables and positive and negative
affect demonstrated discriminant validity. These results pro-
vide evidence for use of the HTKS as a brief, low-cost, easy
to administer measure of EF in older adults. Further research
is needed to determine its potential to identify individuals at
risk for poor cognitive outcomes. Abrief, valid measure may
allow for wider screenings aimed toward intervening early
SOCIAL CONTACT AND COGNITIVE FUNCTIONING
IN OLDER ADULTS LIVING IN THE COMMUNITY
D.Chon1, Y.Lee1, J.Kim1, J.Kim2, K.Lee 1, 1. Institution
to Ajou University, Gyeonggi-do, Korea (the Republic of),
2. Institution to Department of Health Administration,
College of Health Science, Dankook University, Cheonan,
Korea (the Republic of)
Korea is one of the countries showing the fastest growth
in the population of elders, with a rapid increase in the num-
ber of people with dementia. Social contact has been identi-
fied as a potential moderator of cognitive decline associated
with aging. This study examined the relationship between
social contact and cognitive functioning using a national sur-
vey of older adults. Data obtained from 3721 participants
65years and older from the Korean Longitudinal Study of
Aging (KLoSA) (20122014) were analyzed. Social contact
was scored by the frequency of meeting close acquaintances
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and cognitive function was measured by a Korean version
of the Mini-Mental State Examination (MMSE-K). Multiple
linear regression was used to compare social contact in 2012
with the MMSE-K score in 2014, adjusting for covariates.
Participants with higher frequency of social contacts were
more likely to have higher MMSE-K score in the overall
population (B = .138, p < .0001). The magnitude of the
association was stronger among those at risk of dementia
(B=.307, p < .0001), compared with those who were cogni-
tively normal (B = .082, p=.014). This study demonstrated
that frequent social contact was associated with higher lev-
els of cognitive functioning in later life. Further studies are
warranted to investigate whether social relationships buffer
against cognitive decline.
EFFECTS OF BIOFEEDBACK ON BLOOD PRESSURE
AND COGNITIVE FUNCTIONING OF OLDER
ADULTS WITH HYPERTENSION
H.Zeng1, L.Pan2, 1. Xiangya School of Nursing of Central
South University, Changsha, Hunan Province, China, 2.
The Second Xiangya Hospital of Central South University,
Changsha, Hunan Province, China
We explored the effects of biofeedback-assisted relaxa-
tion training on blood pressure and cognitive functioning of
the community-dwelling older adults with essential hyper-
tension. One hundred and eight older adults with essential
hypertension were selected from a community in Changsha
and randomly divided into equal-sized control and experi-
mental groups. Participants in the control group were given
routine service of the community, while those in the experi-
mental group received biofeedback-assisted relaxation train-
ing plus routine service of the community. All participants
were assessed by trained assistants blind to study group allo-
cation using mercury sphygmomanometer, Mini Mental State
Examination (MMSE) and Montreal Cognitive Assessment
(MoCA), before the training and at 3 and 6months of the
training. Spearman correlation analysis indicated SBP and
MoCA score, attention, abstract, delayed recall scores were
related negatively (r=-0.308, -0.317, -0.290, -0.342, respec-
tively) (P0.01); DBP and MoCA, abstract, delayed recall
score were also related negatively(r=-0.206, P0.05r=-
0.218, P0.05; r=-0.245, P0.01). Repeated measures
analysis of variance showed that there was significant time
effect as well as interaction effect between intervention and
time on SBP (P0.01), and significant intervention effect,
time effect as well as interaction effect between intervention
and time on DBP, MMSE and MoCA (P0.05). Therefore,
there is a negative correlation between blood pressure and
cognitive functioning; biofeedback-assisted relaxation can
be used to control hypertension and improve cognitive func-
tioning of community-dwelling older adults with essential
hypertension.
EFFECTS OF SERIAL SUBTRACTIONS ON ELDERLY
GAIT SPEED IN AVIRTUAL REALITY SETTING
T.Leeder, A.Helseth, S.Myers, M.Schieber, J.A.Blaskewicz salizing and potentially obscuring inequalities across lines of
Boron, University of Nebraska at Omaha, Omaha,
Nebraska
Falls are the leading cause of fatal injuries in older adults
aged 65+ with one in three adults falling each year. Cognitive
processes are involved in gait, and thus, as cognitive changes
IAGG 2017 World Congress
331
are normative with age, this may impact fall risk in the
elderly. Sixteen older adults aged 70.85.3years took part
in a dual-task (DT) study where they walked on a split-belt
self-paced treadmill with and without a virtual reality (VR)
setting while simultaneously performing a serial subtraction
(SS) task. For SS, individuals were given a random 3-digit
starting number and told to subtract by three from that num-
ber for one minute; this process occurred three times. Only
correct substitutions were counted toward their total score.
Previous literature showed that individuals will slow their
gait to deal with a cognitive task, and our results supported
this trend. Subjects tended to walk slower in both the VR
and non-VR settings while dual-tasking compared with the
walking-only control trial; walking while SS was significantly
slower in the VR session (p= .008). Initial analyses found no
significant differences in correct scores between conditions,
however, when grouping based on age, there was a significant
difference (p<.001). Subjects below 70years performed bet-
ter in the SS task (69 correct) compared to subjects 70 and
older (30 correct). Overall subjects tended to score higher
and walk faster in the VR condition. This could provide
evidence of VR conditions better approximating daily life
and thus implementing them as part of a fall intervention
program.
SESSION 805 (POSTER)
CRITICAL AND CULTURAL GERONTOLOGY
A CRITICAL ANALYSIS OF AGING IN PLACE AND
AGE-FRIENDLY EFFORTS
J.C.Yeh, University of California, San Francisco, Institute
for Health & Aging, San Francisco, California
Movements to make communities age-friendly are gain-
ing global attention, as population aging and urbanization
pressure cities, including San Francisco, to reconsider how
built and social environments influence residents wellbe-
ing throughout the life course. The preventive frameworks
of age-friendly efforts emphasize that all sectors of society
should adopt and design practices that are age-inclusive,
meaning a separate world should not be built for older peo-
ple alone. Rather, the world must work for all people, regard-
less of age. This qualitative study interrogates the conceptual
frames that inform policies and practices striving to be age-
friendly and how those conceptions compare to the lived
experiences of community-dwelling older adults. To interpret
meaning and processes situated in the experiences of inform-
ants, this study employs constructivist grounded theory as
its methodological approach. Data collection includes semi-
structured in-depth interviews with experts in the field and
low-moderate income older San Franciscans, as well as visual
representation through informant-produced photographs.
Findings include the various meanings and interpretations
of aging in place and age-friendly efforts, as well as the
paradoxical power of age-friendly discourse that is univer-
difference, throughout the life course. Applied, this research
may improve policies and practices affecting an increasingly
longer-living, yet still unequal, society by providing a critical
understanding of how aging and place are co-produced.
332
CHOREOGRAPHIES OF CITIZENSHIP: TOWARDS
ARECONCEPTUALIZATION OF DANCE, DEMENTIA,
AND EVERYDAY LIFE
P.Kontos2,1, A.Grigorovich2,1, 1. Dalla Lana School of
Public Health, University of Toronto, Toronto, Ontario,
Canada, 2. Toronto Rehabilitation Institute - University
Health Network, Toronto, Ontario, Canada
There is a growing literature that argues for the value
of dance as an embodied practice for persons with demen-
tia, as it draws significantly on the bodys potentiality for
innovation and creative action and significantly supports
non-verbal communication and affect. Despite the critical
knowledge base on dance from phenomenological analy-
ses and somatic and performance studies, dance scholar-
ship and practice in the dementia field largely represent a
movement towards cognitive science with an emphasis on
embodied cognition and psychotherapeutic use of dance.
This has restricted understanding of dance in dementia and
has consequently limited the development of opportunities
to more fully support this embodied form of self-expression
in long-term care settings. We articulate this argument by
analyzing findings of an ethnographic study of selfhood in
Alzheimers disease in a Canadian long-term care facility in
the context of a relational model of citizenship. Specifically
we focus on findings that feature self-expression through
dance in the context of everyday life in long-term residen-
tial care, specifically during recreational and religious social
programs, and non-structured activities. We argue that these
examples can more fully be understood and supported with
a relational model of citizenship that recognizes that corpo-
reality is a fundamental source of self-expression, interde-
pendence, and reciprocal engagement. This model brings a
new and critical dimension to understanding self-expression
through dance by persons with dementia, while also address-
ing broader issues of inclusivity and the ethical imperative to
fully support dance through institutional policies, structures
and practices.
AUSTRALIAN ATTITUDES AND POLICIES ON
INTERGENERATIONAL EQUITY: IMPACTS OF
SOCIAL CHANGE
H.L.Kendig1, K.OLoughlin2, R.Hussain1, L.Cannon1, 1. ing, alcohol use, physical activity and vegetable consumption)
Research School for Population Health, Australian National
University, Canberra, Australian Capital Territory, Australia,
2. The University of Sydney, Sydney, New South Wales,
Australia
This paper aims to investigate changing attitudes and
policies concerning intergenerational equity in Australia
through the aftermath of the Global Credit Crises.
Data are from a representative national sample of adults
aged 18years and older in the Australian Attitudes to Ageing
(AAA) study conducted as a component of the national
Australian Survey of Social Attitudes (AuSSA) in 200910
(n= 1525) replicated in 201516 (n= 1211). At baseline a
majority of respondents thought that life-long social and
economic opportunities were better for baby-boomers than
for the preceding cohort now in later life, but views on future
prospects were more divided. Results from the latest round
found continuing stability of attitudes, although there was
an increased perceptions of declining prospects for future
Innovation in Aging, 2017, Vol. 1, No. S1
cohorts and younger people. At both times a majority (espe-
cially among ageing baby-boomers) opposed policies raising
the age of pension eligibility and most believed that older
people were getting less than their fair share of govern-
ment benefits. Across all age groups at both times, only a
small proportion perceived strong intergenerational con-
flict. Significant age, gender, and social class differences were
found at both time periods.
The findings confirm modest increases of social tensions
between age groups that will be interpreted in terms of
cohort succession and responses to contentious government
actions on retirement incomes and debt reduction. Deeply-
seated beliefs in older people as a homogeneous needy
group contrast with increasing evidence of accumulating
wealth inequalities and economic challenges ahead especially
for younger people.
SOCIAL CAPITAL, HEALTH BEHAVIOURS AND
HEALTH: DOES REPORTING HETEROGENEITY PLAY
AROLE?
M.G.ODoherty1, D.French2, A.P.Steptoe3, F.Kee1,
1. UKCRC Centre of Excellence for Public Health for
Northern Ireland, Queens University Belfast, Belfast,
Ireland, United Kingdom, 2. Queens University
Management School, Queens University Belfast, Belfast,
Ireland, United Kingdom, 3. Institute of Epidemiology and
Health Care, University College London, London, United
Kingdom
Social capital has been shown to be associated with self-
reported health and health behaviours. Subjective measures
such as self-reports are not as robust as objective measures
which are too expensive to implement across large cohorts.
To overcome the problems of interpersonal incomparability
of self-reports, anchoring vignettes have been proposed as a
method of identifying reporting heterogeneity and correcting
self-reports for such differences, enhancing the comparability
of subjective measures.
Using ELSA Wave 3 (2006/07) in participants aged
50 years and older (n=9343) associations between three
dimensions of social capital (local area & trust, social sup-
port and social networks) and four health behaviours (smok-
were examined using logistic regression and controlling for
socio-demographic variables. Using vignette methodology
to study the effects of socio-demographic factors and social
capital on self-reported health allowed us to correct for
reporting heterogeneity and threshold variation with a series
of hierarchical ordered probit models for a sub-sample of
2341 subjects who completed the health vignettes.
Positive associations were observed between healthy
behaviours (not smoking and mod/high physical activity) and
local area & trust and social networks; positive associations
were also evident with excessive drinking. All dimensions of
social capital were independently associated with self-rated
health, with physical activity appearing to mediate associa-
tions between social networks and health. Independent of
social status, high levels of social capital were associated
with healthier behaviours and self-reported health. However,
ignoring reporting heterogeneity appears to underestimate
the positive effect of social networks on health.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
AGE AND SEX DIFFERENCE IN WORRIES ABOUT
AGING IN EAST ASIAN SOCIETY
H.Cheng1,2, H.Weng1, T.Lu1, Y.Yang3, 1. Institute of social club model of discussion-based learning and person-
Gerontology, College of Medicine, National Cheng Kung
University, Tainan City, Taiwan, 2. Department of Family
Medicine, National Cheng Kung University Hospital,
Tainan City, Taiwan, 3. College of Medicine, National
Cheng Kung University, Tainan City, Taiwan
Aging may intensify worries about the future according to
personal experience and social stereotypes. In previous stud-
ies, different genders and ages showed different concerns in
some countries. However, there was no study to discuss wor-
ries about aging in different gender and ages across differ-
ent countries simultaneously. In this study, we try to explain
the variables related to worries about aging and that in dif-
ferent ages and gender in the Eastern world. In our study,
3802 participants in China (mean age 47.61 years old),
2134 participants in Taiwan (mean age 47.63 years old),
2496 participants in Japan (mean age 53.70years old), and
1533 participants in Korea (mean age 47.79years old) were
included from East Asian Social Survey (EASS) database
2012. In both Taiwan and China, women had higher worries
about aging than men. Age, education, urbanization, family
members, occupation, and social placements were significant
factors that contributed to worries about aging. In China, the
4164year-old group showed the highest concern, whereas
in Taiwan, it was the 2040 year-old group that had the
most worries. Recognizing the worries about aging is useful
in identifying senior needs and will help determine policies
on the aging society.
GENERATION TO GENERATION: LESSONS LEARNED
FROM AN INTERGENERATIONAL COLLEGE SOCIAL
CLUB
L.Wagner, R.Mannas, O.Traina, Psychology, University of examined hundreds of German-language newspaper articles,
San Francisco, San Francisco, California
Traditional college-aged students have little opportu-
nity to foster meaningful relationships with older adults.
Coursework for gerontology students often focuses on dif-
ficulties in aging, including disease and decline. Students
can easily miss getting to know older adults as vibrant indi-
viduals and may then treat them stereotypically in clinical
settings. Generation to Generation, a gerontology elective
at University of San Francisco (USF) for older (over age
55) and younger (1830 year old) adults, promotes posi-
tive intergenerational contact. Results from the course sug-
gest intergenerational interactions in a classroom setting
increase younger adults positive attitudes toward older
adults (Wagner, Dangerfield, & Rodriguez, 2014). When
the course was not offered (instructor on sabbatical), pre-
vious students formed the Generation to Generation Club.
The club held bi-monthly lunchtime discussions in which
students from USF and the Fromm Institute for Lifelong
Learning discussed topics ranging from dating to ballot
propositions. In addition, a mentorship program matched 19
USF students with 19 Fromm students. Pairs communicated
with the goal of getting to know someone outside their peer
groups. Evaluation indicated that respondents enjoyed group
discussions, the mentorship program, and wished to partici-
pate again. Challenges included coordinating times where
members of both groups were available and encouraging
IAGG 2017 World Congress
333
continued attendance despite last-minute cancellations by
individuals from both groups. The Generation to Generation
alized mentoring succeeded in stimulating intergenerational
relationships and decreased stereotyping of each age group.
Replication on college campuses with lifelong learning or at
senior centers close to educational institutions is encouraged.
OLD VOLK: AGING IN TWO GERMANIES, 19451990
J.Chappel, History, Duke University, Durham, North
Carolina
This paper is a contribution to the historical study of
aging. It uses the natural experiment of the divided German
nation, where for several decades a region with similar eco-
nomic, cultural, and demographic characteristics was divided
into two radically distinct social and political systems. In
West Germany, American-influenced policymakers and soci-
ologists conceived a problem of aging organized around
the concepts of autonomy, dignity, and pension reform. In
East Germany, Soviet-influenced counterparts conceived the
problem entirely differently, avoiding gerontology and the
language of dignity entirely, seeking instead different and
more egalitarian strategies to incorporate the elderly into the
body politic.
My finding is that the socialist style of aging ultimately
failed due to internal contradictions and economic collapse,
but that it nonetheless provides important resources for the
present as we seek ways to manage growing populations of
the elderly in Germany and around the world. Socialists pio-
neered models of housing and community integration for the
elderly that are currently being dismantled at great cost, both
to East Germanys elderly and to scientists from around the
world looking for examples of communal forms of eldercare.
The methodology of this paper is cultural history. I have
social-scientific studies, state archival documents, and even
television shows in order to explore the imagination of aging
in each nation. This is pathbreaking work, as vanishingly lit-
tle work on aging has been written by trained historians.
SESSION 810 (POSTER)
CROSS-CULTURAL AND CROSS-NATIONAL STUDIES
A META-ANALYTIC STUDY OF CULTURAL
DIFFERENCES IN HOLISM AND ANALYTICISM
ACROSS AGE GROUPS
Y.Fang2, H.H.Fung3, M.Lu3, 2. CUHK Jockey Club
Institute of Ageing, Hong Kong, Hong Kong, 3. The Chinese
University of Hong Kong, Hong Kong, Hong Kong
Holism (i.e. a context-dependent processing style more
prevalent in East Asian cultures) and analyticism (i.e., a
context-independent processing style more prevalent in
Western cultures) are well-researched in cultural psychology,
and, to a lesser extent, in developmental psychology. In two
meta-analyses, we examined the degree to which cultural
differences in holism and analyticism between East Asians
and Western Europeans were similar among younger and
older age groups. We based our meta-analysis on 42 studies
(N=2510) that included holism- and/or analyticism-related
334
outcomes and recruited participants from both East Asian
and Western Cultures. Studies that examined age differ-
ences recruited participants from younger (1830 years)
and older (6088 years) age groups. Using random effects
analyses, we found that cultural differences in both holism-
and analyticism- related outcomes were significantly mod-
erated by age group. For holism, younger East Asians were
significantly more holistic than younger Western Europeans,
Hedges g=.55, p<.001, while there were no significant differ-
ence in holism among older East Asians and older Western
Europeans, Hedges g=-.17, p=.385, Q=10.32, p=.001. For
analyticism, younger East Asians were significantly less
analytic than younger Western Europeans, Hedges g=.69,
p<.001, while the same cultural difference was even stronger
among the older adults, Hedges g=1.72, p<.001, Q=10.98,
p=.001. We discuss the implications of these results for the
distinct theoretical perspectives that cultural differences are
more strongly expressed in old age (Fung, 2013), and that
age is an equalizer for cultural differences (Park, Nisbett, &
Hedden, 1999).
PREVALENCE AND CORRELATES OF LATE-ONSET
SUICIDAL IDEATION AND ATTEMPTS AMONG
KOREAN ELDERS
G.Kim, S.Y.Wang, S.Park, The University of Alabama,
Tuscaloosa, Alabama
Purpose of the Study: The present study examined prev-
alence and correlates of late-onset suicidal ideation and
attempts among community-dwelling older adults in South
Korea.
Methods: Drawn from the 2013 national survey of older
adults in South Korea, 10,267 adults aged 65 or older were
analyzed. Data were analyzed using chi-square tests, correla-
tion and logistic regression analyses.
Results: Prevalence rates for late onset suicidal ideation
and attempts were 10.9% and 12.5%, respectively. One of
the main reasons for late onset suicidal ideation was finan-
cial strain (40.4%), followed by health issues (24.4%) and
feelings of loneliness (13.3%). Several significant correlates
of for late onset suicidal ideation and attempts were found.
Those experiencing late onset suicidal ideation were more
likely to be female and have lower educational attainments
and annual income and greater functional limitations. Late
onset suicidal attempts were associated with female gender,
not married status, unemployment, lower annual income and
no functional limitations.
Conclusions: Late-onset suicidal ideation and attempts
among Korean elders were found to be high compared to
older adults in other countries. Understanding correlates of
late-onset suicidal ideation and attempts may help reduce
suicidal rates and improve the treatment for Korean older
adults experiencing late-onset suicidal ideation and attempts.
Clinical implications are also discussed in a cross-cultural
context.
HAPPY LIFE EXPECTANCY AND HEALTH: ACROSS-
NATIONAL STUDY OF JAPAN AND TAIWAN
A.R.Bardo1, T.Yamashita2, D.Liu3, 1. Sociology, Duke
University, Durham, North Carolina, 2. University of
Nevada, Las Vegas, Las Vegas, Nevada, 3. Des Moines
University, Des Moines, Iowa
Innovation in Aging, 2017, Vol. 1, No. S1
Good health is generally recognized as an important con-
dition not only for longevity but also happiness. However,
few studies have simultaneously examined the role of health
for mortality and happiness. The purpose of this study was to
examine the contribution of health to happy life expectancy
(i.e., the proportion of remaining life that one can expect to
live happy) in Japan and Taiwan that share a similar culture
and health profile. Data come from the 2012 wave of the East
Asian Social Survey (Japan: N=2,273; Taiwan: N=1,925)
and the Human Mortality Database. Prior research often
used Sullivans multistate life table method to estimate life
expectancy with cross-sectional survey data, but it is limited
in its ability to include covariates (e.g., education, income,
and health). In this study, we utilized a Bayesian extension of
this method to estimate happy life expectancy. Results show
that, on average, adults with good health can expect to have
relatively long and happy lives. For example, both Japanese
and Taiwanese men who are healthy can expect to live about
21% longer and spend a greater proportion (i.e., approxi-
mately 20%) of their life happy compared to their unhealthy
counterparts. Findings indicate that poor health shortens life
because of an increased risk of mortality, but they also sug-
gest that poor health substantially reduces quality of life in
terms of happiness. This study adds to a growing body of
evidence that shows that health can have a long-term impact
on happiness across the life course.
ARE GERMAN AND KOREAN FAMILIES BETTER OFF
AFTER SOCIAL LONG-TERM CARE INSURANCE?
H.Lee, Health Insurance Policy Institute, National Health
Insurance Service, Wonju, Gangwon-do, Korea (the
Republic of)
Germany and Korea introduced social insurance systems
to finance long term care (LTC) need in 1995 and 2008
respectively. Both LTCI systems aim to help people with LTC
need and their families. Even with the similarities as social
insurance, the two systems took a different approach toward
family caregivers. German LTCI incentivizes family caregiv-
ers such as paying pension premium, while Korean LTCI
lacks those kind of direct support for families. This study
reviews the different approach toward family caregivers of
physically dependent people of both systems and investigates
how subjective wellbeing (SWB) of families was affected
after the introduction of LTCIs in both countries.
To analyze the effect of German LTCI on SWB of German
families, the study used the German Socio-Economic Panel
from 1992 to 2002. For the analysis of the effect on Korean
families, Korean Longitudinal Study of Aging was used from
2006 to 2012. Each analysis included all the adults, who
were interviewed in the baseline year in pre-policy period.
The other waves in both datasets were regarded as post-
policy treatment conditions. This study took difference-in-
difference approach employing logistic regression to evaluate
the LTCI effect on SWB of the families of the LTC needy.
The study found that SWB of German families was
improved while no change was observed in Korean families
after LTCI introduction. The immediate effect of LTCI on
SWB measures of German families was relatively large at the
beginning period. Active policy measures could be needed to
improve SWB of Korean families.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
RELATIONSHIP BETWEEN CULTURAL
ORIENTATION AND ATTITUDES TOWARD AGING
AND THE ELDERLY: U.S. AND CHINA
G.Q.Zhan, S.M.Pearcey, R.Radomski, D.R.Moodie, ing the expectations of parents. Such conflicting factors mean
Kennesaw State University, Kennesaw, Georgia
The current study examined Chinese and American young
peoples cultural orientation (i.e., individualism/collectivism)
in relation to their attitudes toward aging and the elderly.
Seven hundred seventy-nine college students (434 Chinese,
345 American) filled out a questionnaire that included
Triandis and Gelflands IC scale (Cultural Orientation Scale),
Kogans attitudes toward old people scale, as well as rele-
vant demographic and background information. Cronbachs
alphas indicated satisfactory reliability of both scales for the
two cultural groups. Results show the two groups differed
significantly on the IC scale, but in a surprising way that par-
tially challenges the traditional views on individualism/col-
lectivism paradigm. Specifically the Chinese students scored
significantly higher than the American participants on both
the vertical individualism and vertical collectivism subscales,
indicating that while they are more likely to accept hierarchy
and inequality in society, they are nevertheless able to view
the self both as part of a collective and as fully autonomous.
The American students on the other hand scored significantly
higher on both the horizontal individualism and horizontal
collectivism subscales, indicating while they are less likely
to accept hierarchy and inequality in society, they are also
able to view the self both as part of a collective and as fully
autonomous. Results also show that the American partici-
pants hold more positive attitudes toward aging than their
Chinese participants. For both groups, collectivistic orienta-
tion is positively correlated to attitudes toward aging and
the elderly. We will discuss these findings in the context of
globalization and the possible eroding of traditional Chinese
values.
CONSTRUCTING TRANSNATIONAL FAMILIES:
GENERATIONAL TIES, FILIAL PIETY, AND
CAREGIVING ACROSS BORDERS
J.Yoon, Syracuse University, Syracuse, New York
Research at the intersection of migration and aging has
primarily focused on elderly migrants, and has only recently
begun to address the issue of transnational family relation-
ships of older parents left behind by their migrant children.
The current study contributes to this nascent area of research
by examining the intergenerational relationships of Korean
Americans with at least one older parent living in Korea.
Korean immigrants represent a theoretically rich population
to study because, as labor migrants, they have largely been
successful in American society, but retain values of filial piety
from their native culture. The empirical design consists of in-
depth, open-ended interviews of twenty Korean Americans
living in the Northeast of the U.S. Most subjects are first-
generation immigrants from Korea. A grounded-theory
approach is used to detect consistent thematic content across
interviews. Findings suggest that there is uncertainty among
these immigrants as to future expectations for their parents
later years and how to plan for their care. They tend to feel
ambivalent over the difficulties of maintaining family ties
and fulfilling filial obligations over great distance, a challenge
further complicated by practical issues of formal elder care
IAGG 2017 World Congress
335
availability in contemporary Korea. There is also some ten-
sion, both internally for the immigrants and between family
members, over future plans and expectations for care, includ-
that when the time comes to respond, intergenerational care
provision will involve complex negotiations among members
of these transnational families.
FUTURE TIME PERSPECTIVE OF OLDER GERMANS
AND JAPANESE LIVING ALONE
T.Ikeuchi1, F.R.Lang2, H.Osada3, 1. Research Team
for Social Participation and Community Health, Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan,
2. Institute of Psychogerontology, Friedrich-Alexander-
University of Erlangen- Nrnberg, Nuremberg, Germany,
3. Graduate School of Gerontology, J.F. Oberlin University,
Tokyo, Japan
Objectives: Changes in age-related future time perspec-
tive (FTP) were found to influence peoples social network
characteristics (SNC). Earlier studies revealed different pat-
terns of adaptation to their personal network among older
adults with or without nuclear family members. Using the
framework of socioemotional selectivity theory (SST), this
study examined the differential role of living arrangement
in SNC between the cultures of Germany and Japan, which
share many distinct characteristics, including the types of liv-
ing arrangements among older adults.
Methods: Our sample consisted of 139 German (71% live
alone) and 136 Japanese (49% live alone) adults ranging in
age from 60 to 90. The moderating role of living alone in the
three way interactions of subjective health (SH), FTP, and
SNC was tested.
Results: Among Germans, more extended FTP was associ-
ated with an increasing number of very close social partners,
when living alone and having rather poor or average health,
as well as when living with someone and having rather better
health. These findings were consistent with SST. However,
no such associations were found among Japanese. Our addi-
tional analysis on the interaction between the effects of cul-
ture and living alone on FTP revealed a greater cultural effect
in the live-alone situation than in the not-live-alone situation.
Conclusions: Our study suggests that culture-specific
associations between SH, FTP, and SNC may reflect differ-
ences of living arrangements between Germany and Japan.
For example, living alone may have a stronger impact on the
phenomenon of SST in Germany than in Japan.
ELDERCARE NORMS REGARDING THE PROVISION
AND FINANCING OF HOME CARE ACROSS 24
COUNTRIES
A.L.Janus, A.S.Koslowski, Sociology, University of
Edinburgh, Evanston, Illinois
We use 2012 data from the International Social Survey
Program to examine cultural norms surrounding assistance
with daily activities at home for older people across 24
economically developed countries. We focus on individu-
als expressed support for four different elder care arrange-
ments characterized by differences in who provides and
covers the costs of elder care. Peoples elder care beliefs vary
substantially both across and within countries. Support for
private responsibilityi.e., private sources such as family
336
members are responsible for both providing and financing
elder careis greatest in the English-speaking countries (44
percent), followed by Eastern and Southern Europe and East
Asia (both 35 percent), Western Europe (25 percent), and
the Nordic countries (9 percent). By contrast, 74 percent of
people in the Nordic countries express support for public
responsibilityi.e., formal sources such as government
agencies are responsible for both provision and financing
and support for this arrangement ranges between 29 and 41
percent in the other country groups. We use multilevel mod-
els to examine how peoples support for different elder care
arrangements are related to societal opportunity structures,
familial opportunity structures, and ideological factors. Our
results suggest the importance of both opportunity structures
and ideological factors in accounting for peoples elder care
beliefs. The most important factor at the country level is the
percentage of GDP spent on services, which is associated
with greater support for public responsibility in elder care
and less support for private responsibility and publicly
financed informal care.
LIVING IN MANDATORY PALESTINE: PERSONAL
NARRATIVES OF THE GALILEE FROM THE 1940S TO
1967
S.Y.Hantman2, R.R.Greene1, 1. University of Texas-Austin,
Austin, Texas, 2. Tel Hai College, Kiryat Shmona, Israel
This paper presents the results of a research study entitled
Living in Mandatory Palestine: Personal Narratives of the
Galilee from the 1940s to 1967. Forty narratives were col-
lected: twenty from Jewish settlers and twenty from Arabs
who have lived or where born in the Galilee, prior to the
establishment of the State of Israel and thereafter. The study
uses a narrative approach to gerontology that explores the
lives of older study participants from a life courseecological
perspective, encompassing cultural, historical, and political
reminiscence.
Resilience was analyzed through peoples narratives of
critical events that occurred at the personal, interpersonal,
sociocultural, and societal levels. Personal-level narrative
themes spoke about internal feelings. Interpersonal-level nar-
rative themes such as continuity, personal responsibility to
each other, coping, modesty and acceptance addressed rela-
tionships between people. Sociocultural-level themes express
the beliefs and mores of family, tradition, religiosity, Zionism,
modesty and leadership of the time. Societal level narrative
themes such as relating to belonging to persons, places, and
ideologies are indicative of the work of societal institutions.
Initial results point to a strong idealistic commitment to fam-
ily and state regardless of ethnic background.
MULTIMORBIDITY, HEALTH, AND AGING IN
CANADA AND AUSTRALIA: ATALE OF TWO
COUNTRIES
A.Wister1, H.L.Kendig2, B.Mitchell1, I.Fyffe4, V.Loh3, tial, but they vary considerably across countries.
1. Simon Fraser University, Vancouver, British Columbia,
Canada, 2. Australian National University, Acton,
Australian Capital Territory, Australia, 3. University of
Sydney, Sydney, New South Wales, Australia, 4. Gerontology
Research Centre, Simon Fraser University, Vancouver,
British Columbia, Canada
Multimorbidity has been recognized as a major public
health issue that is prevalent among older adults, affecting
Innovation in Aging, 2017, Vol. 1, No. S1
objective and subjective health, and health care utilization.
For instance, in Canadian and Australian population health
surveys, self-reported multimorbidity is estimated between
50% and 65% among persons 65 and over. This explora-
tory study examines selected health outcomes associated
with multimorbidity across older age groups/cohorts and
gender, comparing Canada and Australia. Data were drawn
from the 2008/09 Canadian Community Health Survey and
the 2009 Australian HILDA survey. Seven major chronic ill-
nesses were identical across the two data sets, and were com-
bined into an additive measure of multimorbidity. OLS and
logistic regression models were performed within age group
(4554, 5564, 6574, 75+) and gender to estimate associa-
tions between multimorbidity and several health outcomes,
including: loneliness, life satisfaction, perceived health,
mobility restriction, and hospital stays, adjusting for marital
status, education and foreign born status. Overall, country-
level differences were identified for perceptions of loneliness,
life satisfaction, and perceived health. Australians tended to
experience a greater risk of loneliness and lower self-rated
health in the face of multimorbidity than Canadians, espe-
cially among older men. Canadians tended to experience
lower life satisfaction associated with multimorbidity than
Australians. No country-level differences were identified for
the effects of multimorbidity on hospital stays or mobility
limitations. The effects of multimorbidity on health is vari-
able depending on population, age group/cohort, and gender.
The strongest country-level associations are for indicators
of health-related quality of life, rather than health care or
mobility limitation outcomes.
GENDER GAPS AND SES GRADIENTS IN ALCOHOL
CONSUMPTION AMONG OLDER ADULTS IN 19
COUNTRIES
J.Medina2, E.Calvo1, I.Madero-Cabib1, 1. Universidad
Diego Portales, Santiago, Chile, 2. Calvolab, Santiago, Chile
The prevalence of alcohol consumption and its effects on
mortality and morbidity have received substantial attention.
Most of the evidence is based on single-country studies or in
comparative studies of the general population. In contrast,
comparative estimates of the prevalence of alcohol consump-
tion among older adults have received less attention. Using
recent data from the Health and Retirement Study (HRS),
English Longitudinal Study on Ageing (ELSA), Survey of
Health, Ageing and Retirement in Europe (SHARE), China
Health and Retirement Longitudinal Study (CHARLS), and
Korean Longitudinal Study of Aging (KLoSA), this study har-
monizes information on alcohol consumption and catego-
rizes respondents as: lifetime abstainers, current abstainers,
occasional drinkers, moderate drinkers, and heavy drinkers.
Preliminary results suggest that moderate drinking is more
prevalent in European countries, while lifetime abstainers are
the norm in Asia. Gender gas and SES gradients are substan-
HOME ASSESSMENT OF PERSON-ENVIRONMENT
INTERACTION (HOPE): ACROSS-CULTURAL
VALIDATION STUDY
J.Rousseau1,2, C.Chu3, P.Guitard4, 1. cole de
Radaptation/School of Rehabilitation, Universit de
Montral, Montreal, Quebec, Canada, 2. Research Center
Institut Universitaire de Griatrie de Montral, Montreal,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Quebec, Canada , 3. CIUSSS de lEst-de-Montral,
Montreal, Quebec, Canada, 4. cole des Sciences de la
Radaptation /School of Rehabilitation Sciences, Universit
dOttawa / University of Ottawa, Ottawa, Ontario, Canada
Aging is frequently associated with impaired mobility.
Consequently, the elderly face environmental barriers within
their home environment and Aging-in-Place becomes a chal-
lenge. Few assessment tools exist to address the issue of
home adaptation. HoPE is based on a Person-environment
Interaction Model and specifically designed for home adap-
tation evaluation. Since its original version is in French,
this studys aim was to yield an English version. Based on
a back-translation methodology for cross-cultural research,
the first steps of the Vallerands method were completed:
1)an English experimental version of HoPE was produced
by comparing the original version with the translated and
back-translated versions by independent translators, 2)this
experimental version was submitted to an expert panel to
validate the transcultural equivalence using a consensus
approach. Comparative data analyses included: 1)highlight-
ing the similarities/differences across the three versions of
HoPE (original, translated, back-translated), and 2) report-
ing the experts agreement/disagreement. Results show that
70% of the experimental version is transculturally equiva-
lent. For the remaining 30%, the experts reached a consen-
sus except for 6 terms for which decision was based on the
majority; then, the English version of HoPE was produced.
Considering these results and the psychometric properties of
its original version (French), this cross-cultural adaptation
of HoPE provides clinicians and researchers with a new and
valid tool to understand the Person-Environment Interaction
in the home setting.
THE ASSOCIATION OF MULTI-ETHNICITY AND
HEALTH AMONG OLDER ADULTS: THE CASE OF
COSTA RICA
B.Reyes Fernndez2, T.A.Baker1, 1. University of Kansas,
Lawrence, Kansas, 2. University of Costa Rica, San Jose,
Costa Rica
The Hispanic population is considered one of the most
diverse groups of individuals nationally and globally.
Assessing the multi-ethnic background of Latin America is
very convoluted, and an area that is often ignored, particu-
larly as it deals with health outcomes of older non-White
Hispanic adults. This lack of attention has a direct impact
on the needs of Black Latinos, in particular and other Latin
American minorities in general. This tends to render these
groups as practically invisible in terms of health outcomes,
behaviors, and other related psychological outcomes. To bet-
ter understand the global assessment of older minority popu-
lations, this project takes the case of Costa Rica as an example
of a multi-ethnic country that is aimed at understanding the
health needs of its older adult population. An introduction
is directed at the historical context of immigration and cul-
tural encounters that have taken place in unjust and ineq-
uitable circumstances, particularly among the Black Latino
population in Costa Rica, with emphasis on the population
coast of Limn, Costa Rica. Although ongoing, preliminary
results of a study are provided describing inequities of wealth
and segregation, with its deleterious consequences on health.
Special attention is guided at how health is defined, how race
IAGG 2017 World Congress
337
has impacted well-being, and understanding the dynamics
of this long-standing relationship. These data will direct our
understanding of models, facilitators, and barriers that define
the life experiences of Black Latinos and other marginalized
populations, while highlighting areas that promote medial
advancements, equity in access to care, and health promotion
and well-being.
SESSION 815 (POSTER)
DEATH, DYING, AND BEREAVEMENT
CIRCUMSTANCES SURROUNDING THE DEATH
OF ALOVED ONE AND ADAPTATION TO
BEREAVEMENT
S.T.Stahl, R.Schulz, Psychiatry, University of Pittsburgh,
Pittsburgh
Circumstances surrounding the death of a loved one can
affect surviving family members bereavement experience.
Those who believe their loved one had a good death (e.g.,
death was a relief, expected) may experience better bereave-
ment outcomes than those who were dissatisfied with their
loved ones death experience. This study examined: (1) pre-
death factors associated with caregivers perceptions about
the circumstances surrounding their care recipients death;
and (2) whether a better perception of death is associated
with indicators of adaptation to bereavement. Participants
included 89 informal caregivers (CG) aged 32 - 87 years
(M=63years) who experienced the death of their care recip-
ient shortly after placing him/her in a long-term care facility.
Pre-death measurements included sociodemographic charac-
teristics, depression, and preparedness for death. Post-death
measurements (approximately 3months post-death) included
circumstances surrounding death, restorative health behav-
iors, and complicated grief. Amultivariate regression model
showed that CGs who were White and CGs who felt more
prepared prior to death perceived better circumstances sur-
rounding their loved ones death. CGs who perceived better
circumstances surrounding their loved ones death engaged
in more restorative health behaviors post-death and reported
fewer symptoms of complicated grief. These findings suggest
that a better perception of death facilitates behavioral and
psychological adaptation to bereavement. These findings
raise questions about the specific circumstances surround-
ing death that may facilitate adaption to bereavement and
whether healthcare providers can improve CGs perceptions
of a good death, possibly by preparing them for the death
of their loved one.
PSYCHOLOGICAL VULNERABILITY TO
WIDOWHOOD: FINANCIAL STRAIN, WORRY ABOUT
CARE, AND SOCIAL ENGAGEMENT
J.Min4, L.Xu1, Y.Li2, I.Chi3, 1. University of Texas
Arlington, Arlington, Texas, 2. San Diego State University,
San Diego, California, 3. University of Southern California,
Los Angeles, California, 4. University of Alberta,
Edmonton, Alberta, Canada
Objective. This study examines the ways in which the finan-
cial, social, and care factors (financial strain, worry about hav-
ing no caregiver, and social engagement) modify the association
338
between widowhood and depressive symptoms among older
adults in China. Methods. Using national representative data
from older adults in China in 2000 (n = 15,115), Multiple
regressions were used in this study to examine the moderating
effects of the financial, social and care factors on the associa-
tion between widowhood and depressive symptoms. We also
performed structural equation modeling to test the mediating
effects of these factors on such association.
Results. Compared to their married counterpart, wid-
owed older adults show significantly higher level of depres-
sive symptoms (b = 0.46, p < .001), higher percentage of
worry about having no caregiver (b = 0.11, p < .001) and
financial strain (b=0.10, p < .01), and lower level of social
engagement (b=-0.07, p < .01) which results in higher levels
of depressive symptoms. Worry about having no caregiver
(b = 0.15, p < .001) significantly moderates the relations
between widowhood and depression.
Discussion. This study extends bereavement and psycho-
logical wellbeing research to developing nations by examin-
ing several pathways between bereavement and depressive
symptoms. The results provide important implications for
intervention when working with widowed older adults in
China.
AN EMPIRICAL TEST OF ROLE THEORY IN THE
RELATIONSHIP BETWEEN WIDOWHOOD AND LIFE
SATISFACTION
S.Hye Lim, H.Jun, S.Joo, S.Kim, Yonsei University, Seoul,
Korea (the Republic of)
The purpose of this study was to test the social role theory
in terms of widowhood transition among individuals in mid-
dle and later life. In this study, there were two approaches.
One was the inter-comparison approach between mar-
ried and widowhood individuals. The other was the intra-
comparison between pre-widowhood and post-widowhood
within individuals. For the analyses, data collected across the
years 2006 to 2012, from the 1st to 4th wave of the Korean
Longitudinal Study of Aging was utilized. The sample was
individuals over 45-years-old and who experienced widow-
hood transition once or who stayed married (N=5,735). The
dependent variable was life satisfaction. The independent
variable was widowhood status as time-varying dichoto-
mous variables. Utilizing the STATA program, the pooled
model and the Fixed Effect model were analyzed. In the
pooled model, the differences in life satisfaction between the
married and the widowed were significant. In other words,
widowhood individuals showed lower life satisfaction than
the married. In the fixed effect model, however, widowhood
was not significantly associated with life satisfaction. These
results imply that the social role theory is not supported.
That is, it is likely that other time-invariant characteristics
among individuals may be associated with low life satisfac-
tion in the context of widowhood transition in middle and
later life. Implications and directions for future research are
discussed.
A TARGETED AND TAILORED BEREAVEMENT
INTERVENTION FOR CANCER CAREGIVERS
R.L.Utz1, L.Miller2, M.S.Caserta1, D.A.Lund1, 1.
Sociology, University of Utah, Salt Lake City, Utah, 2.
University of Utah, College of Nursing, Salt Lake City, Utah
Innovation in Aging, 2017, Vol. 1, No. S1
Current literature suggests that interventions be targeted
to those most at risk and flexible enough to accommodate
individual preferences and needs. To explore whether tailor-
ing and targeting modifies the efficacy of an intervention,
this project utilizes a sub-sample of older spousal caregivers
(median age = 64 years) who were randomized to receive
an individually-tailored 14-week bereavement intervention
(n=112) or usual care where they received only the standard
bereavement support provided by hospice (n=114). Results
from a traditional intent-to-treat model find a moderate effect
size: those assigned to the intervention had more favorable
bereavement outcomes over time compared to the control
group. Further analyses revealed that participants benefitted
from the intervention regardless of whether they chose to
receive a high or low dosage of the intervention and regard-
less of whether they were categorized as being at higher or
lower risk for adverse bereavement outcomes. Despite the
similarity in treatment effects, there was substantial variation
in how the intervention was delivered (e.g., total number of
intervention sessions ranged from 1 to 19 across individu-
als). Taken together, these findings suggest that the key to
effectively supporting older adults during a difficult life tran-
sition such as widowhood appears to be in developing an
intervention that meets ones unique needs and preferences.
As clinicians and practitioners, we should be careful to not
force support when it is not needed or wanted, but be willing
to provide high levels of support for others who may desire
it. Funded by NCI, P01-CA138317.
DOES SPOUSAL LOSS PREDICT COGNITIVE
FUNCTION? RESULTS FROM THE MEXICAN
HEALTH AND AGING STUDY.
J.Saenz, B.Downer, M.A.Garcia, R.Wong, Preventive
Medicine & Community Health, University of Texas
Medical Branch, Galveston, Texas
Background: Mortality following spousal loss has received
considerable research attention. The cognitive impacts of
spousal bereavement remain understudied. In the United
States, previous work suggests that bereavement negatively
impacts cognitive function. This has not been studied in
developing countries such as Mexico. We examine whether
widow(er)hood is associated with cognitive function among
older Mexican adults and whether this association differs by
sex and anticipatory spousal loss.
Method: We use Waves 2 (2003) and 3 (2012) of the
Mexican Health and Aging Study including married respond-
ents in 2003. Those who lose a spouse between waves are
analyzed as widow(er)s while the continuously married are
controls. Cognition is measured through verbal learning,
verbal recall, and visual scanning. Models include cognitive
function prior to widow(er)hood. Spousal loss is considered
unanticipated if ones spouse reports good health prior to
death.
Results: Recently bereaved males performed significantly
worse on verbal learning tasks, an effect that seemed to
diminish with time since widowerhood. The effect of spousal
loss on cognitive function for males was stronger when
the loss of their spouse was unanticipated (when the wife
reported good health prior to death). Spousal bereavement
did not seem to affect cognitive function for females regard-
less of anticipatory status.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Discussion: Our results echo previous work suggest-
ing that spousal loss harms cognitive function, that males
are more affected by spousal bereavement, and that ele-
vated risk seems to decline with time since widow(er)
hood. The effect of spousal bereavement on cognitive
function may be more pronounced when spousal loss is
unanticipated.
THE GENDERED EXPERIENCE OF SOCIAL
RESOURCES ACROSS THE TRANSITION TO LATE-
LIFE WIDOWHOOD
L.Isherwood, National Institute of Labour Studies, Flinders
University, Adelaide, South Australia, Australia
Widowhood in later life is a transitional event necessitat-
ing considerable change and presents differing challenges for
men and women. Social resources - close relationships, social
support exchange and opportunities for social participation -
can assist in successful adjustment to spousal loss. Using the
perspective of life course theory, this study sought to under-
stand the gendered experience of social resources during the
transition to widowhood.
Semi-structured interviews were conducted with 20 men
and women (aged between 85 and 96years) who had been
widowed in later life. Participants were asked about the
continuity and changes which had occurred in their social
resources both pre- and post-widowhood. The role that these
resources played in adjustment to spousal bereavement was
also explored. The interview data were analysed thematically
using framework analysis.
Four different phases in the transition to widowhood
were identified each with differential experiences of con-
tact with the social network, support and social par-
ticipation. Older men and women experienced different
opportunities in the accessibility and mobilisation of their
social resources in widowhood. Male participants reported
smaller social networks and received less support then
female participants during all phases in the transition to
widowhood. They also experienced fewer opportunities for
social participation and were consequently more likely to
be socially isolated. The stronger social resources possessed
by older widowed women may assist them in better meet-
ing the challenges associated with spousal bereavement.
Potential gender differences should be taken into account
in the assessment and planning of supports and services for
older widowed adults.
MENTAL HEALTH AND THE RELATING FACTORS
AMONG CHINESE OLDER ADULTS WHO LOST
THEIR ONLY CHILDREN
D.Wang1, X.Cao1, P.Yang2, R.Liu2, 1. Psychology, Beijing dont know. Aging and MMSE scores of less than 24 were
Normal University, Beijing, China, 2. Beijing Hualingyiyang
Mental Health Care Center, Beijing, China
The number of older adults who lost their only children is
increasing year by year with the implementation of the birth
control policy in mainland China. Theywould encounter not
only the pain caused by the loss of the childbut also the pres-
sure imposed by social context. However, few empiricalstud-
ies haverevealed the mental health among these vulnerable
people. This study aimed at investigating the mental health
status and the factors associated among them.
IAGG 2017 World Congress
339
The sample consisted of 116 older adults who lost
their only children (the lost group) and 100 older adults
who didnt (the contrast group) from same communities.
Participants were asked to complete a set of questionnaires
to measure child death-related factors (time and cause of
death), physical health (number of disease and self-rated
physical health), social support (satisfaction of formal social
support, participation in community activity, and marital
quality), resilience, and mental health (depression, loneli-
ness, and anxiety).
The findings revealed that,lost group reported more
depression and anxiety symptoms than contrast group and
females had more depression symptoms than males;Within
the lost group, those whose children died of accidents
showed worse mental health while those who had higher
resilience, marital quality, and better physical health reported
lower level of depression and anxiety. Community practices
should channel more resources to improve the mental health
of older adults who lost their only children. Efforts will be
significantly valuable when focusing on enhancing resilience,
physical health or marital quality of parents according to the
present study.
SURVEYING ELDERLY PATIENTS WISHES ABOUT
ARTIFICIAL NUTRITION DURING END-OF-LIFE
CARE IN JAPAN
Y.Yamaguchi1, H.Mori2, M.Ishii1, K.Yamaguchi1,
S.Iijima3, S.Ogawa1, M.Akishita1, 1. Department of
Geriatric Medicine, Graduate School of Medicine, The
University of Tokyo, Bunkyo-ku, Tokyo, Japan, 2. Nursing
Division, The University of Tokyo Hospital, Bunkyo-ku,
Tokyo, Japan, 3. Rehabilitation Services Bureau, National
Rehabilitation Center for Persons with Disabilities,
Tokorozawa-shi, Saitama, Japan
Because ambiguity is one of the prominent features
of Japanese culture, it is crucial to understand how many
Japanese elderly persons have strong wishes related to
end-of-life care. Ninety-nine consecutive inpatients aged
75years or older were enrolled in the first survey from 2012
to 2014, after excluding patients with a Mini-Mental State
Examination (MMSE) score of 20 or less. The first survey
was performed by interviewing them about their wishes
related to artificial nutrition and hydration (ANH) during
end-of-life care. For the 35 patients who had attended the
first survey, we performed the second survey from 2015 to
2016 by handing them the questionnaire comprised of the
same items as the first survey. 50.0% of the participants
were against ANH at the end stage of their lives on the first
survey. In contrast, only 5.3% wished to receive ANH. The
answers of the other patients were inconsistent or included I
significantly associated with a higher tendency to decline
from participating in the interview. However, the distribu-
tion of the interview answers was not associated with age
or MMSE scores. Interestingly, 87.5% of the patients who
had been against ANH on the first survey selected the same
answers on the second survey, while only 20.0% of the other
patients selected the same answers as the first survey. In con-
clusion, many patients did not have definite wishes in Japan.
However, most of the wishes against ANH did not change
with age.
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SESSION 820 (POSTER)
DEMENTIA AND ALZHEIMERS DISEASE II
IMPLEMENTING PHYSICAL ACTIVITIY PROGRAMS
FOR PEOPLE WITH DEMENTIA: RESULTS FROM
AGERMAN STUDY
M.Reichet, V.Wolter, FK 12, Institute for Sociology,
University TU Dortmund, Dortmund, Germany
Different studies proof the benefit of physical activity
for people with dementia and especially a holistic health
approach is an effective strategy. Feasibility and sustainabil-
ity of physical activity programs are more problematic and
often not considered, when implementing them. This pro-
ject (2014 2016)evaluated 73 local partnerships between
sports clubs and care service providers which introduced
this kind of programs for people with dementia (and their
informal carers). The evaluation comprised a multi-method
approach: (a) focus groups to analyze the needs and expecta-
tions of the two partners involved at three different times, (b)
qualitative interviews with people with dementia (n=12) and
their carers (n=20) to examine the effects of taking part in
the physical activity program and (c) analysis of the user sta-
tistics. Results of focus group discussions confirm the impor-
tance of a local network and a sustainable finance model to
ensure long-term feasibility. People with dementia and their
carers emphasize that the experience of social support, fun
and break from their daily life routine are the most relevant
reasons for participation. Instead, time, place and kind of
physical activity are of less importance. The key factor for a
successful implementation of physical activity programs or
for achieving positive effects for people with dementia and
their carers is besides other favorable framework condi-
tions a local community network which involves all actors
mentioned above. These actors, they are all experts in a par-
ticular way, must have the willingness for communication
and cooperation in order to complement each other.
THE POSSIBILITY OF COUPLES LIFE STORY PROJECT
REDUCING CAREGIVERS BURDEN
M.Ito1, R.Campbell4, A.Kan1, N.Miyamoto2, significantly associated with stimulation specificity (how the
S.Tsuboyama2, Y.Kurokawa3, 1. Human Care Research
Team, Tokyo Metropolitan Institute of Gerontology,
Itabashi-ku, Tokyo, Japan, 2. Keiseikai institute of
Gerontology, Tokyo, Japan, 3. Sophia University, Tokyo,
Japan, 4. University of Michigan, Ann Arbor, Michigan
In Japan, the older population is growing rapidly and it is
estimated that the number of person with dementia will be
7 million in 2025. Over 80% of older people say they prefer
to receive caregiving from their spouse, and a quarter of the
family caregivers are spouses in Japan. Caring for a spouse
with dementia can be very stressful and increase feelings of
burden. The couples life story method which was developed
by Ingersoll-Dayton helps couples review their life together
from the first time they met to the present using photographs
to stimulate conversation. We used couples pictures and a
life story board to conduct interviews with couples over 45
sessions lasting 1 to 2 hours each. Pre-and post-question-
naires for each spouse were used before and after the tape-
recorded sessions; a life story book was produced for each
Innovation in Aging, 2017, Vol. 1, No. S1
couple. 13 couples were included to this project. The average
age of the caregivers was 79.0(7.7), and 3 of them were
male. The average age of care receivers was 80.2(6.9), and
10 were male. The average score of MMSE was 14.2(7.1) in
care receivers. Depression and care difficulty was improved
significantly after 45 session of the couples life story pro-
ject. There was no result to show improvement of couples
relationships from statistical analysis. But some couples used
the life story book to promote their communication even
after this project. This project is recommended to couples
to improve spouse caregivers depression and care difficulty.
EATING PERFORMANCE AND ENVIRONMENTAL
STIMULATION AMONG OLDER ADULTS WITH
DEMENTIA IN NURSING HOMES
W.Liu2, Y.Jao2, K.N.Williams3, 2. University of Iowa
College of Nursing, Iowa City, Iowa, 2. Pennsylvania State
University College of Nursing, State College, Pennsylvania,
3. University of Kansas School of Nursing, Kansas City,
Kansas
Nursing home (NH) residents with dementia experience
increased risk for compromised eating performance due to
cognitive and functional decline and behavioral symptoms.
Beyond the personal factors, there is a lack of evidence
on how environmental stimulation at mealtime influence
individuals eating performance. This study examined the
association between environmental stimulation and eating
performance among NH residents with dementia. A sec-
ondary analysis was completed of 36 baseline eating videos
among 19 nursing assistants and 15 residents with demen-
tia in 8 NHs from a communication intervention study. The
dependent variable was eating performance (Level of Eating
Independence scale). The independent variables were char-
acteristics of environmental stimulation measured by the
Person-Environment Apathy Rating-Environment subscale
(stimulation specificity, interaction involvement, environ-
mental feedback). Multilevel models were used to examine
the association between eating performance and environ-
mental stimulation adjusting for resident characteristics and
nesting effects of resident and staff. Eating performance was
stimulation is delivered and tailored to residents) and was
not associated with other environmental stimulation char-
acteristics, after controlling for resident characteristics. An
environment with more specific stimulation is associated
with better eating performance. For each 1 point increase
in stimulation specificity, eating performance is increased by
8.78 points (95% CI=.59, 16.97). Environmental stimulation
that is personally tailored to residents needs and preferences
and directly offered to residents improves eating perfor-
mance among residents with dementia. The findings will
direct future development and implementation of person-
centered mealtime care programs and dinning environment
arrangements for residents with dementia in NH settings.
PERSONALITY TRAITS AND RISK OF COGNITIVE
IMPAIRMENT AND DEMENTIA: NEW DATA AND
META-ANALYSIS
A.Terracciano, Geriatrics, Florida State University,
Tallahassee, Florida
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Personality traits are relevant risk factors for dementia
because of their widespread impact on individuals behav-
iors, lifestyle, and health. We investigated the association
between personality traits and risk of cognitive impairment
and dementia in a large prospective cohort and in a meta-
analysis of the literature. We also tested whether personality
traits predict the risk of conversion from cognitive impair-
ment to dementia. Participants were drawn from a national
prospective study (N = 13,882), the largest and most rep-
resentative sample to date to test the association between
personality and dementia. Participants completed a brief five
factor model personality measure and their cognitive status
was tracked for up to 8 years and classified into normal,
cognitive impairment not dementia (CIND), and dementia
groups. With Cox regression analyses we found that scor-
ing lower on conscientiousness and higher on neuroticism
was associated with increased risk of incident CIND and
dementia (p < 0.001). Low agreeableness was also associated
with dementia risk (p < 0.001). The association of personal-
ity with risk of dementia remained significant after adjust-
ing for age, sex, education, race, ethnicity, smoking, physical
activity, obesity, diabetes, hypertension, cholesterol, HDL,
Cystatin C, CRP, and Hemoglobin A1c. Among individuals
with CIND at baseline, we found that conscientiousness was
a significant predictor of conversion to dementia (p=0.030),
but there was only a non-significant trend for neuroticism.
The meta-analysis of 7 prospective studies (N = 16,311)
found consistent evidence that conscientiousness, neuroti-
cism, agreeableness, and to a lesser extent openness, are asso-
ciated with risk of dementia.
IT TAKES TWO TO CARE: LESSONS LEARNED WHILE
ENGAGING WITH EARLY-STAGE DEMENTIA DYADS
G.Stockwell-Smith3,1,2, W.Moyle3,1, U.Kellett3,1, 1. Menzies tions and non-pharmacological pain treatments in terms of
Health Institute Queensland, Griffith University, Camp Hill,
Queensland, Australia, 2. Queensland Health, Southport,
Queensland, Australia, 3. Menzies Health Institute
Queensland, Nathan, Queensland, Australia
This presentation reports on the recruitment and imple-
mentation stages of a community based early-interven-
tion support model for older people with Mild Cognitive
Impairment (MCI)/early-stage dementia and their caregivers
(the dementia dyad, n=96). Detailed records on non-partici-
pation and withdrawal reasons were maintained throughout
the study, and intervention acceptability was evaluated using
a mixed method analysis. The study findings highlight some
key issues regarding the acceptability of early intervention/
forward planning approaches to people dealing with a pro-
gressive incurable condition. Public impressions of dementia
heavily influenced dyad participation in the study, with nearly
half (45%) of those who initially expressed interest abstain-
ing. A significant barrier to participation was inter-dyadic
disagreement, commonly related to one members apprehen-
sion over involvement in a study for people with demen-
tia. Stigma continued to have an impact post-recruitment.
Two dyads in the intervention group and one in the control
group withdrew from the study because they found talking
about dementia and associated deficits confronting. Among
intervention group dyads that completed the intervention
(n=35), the majority of dyads (75%) stated they felt better
informed and identified tangible actions taken to plan for the
IAGG 2017 World Congress
341
future. Akey challenge in intervening early with people with
dementia is how to refute stigma myths and accommodate a
positive perspective to adjustment to declining function. The
significant impact that stigma has on the decision to engage
in research activities associated with dementia may prove
insurmountable, until dementia treatment options improve.
IMPLEMENTING OBSERVATIONAL PAIN
MANAGEMENT PROTOCOL FOR PAIN
MANAGEMENT OF RESIDENTS WITH DEMENTIA
J.Liu1,2, C.K.Lai1,2, 1. The Centre for Gerontological
Nursing, Hong Kong, Hong Kong, 2. The School of
Nursing, The HK Polytechnic University, Hong Kong, Hong
Kong
Objective: To investigate whether the implementation of
the Observational Pain Management Protocol (Protocol) can
improve pain management for nursing home residents with
dementia.
Design: Atwo-group, single-blinded, cluster-randomized
controlled trial
Participants: 128 recruited residents with advanced
dementia and pain-related diagnoses from 17 nursing homes
were allocated to either the control or the experimental con-
ditions based on the randomized group allocated to their
home.
Interventions: The Protocol, which includes assessing,
interpreting, and verifying the participants observed pain
scores, initiating pain-relieving interventions according to the
observed pain scores, and reassessment, was implemented in
the experimental homes for 12 weeks to guide the pain man-
agement of the participants. Meanwhile, the control homes
continued to employ their usual pain management strategies.
Measurements: These included the use of pain medica-
types and frequency, as well as the participants observa-
tional pain scores (assessed by Chinese-Pain Assessment IN
Advanced Dementia).
Results: Asignificant increase in the frequency (95% CI:
-0.13 to -0.09, p<0.01) and type (95%CI: -0.05 to -0.02,
p<0.01) of non-pharmacological interventions used was seen
in the experimental homes in comparison with the control
homes. However, no statistically significant difference in the
use of pain medications was observed. A significant reduc-
tion in the observational pain score (95% CI: -0.26 to -0.17,
p<.001) was obtained only in the experimental home.
Conclusion: This study supports the view that the
Protocol is of clinical utility in enhancing the use of non-
pharmacological pain-relieving interventions among resi-
dents with advanced dementia, leading to a reduction in their
observational pain-related behaviors.
QUALITY IS PERSONAL: NEGOTIATING CHOICE
AND RISK IN COMMUNITY BASED DEMENTIA CARE
D.P.Goeman1,2,3, M.Dickins1, F.OKeefe1, 1. RDNS
Institute, RDNS, St Kilda, Victoria, Australia, 2. The
University of Newcastle, Newcastle, New South Wales,
Australia, 3. Monash University, Melbourne, Victoria,
Australia
With a growing population of people with dementia living
at home, practitioners working in the community are faced
with the challenge of delivering services that provide control
342
and reflect the choices of this high risk population. The bal-
ance between providing older people with the opportunity
to be active partners in their care and ensuring that they are
not at risk is a difficult one, however it is imperative that we
understand the issues that are important to each older person
and act accordingly. Despite this, there are currently no gold
standard guidelines to assist community health professionals
in providing services that address client choices while mitigat-
ing risk. This presentation will detail the findings from a study
that explored the issue of safety and risk in dementia care, and
the creation of a tool that allows health professionals, clients
and carers to negotiate the risk to the client. Interviews were
used to explore the perceptions of healthy older people, older
people with dementia, carers, health professionals and repre-
sentatives of a community health service organisation. Using
case studies from the data, this presentation will report on the
development and acceptability of a tool and whether it allows
health professionals, clients and carers to negotiate risk while
ensuring that clients are active partners in their care.
POSITIVE EXPERIENCES IN DEMENTIA
C.Smits1, E.Dusee2, L.Groen - van de Ven1, 1. Windesheim
University of Applied Sciences, Zwolle, Netherlands, 2.
University of Utrecht, Utrecht, Netherlands
The negative image of dementia hampers empowerment
and positive health in persons with dementia, their caring
relatives and care professionals. Two pilot projects aim to
highlight any positive aspects of living with dementia.
The first project used interviews with five family carers
and two persons with dementia. Analyses of the interview
transcripts involved content analyses.
The second project expanded on the findings of the first.
It involved a multiple case study including four cases (each
involving a person with dementia, family carer and care pro-
fessional). The family carers were invited to take photographs
of positive daily aspects (cultural probe). All 12 case mem-
bers were interviewed, using the photographs as prompts.
Interview transcripts were analysed within and cross cases.
The findings of the first project show that the positive
experiences of persons with dementia and carers involved
social contacts, positive life attitude, meaningful and pleas-
ant activities and daily events, positive management of
dementia, personal growth and satisfaction as carer, and a
pleasant environment.
The analyses of the second study show that all three par-
ties report positive experiences reflected in three themes: (1)
Its the little things that matter, (2) being surrounded by loved
ones, and (3) life is what you make of it.
We conclude that people with dementia, their informal
and professional carers have positive experiences relating
to the enjoyment of small things in life and meaningful and
pleasant social interactions. These insights may be used to
design educational interventions for the general public and
professionals and contribute to a dementia-friendly society.
DISCLOSING RISK FOR AD: ATTITUDES AND
PERCEPTIONS IN THE GENERAL PUBLIC
J.Gooblar, Washington University in St. Louis, Saint Louis,
Missouri
Recent biomedical research has focused on early detec-
tion of Alzheimers disease (AD) pathology in people who do
Innovation in Aging, 2017, Vol. 1, No. S1
not yet have symptoms of the disease. This focus represents
a shift in current diagnostic practices from detection of cog-
nitive impairment to include detection of disease risk. The
current study examines attitudes regarding preclinical risk
detection for AD in N=581 individuals aged 1965 recruited
online using Amazons Mechanical Turk. Participants were
randomized to view an educational intervention (varying
depth of education) and viewed a videotaped disclosure of
hypothetical risk for AD to themselves (varying level of risk).
Participants also reported on several individual difference
variables (e.g., prior knowledge, experience with AD) as well
as their interest in predictive testing and subjective risk of
AD. The results of this study show that greater prior knowl-
edge and health literacy was associated with better recall of
novel information about preclinical AD. Experience with AD,
although not age, was associated with greater interest in pre-
dictive testing and higher subjective risk. Participants who
were disclosed a hypothetical diagnosis of preclinical AD and
who viewed in-depth information about the disease reported
lower subjective risk compared to participants who learned
only basic information about the disease. These findings have
implications for the development of empirically-supported
education interventions and disclosure processes for preclini-
cal AD in research settings and in clinical practice.
RLIFE: AN ONLINE PLATFORM TO SUPPORT THE
SOCIAL INTERACTIONS OF INDIVIDUALS WITH
DEMENTIA
A.Yurkewich1,2,3, V.Chenel1,4,5, C.McGrath1,6, M.Koch1,7,
J.Blumenthal1,8, A.Moreno1,5,9, 1. AGE-WELL NCE,
Toronto, Ontario, Canada, 2. Institute of Biomaterials and
Biomedical Engineering, University of Toronto, Toronto,
Ontario, Canada, 3. Toronto Rehabilitation Institute,
Toronto, Ontario, Canada, 4. School of Rehabilitation,
Faculty of Medicine, Universit de Montral, Montral,
Quebec, Canada, 5. Centre for Interdisciplinary Research
in Rehabilitation (CRIR), Montral, Quebec, Canada, 6.
Ontario Shores Centre for Mental Health Sciences, Whitby,
Ontario, Canada, 7. University of Waterloo, Waterloo,
Ontario, Canada, 8. Department of Mechanical and
Industrial Engineering, University of Toronto, Toronto,
Ontario, Canada, 9. McGill University, Montral, Quebec,
Canada
Social connectedness and participation in meaningful
activities can help individuals with dementia maintain a sense
of belonging, stay independent at home longer, slow cogni-
tive decline, increase life satisfaction, and promote aging in
place. However, there is a lack of consolidated resources to
support individuals with dementia with the fulfillment of
their social needs after a dementia diagnosis. There are some
websites and online information boards to support individu-
als with dementia; however, the amount of information can
be overwhelming because it is not adapted to their needs.
The demand to increase and facilitate social connectedness
for individuals with dementia encourages the development
of solutions tailored to this population. The objective of
this work is to develop a prototype of an online platform
to Reconnect individuals with mild to moderate dementia
to Life, through social Interaction and Fulfilling Experiences
(rLifeTM). Using a transdisciplinary approach, a proto-
type was co-created based on the information provided by
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
different stakeholders (i.e., individuals with dementia, clini-
cians, technicians, engineers, family caregivers, and research-
ers). We first identified areas for social interaction and
translated them into the conception of a matching algorithm
aimed at connecting individuals with dementia to personal-
ized opportunities tailored to their needs, values and prefer-
ences. We then defined a non-profit model of operation that
utilizes partnerships with dementia-focused organizations to
ensure the sustainability of the platform. Future directions
include developing the services offered on the platform, and
designing and testing the user interface with individuals in
our target population.
EVALUATION OF THE MEETING CENTER SUPPORT
PROGRAMME FOR PEOPLE WITH DEMENTIA AND
THEIR FAMILY CARERS
S.Evans5, D.Brooker5, R.Droes1, F.Meiland1, Specifically, veterans and caregivers averaged: 15 telephone/
J.Rymaszewska2, D.Szczesniak2, R.Chattat3, E.Farina4, 1. computer contacts over the 12 months; 9 and 3 triggered
VU University Medical Center, Amsterdam, Netherlands,
2. Wroclaw Medical University, Wroclaw, Poland, 3.
University of Bologna, Bologna, Italy, 4. Fondazione Don
Carlo Gnocchi, Milan, Italy, 5. University of Worcester,
Worcester, United Kingdom
The Meeting Centre Support Programme (MCSP) is a
community-based approach to supporting people with mild
to moderate dementia and their families, developed in the
Netherlands where they are now widespread. Evaluation
studies showed benefits including reduced behavioural and
mood problems, delayed admission to residential care, higher
levels of carer competence and lower levels of burden. The
JPND funded MeetingDem project aimed to implement and
evaluate Meeting Centres in the UK, Italy and Poland.
Our evaluation adopted a before and after control group
design with matched patient-carer dyads. In each country we
compared a minimum of 25 dyads using the MCSP with 25
receiving usual care. Baseline data were collected at month 1
with a follow up at month 7.Validated measures were used
to assess quality of life, depression, social support and car-
egiver competence. Data were also collected on intervention
costs and the use of other services in order to allow a cost-
effectiveness analysis. Finally, surveys and focus groups were
used to evaluate user satisfaction with the MCSP.
Initial findings suggest significant effects for MCSP com-
pared to usual care, including reduced behavioural prob-
lems and improved caregiver coping. This presentation will
describe the MCSP approach, present the full evaluation find-
ings and consider the potential for wider implementation.
FINDINGS FROM AREAL-WORLD TRANSLATION
STUDY OF THE EVIDENCE-BASED PARTNERS IN
DEMENTIA CARE
D.M.Bass1, B.Primetica1, K.Kearney1, K.McCarthy1, adjusted AD death rate per 100,000 population significantly
J.H.Rentsch1, M.Kunik2, J.Miller3, T.Hornick4, 1. Center increased by 54.5% from 16.5 (44,536 deaths) in 1999 to
for Research and Education, Benjamin Rose Institute on
Aging, Cleveland, Ohio, 2. Houston VA Health Services
Research and Development Center of Excellence, Houston,
Texas, 3. Greater East Ohio Alzheimers Association
Chapter, Canton, Ohio, 4. Louis Stokes VA Medical Center,
Cleveland, Ohio
Numerous non-pharmacological programs for per-
sons with dementia and family caregivers have been found
IAGG 2017 World Congress
343
efficacious in randomized controlled trials. However, few
programs have been tested in translation studies to assess
feasible and outcomes in less-controlled, real-world imple-
mentations. This translation study of the partnership ver-
sion of BRI Care Consultation, Partners in Dementia Care
(PDC), tested feasibility and outcomes, when delivered via
partnerships between Stokes VA Medical Center, Greater
East Ohio Alzheimers Association Chapter, and Western
Reserve Area Agency on Aging. The sample was 200 north-
east Ohio veterans with dementia and their family caregiv-
ers. Data came from the computerized program record
and research interviews with caregivers, and veterans who
were able. Interviews were conducted before enrollment
and 12-months later. Record data showed the program was
feasible for regular employees of partnering organizations,
with high-levels of fidelity to the evidence-based protocol.
problems in the initial assessment, respectively; and over 11
behavioral action steps to address triggered problems. Similar
to past controlled studies, repeated measures ANOVA of pre-
post data showed significant changes in various outcomes,
especially when veterans were more impaired. Caregivers
had significant improvements in: confidence, isolation,
physical health strain, unmet needs, informal support, and
support service use. Veterans had significant improvements
in: embarrassment about memory problems, unmet needs,
informal support, and community service use. Encouraging
translation-study findings are being used to engage VAs,
health systems, and community agencies in discussions about
organizational partnerships to deliver PDC.
DEATHS FROM ALZHEIMERS DISEASEUNITED
STATES, 19992014
C.A.Taylor1, S.Greenlund2, L.C.McGuire1, H.Lu1,
K.Greenlund1, J.B.Croft1, 1. Centers for Disease Control
and Prevention (CDC), Atlanta, Georgia, 2. Georgia State
University, Atlanta, Georgia
Alzheimers disease (AD) is the sixth leading cause of
deaths in the US. Mortality is important to examine because
persons with AD might live several years with adverse
health effects which places a heavy burden on patients, their
families, caregivers, and community. US AD mortality data
has been presented at the state level but not counties. We
examined AD deaths at national, state, and county levels.
Mortality data for 1999 through 2014 from the Centers
for Disease Control and Prevention Wide-ranging Online
Data for Epidemiologic Research was examined to generate
state- and county-level AD statistics. AD was defined using
International Classification of Diseases, Tenth Revision
underlying cause-of-death codes G30.x. Nationally, the age-
25.4 (93,541 deaths) in 2014. Significant increases occurred
across the same period for all age groups, sexes, and race
and Hispanic origin categories. From 1999 to 2014, AD
death rates significantly increased for 41 states and DC.
Only one state had a significant decrease in age-adjusted AD
deaths (Maine). County-level age-adjusted death rates were
aggregated for 20052014 to improve stability and ranged
from 4.3 to 123.7 per 100,000. Counties with the highest
344
age-adjusted rates were primarily in the South with addi-
tional areas in the Midwest and Pacific Northwest. Increases
in the number of AD deaths might be because of improved
diagnostic capabilities and improved public knowledge
encouraging patients and families to seek a diagnosis or care
when symptoms appear.
EFFICACY OF SCHEDULED ACTIVITY ON
CIRCADIAN RHYTHMS IN PERSONS WITH
DEMENTIA: HEALTHY PATTERNS TRIAL
N.A.Hodgson, Biobehavioral Health Science, University of
Pennsylvania School of Nursing, Cherry Hill, New Jersey
sOver 60% of persons with dementia experience dis-
ruptions in sleep wake patterns associated with circadian
rhythm disorders. This pilot trial tested whether the Healthy
Patterns behavioral intervention demonstrated efficacy in
reducing symptoms of circadian rhythm disorders in home
dementia patients with sleep disorders. A prospective, two
group controlled trail randomized 33 persons with demen-
tia and their family caregiver (dyads) to treatment or atten-
tion control conditions. Dyads were interviewed at baseline
and10days (trial endpoint). Sleep parameters were collected
via caregiver report and actigraphic measures. The 4 session
intervention involved a cognitively-engaging activity in the
morning, a physically-engaging activity in the afternoon and
a sensory based activity in the evening. At 10days, compared
to controls, intervention participants were more likely to
experience improvements in wakefulness after sleep onset
(62% improved versus 20% improved; p.042) and improve-
ments in number of night awakenings (69% improved ver-
sus 20% improved; p=.021). Total sleep time improved in
the intervention but not the control group. Results suggest
clinically-relevant benefits in sleep parameters associated
with circadian rhythm disorders in home-dwelling persons
with dementia. Routinizing the day based on circadian needs
into a predictable but engaging schedule may reduce dis-
rupted sleep cycles and may have future potential for scaling
the intervention for adult day care or other dementia care
settings.
A SOCIAL ROBOT CALLED PARO AND ITS EFFECT
ON PEOPLE LIVING WITH DEMENTIA
W.Moyle1, E.R.Beattie2, B.Draper4, D.Shum1, L.Thalib3, The secondary outcome measures were apathy, other neu-
C.Jones1, 1. Menzies Health Institute QLD, Griffith
University, Brisbane, Queensland, Australia, 2. Queensland
University of Technology, Brisbane, Queensland, Australia,
3. Qatar University, Qatar City, Qatar, 4. UNSW, Sydney,
New South Wales, Australia
Apathy, agitation, loneliness and depression are common
behavioral and psychological symptoms of dementia (BPSD).
These symptoms can make life distressing for the person
with dementia and can also make it challenging for care
staff to meet the needs of the person. In recent years, social
robots have been used as a means to reduce BPSD. However,
to date, studies have mostly been descriptive or had small
samples. This paper presents a cluster-randomized controlled
trial with three treatment groups: a robotic animal (PARO),
a non-robotic animal (Plush-Toy), and usual care (control).
Older people (n=415) with a diagnosis of dementia and liv-
ing in long-term care participated in the trial. The interven-
tion consisted of three individual 15-min non-facilitated
Innovation in Aging, 2017, Vol. 1, No. S1
sessions with PARO or Plush-Toy per week for a period
of 10 weeks. This allowed both short-term (5-weeks) and
long-term follow-up (10-weeks), and sustainability follow-
ing withdrawal of intervention (15-weeks). Interim analysis
found the majority of participants were female (n=314), with
a diagnosis of Alzheimers disease (n=148), a mean age of
84.9years and a mean CMAI-SF score of 30.13/70. PARO
group experienced significantly higher pleasure than control
(p<.0005) and Plush Toy (p<.005) at end of treatment. Both
verbal (p<.0005) and visual (p<.0005) engagement were also
significantly higher in the PARO condition. The majority
of participants enjoyed the opportunity to spend time with
PARO. This presentation outlines what we have learnt to
date about the impact of PARO through the secondary out-
comes of interest sleep duration and activity (step count
-Sensewear).
INTEGRATIVE COGNITIVE BEHAVIOR THERAPY
FOR PEOPLE WITH MILD ALZHEIMERS DISEASE:
RESULTS OF AN RCT
S.Forstmeier1, A.Maercker2, E.Savaskan3, T.Roth3,
1. Institute of Psychology, University of Siegen, Siegen,
Germany, 2. University of Zurich, Zurich, Switzerland, 3.
Psychiatric University Hospital Zurich, Zurich, Switzerland
About 90% of all mild Alzheimer dementia (AD) cases
experience neuropsychiatric symptoms. Although some
research has supported the effectiveness of specific psycho-
therapeutic approaches for mild AD, there are only few
attempts to evaluate a multi-component treatment pro-
gramme. This randomized controlled trial evaluates the effect
of an integrative psychotherapy approach on the health of
patients with mild AD and their caregivers. It consists of 25
weekly sessions, including eight modules: goal setting; psy-
choeducation; engagement in pleasant activities; cognitive
restructuring; live review; behavior management; interven-
tions for the caregiver; and couples counselling. 50 partici-
pants and their caregivers have been randomized to either
the CBT-based intervention group (CBT) or to the control
group, which received treatment-as-usual (TAU). Before and
after the treatment phase, participants have been assessed.
Follow-ups took place at 6, and 12months post-treatment.
The primary outcome was depression in the patient with AD.
ropsychiatric symptoms, functional abilities, quality of life,
and quality of the relationship to the caregiver. CBT reduced
depression significantly more than TAU (interaction: F=5.3,
p < .05), with a moderate-to-large effect size (d = 0.76).
There were also a significant advantage for CBT with regard
to apathy (F=4.7, p <.05; d=0.71) and quality of the rela-
tionship to the caregiver (F=4.3, p <.05; d=0.77). There
was no advantage with regard to other neuropsychiatric
symptoms, functional abilities, and quality of life. The results
are very encouraging and stimulate an adequately powered
multi-center-study.
PREVENTING LOSS OF INDEPENDENCE THROUGH
EXERCISE IN PERSONS WITH DEMENTIA IN THE VA
(PLI-VA)
D.E.Barnes2,1, J.Lee2,1, M.A.Chesney2,1, K.Yaffe2,1,
G.Abrams2,1, W.Mehling2,1, 1. Psychiatry and
Epidemiology & Biostatistics, University of California, San
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Francisco, San Francisco, California, 2. San Francisco VA
Medical Center, San Francisco, California
We have recently developed a novel, multi-modal,
group movement program for people with dementia called
Preventing Loss of Independence through Exercise (PLI)
that is grounded in neuroscience and focuses on abilities that
are relatively well-maintained (procedural memory, mindful
body awareness, social connection). This randomized, con-
trolled trial (N=120) compares PLI to a waitlist control
group for its effects on physical and cognitive function, qual-
ity of life and caregiver burden. Study sites are adult day cent-
ers that contract with the Veterans Health Administration.
Inclusion criteria are mild-to-moderate dementia, English flu-
ency and ability to participate in intervention activities. Study
participants are randomly assigned to Group1 or Group2
in blocks (20/site, 6 sites). Group1 participates in PLI for
1 hour, 23days/week for 4months while Group2 is placed
on a waitlist. Then Group2 participates in PLI for 1 hour,
23 days/week for 4 months. Assessments are performed
at baseline, 4 and 8 months. The co-primary outcomes are
change in physical performance (Short Physical Performance
Battery), cognitive function (Alzheimers Disease Assessment
Scalecognitive subscale), and quality of life (Quality of Life
in Alzheimers Disease) for affected individuals and caregiver
burden (Caregiver Burden Intentory) for caregivers. We
have completed site 1 with 19 enrolled and 13 completed
(7 Group1, 6 Group2). Withdrawals were due to unrelated
medical conditions and disease progression. Qualitative data
to date suggest noticeable improvements in ability to sit and
stand, articulate thoughts, and share experiences with others.
Quantitative data collection is ongoing.
EFFECTS OF DANCE MOVEMENT INTERVENTION
AND EXERCISE ON ELDERLY WITH EARLY
DEMENTIA
R.Ho1,4,6, T.Fong1, T.Hon1, B.Li4, W.Chan2, J.Kwan3,
P.Chiu3, L.Lam5, 1. Centre on Behavioral Health, The
University of Hong Kong, Hong Kong, Hong Kong, 2.
Department of Psychiatry, The University of Hong Kong,
Hong Kong, Hong Kong, 3. Department of Medicine,
The University of Hong Kong, Hong Kong, Hong Kong,
4. Department of Social Work and Social Administration,
The University of Hong Kong, Hong Kong, Hong Kong, 5.
Department of Psychiatry, The Chinese University of Hong
Kong, Hong Kong, Hong Kong, 6. Sau Po Center on Aging,
The University of Hong Kong, Hong Kong, Hong Kong
Dementia is marked by progressive deteriorations in
memory, spatial navigation and language functioning and
disturbances in daily functioning. Non-pharmacological
interventions target cognitive impairments, prognosis and
psychosocial effects of dementia. Dance-movement interven-
tion (DMT) and physical exercise have shown benefits in
cognitive functioning and emotional and social support in
dementia. The present study is an ongoing randomized con-
trolled trial (RCT) that investigates the effects of DMT and
exercise on physical and psychological well-being of Chinese
elderly. The target sample size was 201 elderly with early
dementia. Participants were randomized into three groups: (i)
DMT, (ii) exercise, and (iii) waitlist-control group. The two
intervention groups received an 1-hour intervention, twice
a week, for 12 weeks. The participants were assessed before
IAGG 2017 World Congress
345
randomization, post-intervention (3-month), at 6-month
and 12-month. Primary outcomes included neuropsychiatric
symptoms, psychosocial well-being, cognitive functioning,
and daily functioning. So far, 114 participants have been
recruited and randomized into the three arms. The majority
of them were female (76.9%) with mean age of 80.6years
old (SD=7.1). The study is on-going and preliminary analy-
sis on data in 30 participants who have finished post-inter-
vention assessment showed a positive trend in improvement
in physical function and positive emotions. Depression was
not improved in DMT group but the other groups deterio-
rated. Changes were not statistically significant due to the
current small sample but trends aligned with clinical obser-
vation. Presentation will focus on the intervention model
and more data will be shown. This study is supported by
the General Research Fund, Research Grants Council (GRF/
HKU17402714H).
GAMIFICATION OF DEMENTIA EDUCATION IN
ACUTE CARE
D.Bohl2, L.Hung1, J.Tabamo2, S.Sandhu3, S.Vajihollahi3,
1. Nursing, University of British Columbia, Vancouver,
British Columbia, Canada, 2. Vancouver General Hospital,
Vancouver, British Columbia, Canada, 3. Langara College,
Vancouver, British Columbia, Canada
Background: About 40% of older people in general hospi-
tals have dementia, and evidence showed that hospitalization
has detrimental effects on people with dementia. Hospital
leaders are challenged to engage staff in change of attitudes,
knowledge and culture to meet the changing needs of patient
population. This poster presents a project of using gamifica-
tion to achieve the goal of motivating staff engagement and
passion to improve care of patients with dementia.
Methods: We used qualitative methods to investigate the
benefits and challenges of using gamification in staff educa-
tion for dementia care. Gamification refers to applying game
thinking to non-game context to make learning more exciting,
fun and effective. Our intervention focused on game dynam-
ics such as receiving rewards, recognition, social experience
and appreciation. Staff received surprise prizes when they
completed various games in two fun fairs. These included
virtual badges, recognition from clinical leaders and points
redeemable for prizes. The fun fairs were videotaped, and the
video data were co-analyzed by staff and the researchers in
focus groups. Thematic analysis was conducted.
Results: The results of the education intervention included
three themes: (a) games reinforced previous learned knowl-
edge in dementia care; (b) healthy competitions among staff
created fun learning experiences; (c) collective learning
inspired commitment to actions.
Conclusion: Our findings suggest that gamification could
tap into both extrinsic and intrinsic motivations and has
potential to increase sustained staff behavioural change.
OF SOUND MIND: USING PUBLIC ACCESS TV
FOR COMMUNITY OUTREACH AND TO RAISE
DEMENTIA AWARENESS
A.C.Bilbrey1,2, F.T.Bockmann3, N.Askari2,1, D.Gallagher-
Thompson1,2, 1. Psychiatry & Behavioral Sciences, Stanford
University School of Medicine, Sunnyvale, California, 2.
346
Stanford Alzheimers Disease Research Center, Stanford,
California, 3. MidPen Media Center, Palo Alto, California
Every day, Americans spend on average 2.8 hours watch-
ing television (TV). After retirement, the time spent watching
TV increases. Public-access television (PATV) is a non-com-
mercial media where the general public can create content
programming, which is shown through cable TV specialty
channels. While there is limited marketing research on the
audiences of PATV, Chen and colleagues (2013) found PATV
remains relevant, especially for underprivileged populations
who have been shown to rely on TV to gather information
on health concerns. In a 2009 survey of Spanish speakers
in Baltimore City, 82.4% obtain their health information
through TV. While abundant information concerning demen-
tia exists for those with access to the internet, there is lim-
ited approachable information available through the TV. Of
Sound Mind was designed to address multiple needs, includ-
ing the need for accurate, research-based information about
dementia and healthy cognitive aging, which can be scarce
on most TV programming. The development of a public
access talk show can be split into production and content.
Production will contain the steps needed to produce a talk
show, including securing a partnership with a local public
access studio. Content describes the material being covered,
guest recruitment, and establishing credibility. The direct
and indirect benefits for the organization producing the talk
show are explored. With the inability to gain direct viewer-
ship numbers, methods of determining success are reviewed.
Finally, the future plans for Of Sound Mind are discussed.
SESSION 825 (POSTER)
DEMENTIA II
PARTICIPATION OF PEOPLE WITH DEMENTIA IN
DEVELOPING AN INTERACTIVE WEB TOOL
M.Span1, M.Hettinga1, L.Groen - van de Ven1,
J.Jukema1, R.Janssen1, M.Vernooij-Dassen2, J.Eefsting3, risk was found in separate analyses of men and women. No
C.Smits1, 1. Windesheim University of Applied Sciences,
Zwolle, Netherlands, 2. Radboud University, Nijmegen,
Netherlands, 3. Zonnehuis groep IJssel-Vecht, Zwolle,
Netherlands
Involvement of people with dementia is not self-evident.
The aim of this study was to gain insight into the ways in
which people with dementia participated in developing the
DecideGuide, an interactive web tool facilitating shared deci-
sion-making in their care networks.
An explanatory case study design was used when devel-
oping the DecideGuide. Asecondary analysis focused on the
data gathered from the participating people with dementia
during the development stages: semi-structured interviews
(n=23), four focus groups with a total of 18 participants,
three usability tests, and a pilot study with 4 participants.
Framework analysis was applied to the data.
People with dementia participated especially as inform-
ants and advisors in most phases of the development. Four
themes proved to be important regarding the impact of the
participation by people with dementia: influence on content
and design of the DecideGuide, motivation to participate,
Innovation in Aging, 2017, Vol. 1, No. S1
time investment, and the balance between challenge and
concern.
People with dementia can give essential feedback and,
therefore, their contribution is valuable. Other roles than
informant and advisor need to be explored. Significant par-
ticipation of people with dementia takes time that should be
taken into account. It is important for people with dementia
to be able to reciprocate the efforts others make and to feel
of significance to others.
GENDER, PSYCHOTROPIC DRUG USE AND
MORTALITY IN OLDER PEOPLE WITH DEMENTIA
G.Bostrm, J.Brnnstrm, E.Rosendahl, P.Nordstrm,
H.Littrand, H.Lvheim, Y.Gustafson, Ume University,
Ume, Sweden
Psychotropic drugs are commonly prescribed to older
people with dementia and have been associated with
increased mortality. Behavioral and psychological symptoms
of dementia, prescription patterns of psychotropic drugs,
and adverse effects from these drugs seem to differ by gen-
der. However, gender differences in mortality risk have not
previously been analyzed. Associations between mortality
risk and baseline use of antipsychotics, antidepressants, and
benzodiazepines were analyzed among people with dementia
65 years. Participants (n=1037) from four cohort studies
were included and followed for 2years. Cox proportional-
hazard regression models were used to analyze associations
and gender differences adjusted for confounders. None of the
psychotropic drug classes were associated with 2-year mor-
tality in fully adjusted models. Significant gender differences
were found in association between mortality risk and antide-
pressant use (P=0.047). When analyzed separately, a reduced
risk was found in men, but not in women (hazard ratio [HR]
0.61, 95% confidence interval [CI] 0.400.92 and HR 1.09,
95% CI 0.871.38, respectively). Significant gender differ-
ences were also found in associations between mortality risk
and benzodiazepine use (P=0.029), with a relatively higher
mortality risk in men compared with women. However, no
gender differences were found in mortality risk associated
with antipsychotic use.
In conclusion, baseline use of antipsychotics, antide-
pressants, or benzodiazepines may not be independently
associated with increased mortality risk in older peo-
ple with dementia. Gender may moderate the mortality
risk associated with baseline use of antidepressants and
benzodiazepines.
LATENT CLASSES OF DEMENTIA COURSE SHOW AN
OPTIMISTIC PROGNOSIS FOR THE MAJORITY OF
PATIENTS
M.Haaksma1, J.Leoutsakos2, M.Olde Rikkert1,
R.J.Melis1, 1. Radboudumc Alzheimer Center, Nijmegen,
Netherlands, 2. Johns Hopkins University School of
Medicine, Baltimore, Maryland
Dementia is a neurodegenerative syndrome affecting mul-
tiple aspects of life. The large heterogeneity in disease course
causes high uncertainty about patients prognosis. Patients
may live in fear of rapid cognitive decline, while in fact their
disease progresses slowly and vice versa. This study aims to
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Innovation in Aging, 2017, Vol. 1, No. S1
provide patients with an individualized prognosis by inves-
tigating trajectories of cognition and functioning simultane-
ously over time.
In the Clinical Course of Cognition and Comorbidity
study, 331 dementia patients were followed yearly from
diagnosis onwards for a maximum of three years. Cognition
was measured using the Mini Mental State Examination.
Functioning was recorded according to the Disability
Assessment for Dementia. We built a parallel-process growth
mixture model to jointly model cognitive and functional
progression and used the Bayesian Information Criterion to
assess model fit.
Three distinct classes of cognitive and functional trajec-
tories were observed: 32% of the patients showed moderate
progression speed, 12% declined rapid and 56% exhibited
slowly declining trajectories for both cognition and function-
ing over time. Cognitive and functional rates of decline were
highly correlated (r=0.86, p=0.000).
This study shows that heterogeneity in the course of
dementia could be modeled as latent classes of trajectories
and that most individuals were members of a class with sta-
ble and slow progression. This presents a more optimistic
picture of dementia progression as compared to presenting
the mean trajectory across the entire population. Relating
classmembership to baseline variables can help explain the
heterogeneity in disease progression.
PEOPLE WITH DEMENTIA AND SOCIAL ROBOTS:
BEST FRIENDS FOREVER?
M.Span, C.Smits, M.Hettinga, Windesheim University of
Applied Sciences, Zwolle, Netherlands
People with dementia want to stay at home for as long as
possible. Social robots that offer interaction and companion-
ship may help them to fulfill that wish. This study aims to
identify how social robots may help people with dementia
to stay at home longer and what these social robots should
offer. We aim to do this in co-creation with them.
Sixteen semi structured individual interviews and four
separate focus groups with eight people with dementia and
eight informal caregivers were conducted. These focused on
what is important to people with dementia, their needs in
daily life and which help they would like from social robots.
The topic list was illustrated by a video clip and photos of
two types of social robots that were presented to people with
dementia.
Results show that most people with dementia and infor-
mal caregivers are positive about the usefulness of social
robots in their home environment. Both think that social
robots can support people with dementia by providing guid-
ance in daily life. People with dementia see opportunities in
using social robots as support for their memory and in man-
aging their daily life. They expect to feel more independent
from their informal caregivers. Supportive functions men-
tioned are: helping people with dementia to structure daily
life by giving reminders for appointments and medications,
answering repetitive questions, falls detection, answering
questions on the whereabouts of a spouse, and making a
conversation. Both people with dementia and informal car-
egivers were interested to participate in further research on
social robots.
IAGG 2017 World Congress
347
ACUTE STRESS REACTIVITY LINKS TO QUALITY
OF LIFE (QOL) IN AMNESTIC MILD COGNITIVE
IMPAIRMENT (MCI)
P.Ren, A.Jacobs, F.V.Lin, University of Rochester Medical
Center, Rochester, New York
Diminished QoL is a major concern among older adults
in Alzheimers disease associated neurodegenerative pro-
cesses, such as amnestic MCI. To better assess and improve
their well-being, it is important to understand the neural
basis of QoL and factors leading to better QoL. In this case-
controlled study (MCI, n=18; healthy control (HC), n=21),
we examined the relationship between QoL and cognition-
demanding acute stress tasks, and the neural mechanism
linking these two. Acute stress tasks were the total 20-min-
ute Stroop Word Color task and Dual 1-back task. The dis-
crepancy of amplitude of low-frequency fluctuations (ALFF)
of the resting-state functional magnetic resonance imaging
administered before and after the tasks was extracted as
the neural stress reactivity. The discrepancy of psychologi-
cal valence and arousal rating was considered the psycho-
logical stress reactivity. QoL and ALFF reactivity in three
regions (anterior cingulate cortex, medial prefrontal cortex
(MPFC), and superior frontal gyrus (SFG)) significantly dif-
fered between groups. The associations of MPFC and SFGs
reactivity with QoL were not group-specific while the asso-
ciations of valence and arousal reactivity with QoL were
group-specific. Greater arousal reactivity (adaptive coping)
was associated with better QoL in HC; lower valence reac-
tivity (maladaptive coping) was associated with worse QoL
in MCI. SFG reactivity significantly mediated the association
between valence reactivity and QoL for the entire sample.
The MCI group may be more sensitive to maladaptive cop-
ing. Enhancing SFG, especially among those with MCI, may
be a way to intervene in the negative impact of maladaptive
stress regulation on QoL.
ENHANCED CARDIOVASCULAR FITNESS
ATTENUATES COGNITIVE DECLINE IN
ALZHEIMERS DISEASE
D.Salisbury, M.A.Mathiason, F.Yu, School of Nursing,
University of Minnesota, Minneapolis, Minnesota
Dementia is an endemic affecting 44.4 million people
worldwide in 2013 and will afflict 135.5 million by 2050.
Alzheimers disease (AD) accounts for 6080% of all
dementias and cannot yet be prevented, slowed, or cured.
Cardiovascular exercise training may attenuate ADs course
through its action on improving cardiovascular fitness which
in turn mediates positive changes in brain structure and
function. The purpose of this secondary data analysis was to
examine the relationship between cardiovascular fitness and
cognition in AD. Twenty-seven community-dwelling older
adults with mild-to-moderate AD completed a 6-month,
moderate intensity cycling intervention, 3 times a week in
two pilot studies. Cardiovascular fitness and cognition were
assessed using the intermittent shuttle walk test (ISWT)
and AD Assessment Scale-Cognition (ADAS-cog), respec-
tively, at baseline and 6months. Data were analyzed using
Pearsons correlation and linear regression. Adjusted for
age (79.36.9years), the 6-month change in ISWT has an
inverse relationship with the 6-month change in ADAS-cog
348
(r=-.40; p=0.04), indicating that enhanced cardiovascular fit-
ness was associated with improved cognition over 6months.
The age-adjusted linear regression was also significant
(F(2,24)=3.70, p=0.04, R2=0.24). Predicted change in ADAS-
cog=33.8 0.39 (Age) 0.88 (change in ISWT). For each Health Insurance Population-Based Database. Study results
additional meter walked in the ISWT at 6months, a partici-
pants ADAS-cog score improved 0.88 point. In conclusion,
enhanced cardiovascular fitness may be essential for cardio-
vascular exercise to attenuate cognitive decline in individuals
with AD. Future studies are needed to replicate these find-
ings and further elucidate the physiological mechanism of
exercise-induced neural protection.
PSYCHOMETRIC EVALUATION OF THE EATING
BEHAVIOR MANAGEMENT NEEDS SCALE IN NH
RESIDENTS WITH DEMENTIA
K.Lee, J.Song, Korea University, Seoul, Korea (the Republic
of)
This study reports the initial psychometric properties
of a recently developed instrument, the Eating Behavior
Management Needs Scale (EBMNS), among nursing home
residents with dementia. Using a convenient sample of
171 nursing home-dwelling Korean elders with dementia
(mean age= 84.35; mean MMSE=8.44; mean duration of
dementia=60month), preliminary version of the EBMNS con-
sisting of 31 items with 3 point Likert-type scale was evalu-
ated for content validity, criterion related validity, internal
consistency, test-retest reliability, and inter-rater reliability.
Through repeated principal component factor analysis with
oblimin rotation, the six-factor solution with 24 items for the
EBMNS was derived and it explained a total of 63.30% of
the variance. Factors were named eating behavior associated
with cognitive function problem (7 items), eating behavior
associated with physical operation and functional problem
(5 items), eating behavior associated with BPSD (4 items),
excessive eating behavior (2 items), passive eating behavior
(3 items), subject influencing factor (3 items). The criterion
related validity was established by its significant (<.001) cor-
relation with Korean Mini Mental State Examination (r=
-.564), Korean Activities of Daily Living (r= .602), Eating
Behavior Scale (r= -.626), and Edinburgh Feeding Evaluation
in Dementia Questionnaire (r= .734). Cronbachs alpha for
total items was .888 and test-retest reliability and inter-rater
reliability was r=.997, and r=.989, respectively. Although
these initial estimates of the psychometric properties of the
EBMNS are promising, caution in using the measure is war-
ranted. Therefore, we advise confirmation of these results in
an independent random sample and extension of analyses in
community samples. Correspondence to jasong@korea.ac.kr.
THE RISK OF ACCIDENTAL INJURY ADMISSIONS
AMONG DEMENTIA PATIENTS IN TAIWAN
Y.A.Huang1, C.Li2, C.Huang3, 1. Kaohsiung Medical
University, Kaohsiung City, Taiwan, 2. Rush University,
Chicago, Illinois, 3. E-Da Hospital, Kaohsiung, Taiwan
Dementia that interferes with peoples independent func-
tioning is a significant chronic condition in older adults.
In Taiwan, as the number of elderly people is increasing
rapidly, dementia has become a major public health issue.
Little is known about dementia-related accidental injuries
among Taiwanese patients. This study aimed to investigate
Innovation in Aging, 2017, Vol. 1, No. S1
differences in accidental injury admissions between peo-
ple with dementia and those without dementia. The age-
standardization admission rate ratio (ASARR) was used for
comparison. Data was obtained from Taiwans National
showed that dementia patients had lower likelihood of
being admitted due to traffic accident (ASARR=0.74),
but had higher likelihood of being admitted for acciden-
tal falls (ASARR=2.26), burns (ASARR=1.94), homicide
(ASARR=1.65), poisoning (ASARR=3.01), and submersion
and suffocation (ASARR=3.42). Dementia is a potential risk
factor for accidental injuries. The development of prevention
and intervention for dementia-related accidental injuries is
necessary in the long-term care settings and local community
organizations.
ANTICHOLINERGIC BURDEN AND DEMENTIA IN
OLDER ADULTS WITH SUBJECTIVE COGNITIVE
DECLINE
I.Naharci, U.Cintosun, A.Ozturk, H.Oztin, T.Turker,
E.Bozoglu, H.Doruk, Gulhane Military Medical Academy,
Ankara, Turkey
Data on the effect of anticholinergic burden (ACB) on
cognitive status in older adults with subjective cognitive
decline (SCD) are limited. Our aim was to study whether
ACB increases the future risk of dementia in older adults
with SCD.
The analysis was carried out on 1496 older adults. Out
of those, 109 older patients had been diagnosed with SCD at
baseline and followed up over 36months were studied. They
were divided into two groups according to cognitive status
at last visit: group Iincluded the subjects with SCD who did
not progress to dementia and group II included those who
progressed to dementia. ACB was calculated for each subject
by adding the score of each drug and classified as no or low
ACB (ACB 2)and high ACB (ACB 3).
Sixteen (13.8%) of 109 participants with baseline SCD
developed dementia. High ACB was present in 17 sub-
jects (18.1%) in group I and 8 subjects (53.3%) in group
II (p=0.003). The 7584 and 85+ age groups (HR=3.595;
CI:1.11711.574; p=0.032 and HR=12.203; CI:2.889
51.537; p=0.001, respectively), hypertension (HR=7.835;
CI:1.02060.189; p=0.048), and high ACB (HR=4.312; CI:
1.56311.899; p=0.005) were found to be possible risk fac-
tors for dementia among subjects with SCD in the univariate
model. In the final multivariate cox regression model, sub-
jects with high ACB had a 3.3-fold the risk of the develop-
ment of dementia.
High ACB is associated with an increased risk of dementia
in older adults with SCD.
ANTIPSYCHOTIC MEDICATION IN RELATION
TO NATIONAL DIRECTIVES IN PEOPLE WITH
DEMENTIA IN SWEDEN
S.Karlsson1,2, I.R.Hallberg1, P.Midlv1, C.Fagerstrm3,4,
1. Lund University, Lund, Sweden, 2. Halmstad University,
Halmstad, Sweden, 3. Blekinge Institute of Technology,
Karlskrona, Sweden, 4. Blekinge Centre of Competence,
Karlskrona, Sweden
The aim of this study was to explore trends in treatment
with antipsychotic medication in Swedish dementia care as
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
reported in the most recent empirical studies on the topic,
and to relate these trends to directives and recommendations
from national authorities. The study included two scoping
review studies and two empirical studies. The scoping stud-
ies reviewed published data in electronic databases as well as
Swedish recommendations and directives in the field. During
the past decade, recommendations have been developed
regarding antipsychotic medication in Sweden. These recom-
mendations were generic at first, but have become increasingly
specific and restrictive with time. The scoping review showed
that treatment with antipsychotic drugs varied between 6%
and 38%, and was higher in younger older persons and those
with moderate cognitive impairment and living in nursing
homes for people with dementia. Atrend towards a decrease
in antipsychotic use has been seen over the last 15years. The
empirical studies showed that the medication with antipsy-
chotics decreased from 23.4% in 2001 to 11.5% in 2007, for
older people in general as well as for older people with demen-
tia. Among older people with dementia, 10% were utilizing
antipsychotic medication, with no difference between those
cared for at home and those in nursing homes. Directives from
Swedish national authorities seem to have had an impact on
antipsychotic medication for people with dementia. Treatment
with antipsychotic medication has decreased, while other psy-
chotropic medication has increased. National directives may
possibly be even more effective, if applied in combination with
systematic follow-ups.
THE RUBBER MEETS THE ROAD: INTERACTIVE
THEATER TO PROMOTE DRIVING SAFETY FOR
PERSONS WITH DEMENTIA
D.K.Pastor5, A.L.Jones4, T.Arms5, M.Pate3, D.Tilley4, (AORs) with 95% confidence intervals (CIs) for factors asso-
B.Saypol2, 2. Theater Delta, Chapel Hill, North Carolina,
3. Alzheimers North Carolina, Wilmington, North Carolina,
4. School of Social Work, University of North Carolina
Wilmington, Wilmington, North Carolina, 4. North
Carolina Nurses Association, Raleigh, North Carolina, 5.
University of North Carolina Wilmington, Wilmington,
North Carolina
Driving safety for older adults with dementia presents a
continuing complex challenge in the community for health
care providers. More than 5 million people in the United
States suffer from dementia, and their numbers are expected
to grow. Evidence-based resources to identify and manage
driving risk in older adults with dementia do exist, but the
challenges of limited time in primary care and outpatient set-
tings can make application difficult. This innovative project,
funded by a Hartford Foundation Change AGEnts Action
grant award, focused on interprofessional work to address
the educational need for primary care professionals and fam-
ily caregivers to manage driving safety for their loved ones
with dementia. After a live interactive theater performance
in April 2016 at a medium sized public universitys College
of Health and Human Services, post-performance surveys
assessed audience members positive satisfaction with inter-
active theater as a communication strategy, as well as self-
reported knowledge, attitudes and beliefs about driving and
dementia. Using a videotape of the theater performance, the
research team produced an educational DVD to promote
continued driving safety and driving decision making for
community-dwelling persons with dementia and their family
IAGG 2017 World Congress
349
caregivers. The DVD will be widely distributed to state-
level community partners (Alzheimers North Carolina and
Nurse Practitioner Council of the North Carolina Nurses
Association), in order to guide and educate advanced prac-
tice nurses and social workers caring for this population.
This practice change project also forged new sustainable
interprofessional community partnerships among educators/
researchers and health providers caring for this vulnerable
community population.
NATIONAL TRENDS IN ANTIHYPERTENSIVE
PRESCRIBING IN OUTPATIENTS WITH DEMENTIA
IN THE UNITED STATES
E.C.Tan1,2, J.Bell2,3, C.Y.Lu4, S.Toh4, 1. Aging Research
Centre, Karolinska Institutet, Stockholm, Sweden, 2.
Monash University, Parkville, Victoria, Australia, 3.
Sansom Institute, University of South Australia, Adelaide,
South Australia, Australia, 4. Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts
This study aims to investigate national trends in outpa-
tient antihypertensive prescribing in people with dementia
in the United States between 2006 and 2012, and to deter-
mine clinical and demographic factors associated with dif-
ferent prescribing patterns. Outpatient visits by people aged
65 years with documented dementia were analyzed in
the National Ambulatory Medical Care Survey (NAMCS)
and the outpatient department component of the National
Hospital Ambulatory Medical Care Survey (NHAMCS).
Complex samples multivariate logistic regression was con-
ducted to estimate temporal trends and adjusted odds ratios
ciated with prescribing of antihypertensives, multiple anti-
hypertensives and different antihypertensive classes. There
was a statistically significant increase in the proportion of
physician visits by older people with dementia with a doc-
umented diagnosis of hypertension from 49.3% (95%CI:
41.3%57.4%) in 2006 to 55.7% (95%CI: 50.2%61.2%)
in 2012. There were non-significant increases in overall anti-
hypertensive use and the use of multiple antihypertensive
classes. Male sex was associated with a higher prescribing
of any antihypertensive (AOR 1.37, 95%CI 1.021.84) and
multiple antihypertensive medications (AOR 1.52, 95%CI
1.142.04). Black race (AOR 2.04, 95%CI 1.123.71) and
Midwest residence (AOR 2.03, 95%CI 1.462.82) were
associated with a higher prescribing of multiple antihyper-
tensive medications. In conclusion, there was an increase in
documented hypertension in physician visits by older people
with dementia from 2006 to 2012, but minimal increases in
overall antihypertensive use. Various demographic and clini-
cal factors were associated with the prescribing of antihyper-
tensives in people with dementia.
POTENTIAL THERAPEUTIC BENEFITS OF
DECREASING A PRODUCTION THROUGH BACE
INHIBITION
L.H.Gold, M.F.Egan, M.S.Forman, T.Dam, Y.Zhang,
J.T.Kost, D.Michelson, Merck & Co., Inc., Kenilworth,
New Jersey
Alzheimers disease (AD) is a devastating global epidemic
with economic and social burden. The amyloid hypothesis
350
proposes that toxic aggregation of A peptides, produced
via cleavage of Amyloid Precursor Protein by -secretase
(BACE1) followed by gamma-secretase, leads to neurode-
generation. Inhibition of BACE1 reduces A production,
and may slow progression of AD. Verubecestat, a potent
BACE1 inhibitor, has been shown to lower CSF A by as
much as 80% in healthy controls and patients with AD
after one week of once daily dosing. Based on these results,
two ongoing phase 3 studies are evaluating the ability of
verubecestat to safely delay disease progression in mild to
moderate (EPOCH NCT01739348) and prodromal (APECS
NCT01953601) AD populations. However, as amyloid
deposition takes place years before AD diagnosis, admin-
istering an anti-amyloid therapy even earlier in the disease
process, before clinical onset, may be necessary to exploit the
full potential of this mechanism. Thus secondary prevention
trials in individuals with biomarker evidence of A pathol-
ogy or genetic risk but no clinical symptoms, and primary
prevention trials, intervening before the appearance of any
pathology, have been proposed as important next steps in
testing the amyloid hypothesis. A review of learnings from
the ongoing verubecestat and other AD studies in the con-
text of addressing the methodological issues and challenges
of earlier intervention studies will be presented.
DEMENTIA DUE TO ALZHEIMERS DISEASE AND
BRAIN MORPHOMETRIC ALTERATIONS
J.C.Moriguti, S.R.Silva Filho, A.C.Santos, E.Ferriolli, AD topics (eg caregivers exhaustion, crisis situations) and at
N.K.Lima, Internal Medicine, Ribeiro Preto Medical
School of University of So Paulo, Ribeiro Preto, So
Paulo, Brazil
Introduction: Dementia due Alzheimers disease (DAD) is
a primary and progressive neurodegenerative disorder. There
are atrophy in hippocampus and other basal areas. This
work evaluated the brain morphometry of DAD patients in
all disease stages, aiming at identifying the structural neuro-
degeneration profile in every phase. Methods: DAD patients
above 60 years old (n=44) and age paired controls (n=16)
were recruited. The brain images acquired in Achieva 3T
magnetic resonance tomograph. Volumetric quantitative
data and cortical thickness measurements were obtained by
automatic segmentation using Freesurfer. The volume of
each region was normalized considering whole brain volume.
Results: Brain regions targeted by the disease during the ini-
tial stages were found to be altered until in the later stages
of the dementia. No correlation was observed between brain
cortical volume or thickness, age and years of education.
We found an association between cortical volume or thick-
ness and cognitive indexes Mini Mental State Examination
(R2<0.47), Clinical Dementia Rating and disease duration in
years (R2<0.52). Conclusion: The most affected brain regions
suffer atrophy in a linear fashion until the later stages of the
disease, what seems contrary to the hypothesized models,
which consider a faster degeneration in earlier stages. These
regions are closely related to neuronal loss and gliosis. The
cortical thickness measurements were less sensible in dif-
ferentiating the groups than cortical volume, what may be
due to the fact that cortical thickness is more dependent of
segmentation quality. These findings favor a better under-
standing of the physiopathological process in the advanced
diseases stages.
Innovation in Aging, 2017, Vol. 1, No. S1
THERAPEUTIC EDUCATION IN ALZHEIMERS
DISEASE AND QUALITY OF LIFE: THERAD
RANDOMIZED CONTROLLED TRIAL
H.Villars1, V.Gardette3,2, C.Hein1, A.Perrin1, E.de Peretti1,
A.Zueras1, B.Vellas1,4, F.Nourhashemi1,4, 1. Geriatric
department, Toulouse University Hospital, Toulouse,
France, 2. Inserm U 1027, University Toulouse III, F-31073,
Toulouse, France, Toulouse, France, 3. Department of
Epidemiology and Public Health, Toulouse, France,
Toulouse, France, 4. Inserm U 558, University Toulouse III,
F-31073, Toulouse, France, Toulouse, France
Therapeutic education is expanding in the management
of Alzheimers disease (AD) patients. However, to date, no
study has evaluated its impact on the quality of life of the
AD patient him/herself. The THERAD study is a monocen-
tric 12-month randomized controlled trial undergoing since
January 2013. 196 dyads (AD patient/ caregiver), have been
enrolled (MMSE 11 to 26, living at home and receiving sup-
port from a family caregiver), 98 in each group. The two
month length intervention was a therapeutic educational
programme, addressed to both patients (individual session)
and caregivers (group sessions) performed by a geriatric
team (geriatrician, nurse, psychologist and social worker)
specifically trained to patient education and counselling.
The first visit (M0) included the educational diagnoses
of the dyad. Between M0 and M2 the primary caregivers
received one 3 hours group sessions per week, on the main
M2, an assessment visit. The control group received routine
care. Our primary outcome is the AD patients quality of life
assessed by Logsdons Quality of Life in Alzheimers Disease
scale (QoL-AD) reported by the caregiver at two months.
Secondary endpoints are caregivers burden (ZBI), depres-
sion (GDS) and quality of life (NHP), patients behavioural
and psychological symptoms (NPI), autonomy (ADL, IADL)
and self-reported quality of life (QoL-AD). Intention to treat
analysis will be performed using linear mixed model. Final
results, at the end of 2017, may indicate if such an approach
needs to be implemented in the care of AD patients.
THE CHANGING FACE OF MCI ATWO-DECADE
COMPARISON IN OVER-65S FROM THREE AREAS OF
ENGLAND: CFAS I& II
C.Richardson1, F.Matthews1,2, B.Stephan1, L.Robinson1,
C.Brayne2, 1. Newcastle University, Newcastle Upon Tyne,
United Kingdom, 2. University of Cambridge, Cambridge,
United Kingdom
Much work on identifying individuals at high risk of
dementia has focused on the clinical concept of mild cogni-
tive impairment (MCI), which is considered to be an interme-
diate state between normal cognitive ageing and dementia.
How the population with this intermediate state has changed
over generations is unknown. This study aimed to estimate
the prevalence of MCI in the UK now, as well as investigate
any changes in MCI and mild dementia prevalence over two
decades using the identical diagnostic criteria in the MRC
Cognitive Function and Ageing Study I and II. In addition
the incidence of dementia at two years by baseline cognitive
status will also be estimated.
The aim was to define the complete population into groups
based on their cognitive states. Including all individuals in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
CFAS Iand II into no cognitive impairment, amnesic-MCI,
non-amnesic-MCI, multiple-MCI, other cognitive impair-
ment no dementia, mild and moderate dementia. Cognitive
domains from the MMSE and (in full) CAMCOG were used
to define the cognitive impairment levels.
Prevalence of each condition was modelled using age,
sex terms in logistic regression models. Many of the impair-
ment definitions have reduced in prevalence, as found with
dementia, however this was not seen consistently across all
definitions.
The incidence of dementia over two years by baseline cog-
nitive state in CFAS Iand CFAS II will be estimated together
with the change over 20years to see whether the incidence of
dementia has changed within baseline risk group. The impact
of these changes on the health of the general population will
be discussed.
SESSION 830 (POSTER)
DEPRESSION, ANXIETY, AND PERSONALITY II
WHAT CAUSES LATE-LIFE DEPRESSION?:
AQUALITATIVE STUDY AMONG DEPRESSED
IRANIAN SENIORS
M.Sadeghipour Roudsari1, M.Foroughan1, S.Nedjat2, retired; which supported the first hypothesis. Similarly, the
F.Mohammadi1, 1. University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran (the Islamic Republic
of), 2. Tehran University of Medical Sciences, Tehran, Iran
(the Islamic Republic of)
Depression is a major health problem in old age that
is closely related to cultural and social context. Studies
have shown higher prevalence of geriatric depression
in Iran. This qualitative content analysis study aimed to
explore psychosocial factors related to experience of late
life depression in Iranian older people.This is a qualita-
tive study with directed content analysis approach which
took place in Tehran, 2015. First, a systematic search in
major English and Persian data banks was performed to
develop an analysis matrix. Then, participants with most
variation in demographic characteristics were recruited
from psychiatric clinics if they met inclusion criteria
including 1)age 60 and over and 2)having depression in
the previous 6months. Six men and 6 women participated
in this study. Semi structured interviews were performed,
recorded, transcribed and analyzed according to the pre-
pared matrix, up to reaching data saturation.Analysis of
gathered data showed six main categories 1) transition
of values system,2) role changes,3) life concerns,4) inad-
equacy of social relations, 5)regrets and 6)impaired health
and function. Considering recent changes in Iranian com-
munity and family structures and impaired social rela-
tions and inadequate support in the context of physical
and social function decline, Iranian older adults have been
more Susceptible to geriatric depression. As population of
Iran is graying very fast, some context-based interventions
such as community alertness and providing more formal
support may be helpful in preventing late life depression.
IAGG 2017 World Congress
351
DEPRESSIVE SYMPTOMS, SELF-RATED HEALTH
STATUS, AND RETIREMENT STATUS AMONG
OLDER ADULTS IN THE U.S.
J.Parajuli, Sociology and Gerontology, Miami University,
Oxford, Ohio
This study investigated if the association between depres-
sive symptoms and self-rated health status was moderated by
the retirement status among older adults aged 65 and above
in the United States and tested the following hypotheses:
(1) the older adults who are depressed and retired will have
worse health compared to individuals who are depressed
and not retired (2) the effect of depressive symptoms on
self-rated health status among older adults will depend on
the retirement status of those individuals. Data was used
from the 2012 wave of the Health and Retirement Study.
Ordinal regression was conducted to assess the relation-
ship between self-rated health status, depressive symptoms,
and retirement status. Interaction terms between depressive
symptoms and retirement status were included in the final
model. Ordinal regression results revealed that the interac-
tions between depressive symptoms and retirement status
were significant in the model (p<.0001). The results of inter-
action effects revealed that having depressive symptoms and
being completely retired decreased the odds of having bet-
ter health compared to having depressive symptoms but not
significant interaction between depressive symptoms and
retirement status imply that the retirement status has a mod-
erating effect on the relationship between self-rated health
status and depressive symptoms; which supported the second
hypothesis. The results of this study have implications for
health policy makers to identify and address factors that lead
to depressive symptoms.
A BEHAVIORAL AVOIDANCE TASK FOR HOARDING
DISORDER IN OLDER ADULTS
M.E.Dozier1,2, C.Ayers2,3, 1. SDSU/UCSD Joint Doctoral
Program in Clinical Psychology, San Diego, California, 2.
VA San Diego Healthcare System, San Diego, California, 3.
University of California, San Diego, San Diego, California
Hoarding disorder (HD) is functionally and cognitively
debilitating, as well as socially isolating, particularly in older
adults. There is strong avoidance to the distress of parting
with personal possessions in HD. The current study explored
the feasibility of a behavioral avoidance task (BAT) for HD
by utilizing subjective and behavioral assessments of fear
response during a sorting task administered to older adults.
The current study utilized data from 16 older adults (mean
age 68, range 6082) meeting DSM-5 criteria for HD. During
the BAT, participants subjective units of distress (SUDS) were
recorded at regular intervals. The number of items sorted and
the percent of items discarded were recorded as behavioral
indicators of approach-orientation to the task.
Twelve of the 16 participants were able to engage in
the task for a full five minutes. The average initial SUDS
score was 21 out of 100 with 100 being the most amount
of distress. The average peak SUDS score was 39. The aver-
age within-session habituation was 14 points. Participants
were able to sort an average of 39 items and discard 49%
of sorted items. The majority of participants (62%) reported
that the task was at least somewhat similar to what they
352
experience when sorting objects in their homes. Participants
with higher initial SUDS scores were able to sort more items
(r=.74, p=.001) but did not discard a significantly higher per-
centage of items (r=.39, p=.14).
Clinicians treating geriatric HD should consider utiliz-
ing a BAT to monitor change in distress and avoidance of
sorting/discarding.
IS THERE ARELATIONSHIP BETWEEN BODY
POSTURE AND PSYCHOMOTOR RETARDATION IN
DEPRESSED OLDER ADULTS?
T.Deschamps1, A.Sauvaget2, S.Bulteau2, V.Thomas- older women in Buenos Aires and Havana, and to older men
Ollivier1, 1. Laboratory Movement, Interactions,
Performance (E.A. 4334), University of Nantes, France,
Nantes, France, 2. Department of Addictology &
Consultation-Liaison psychiatry, Nantes University
Hospital, Nantes, France, Nantes, France
The current study supported the idea that postural con-
trol variables, particularly the center-of-pressure veloc-
ity-based parameters, could be a relevant hallmark of
depression-related psychomotor retardation (PMR). The
purposes were twofold: first, it aimed to clearly look at the
interplay between the subjective PMR scores and the pos-
tural performance in patients with major depressive disorder
(MDD), as compared to age-matched healthy controls; sec-
ondly, it focused on the impact of a repetitive Transcranial
Magnetic Stimulation (rTMS) treatment on depression, PMR
objective and subjective evaluations. Sixteen MDD patients
(mean age 57.913.9 years) were compared to 16 healthy University, Morgantown, West Virginia, 2. Geriatric
controls adults (mean age 60.79.6years). All participants Psychiatry Program, University of Rochester Medical
were asked to maintain standing position on a force plat-
form during two trials of quiet standing balance with eyes
open or eyes closed, and two dual task trials while back-
ward counting by two from a random number around 100.
During the 60-s trials, dependent variables computed from
the analysis of center-of-pressure trajectories were recorded.
Before and after the rTMS session, the depression level and
the PMR were scored with the French Retardation Rating
Scale for Depression (ERD). The present results contributed
to a deeper understanding of the motor performance that
characterizes objectively the depression-related PMR. In fact,
significant partial correlations between body posture and
ERD scores, and positive effects of rTMS treatment on pos-
tural instability in dual task, PMR and depression (p < 0.05)
validated the view that the assessment of postural perfor-
mance constitutes an objective marker of PMR in depressed
patients.
CHILDLESSNESS AND DEPRESSION AMONG OLDER
ADULTS IN LATIN AMERICA AND THE CARIBBEAN
N.Quashie2, F.Andrade1, 1. Kinesiology and Community
Health, University of Illinois--Urbana-Champaign,
Champaign, Illinois, 2. Chulalongkorn University, Bangkok,
Thailand
Rapid fertility declines within Latin American and
Caribbean countries since the 1960s have contributed to
smaller family sizes among the current cohorts of older
adults, and increased the likelihood that future cohorts
will not have children. This can have implications for men-
tal health in later life in societies where the family unit is
highly valued as a source of welfare. Drawing on data from
Innovation in Aging, 2017, Vol. 1, No. S1
the 2000 Survey of Health, Well-Being and Aging in Latin
America and the Caribbean (SABE), this study examines
the association between parental status and the likelihood
of experiencing depressive symptoms among older adults
60years and over in seven cities of Latin America and the
Caribbean (N=9756). Estimates from logistic regressions
are provided for pooled data, and disaggregated by sex and
city. Findings show that compared to the childless, older
adults with two or more children had lower odds of expe-
riencing moderate to severe depressive symptoms. Having
multiple children was shown to be especially protective to
in Montevideo. Other significant covariates such as being
unmarried, uneducated, having no access to independent
income, experiencing disability and comorbidity were each
positively associated with depression. While children may
represent a critical component of the welfare mix for older
adults, increasing longevity and changes in family struc-
tures that accompany population ageing require broader
investments in education and health across the life course
to improve individual psychological wellbeing, regardless
of family status.
SUICIDAL IDEATION IN MEDICALLY ILL OLDER
ADULTS: THE IMPORTANCE OF CONTROL
STRATEGIES
A.Fiske1,5, L.Henry4, K.Marshall1, Y.Conwell2,
C.A.Reynolds3, 1. Department of Psychology, West Virginia
Center, Rochester, New York, 3. Department of Psychology,
University of California River, Riverside, California, 4.
Heart and Vascular Institute, West Virginia University,
Morgantown, West Virginia, 5. WVU Injury Control
Research Center, Morgantown, West Virginia
Suicide rates are elevated among older men globally.
Suicides in this age group often reflect concerns about
threats to the older adults independence and sense of con-
trol. Physical illness and associated functional limitations
are common in late life, but most individuals adapt by alter-
ing their strategies for exerting control (Heckhausen et al.,
2010). Evidence suggests that those who do not adapt may
be at risk for depression and suicidal thinking (Fiske etal.,
2013). In this pilot study, N = 7 adults aged 5085 with a
heart attack or a new diagnosis of heart failure within the
past six months were assessed for health-related limita-
tions, control strategies, and affective states at baseline and
6-week follow up. The Wilcoxson sign rank test was used
to test the hypothesis that more limited use of control strat-
egies would be associated with greater risk of depressive
symptoms, hopelessness and suicidal ideation. At baseline,
87% of participants endorsed clinically significant levels of
depressive symptoms (CESDR) and 14% scored above the
recommended cutoff on the Geriatric Suicide Ideation Scale.
Results indicated that both Selective Primary Control (SPC)
strategies and Compensatory Primary Control (CPC) strate-
gies (e.g., getting help from others or modifying the task)
were significantly linked to hopelessness and suicidal idea-
tion at baseline. At the 6-week follow up, both SPC and CPC
were associated with depressive symptoms and hopelessness.
These findings suggest that it may be important to focus
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
on strategies older adults may use to cope with functional
impairments.
OLDER VETERANS PERCEPTIONS OF ANXIETY
SYMPTOMS
C.E.Gould1,2, N.Mashal1,2, A.L.Zapata1, J.L.Wetherell3,
M.K.Goldstein1,2, S.A.Beaudreau1,2, R.OHara2,1, 1.
VA Palo Alto Health Care System, Palo Alto, California,
2. Stanford University School of Medicine, Stanford,
California, 3. UCSD/VA San Diego, La Jolla, California
Although studies have examined anxiety in the general
population, few studies examine anxiety among older veter-
ans. To this end, we characterized anxiety in older veterans
using mixed methods. We used quantitative measurements of
geriatric anxiety (Geriatric Anxiety Scale; GAS) and depres-
sion (Patient Health Questionnaire 9-item), and qualitative
information about perceptions of anxiety. Twenty veterans
aged 6085years old participated (M=69.5; SD=7.3years; ety disorders among older alcohol users, few studies have
50% White). Veterans were characterized as high and low
anxiety based on a median split of GAS scores. As expected,
the high anxiety group (M=35.36, SD=9.94) had worse
anxiety than the low anxiety group (M=6.33, SD=4.38;
t(18), 15.54, p=.001). The groups also differed on depres-
sion severity (t(18), 15.94, p=.001), but not on age (t(18),
1.28, p = .27). In the interviews, veterans described what
anxiety means to them and identified thoughts, emotions
and body sensations associated with anxiety. Responses were
transcribed and coded using both inductively and deductively
developed codes (Cohens Kappa=0.79 to 0.86). Thematic
analysis revealed that most anxiety symptoms were univer-
sally experienced; however, the high and low anxiety groups
differed in appraisals of anxiety and in perceived ability to
deal with anxiety. The high anxiety group described being
stuck and trapped by anxiety. These findings suggest that
anxiety symptoms are dimensional and veterans ability to
cope and manage symptoms varies as a function of symptom
severity. Implications for anxiety assessment and treatment
in older veterans will be discussed.
SUPPORT IS COMPLICATED: HOW INCREASED
SUPPORT AFTER CRITICAL ILLNESS CAN CREATE
INCREASED ANXIETY
L.Johnston1, D.Terp2, 1. Social Sciences, Cal Poly
University, San Luis Obispo, California, 2. Curry Senior
Center, San Francisco, California
This presentation summarizes a mixed methods study of
32 older adult ICU patients as they recovered from critical
illness. These results are compared and contrasted to a quali-
tative study of 50 homebound patients who were recovering
from less severe illness. The presentation will offer empirical
research combined with practical practice guidance for the
range of professionals who assist older adults. The authors
are medical social workers who combine ongoing counseling
practice with research in order to better understand older
adults and their social support system in the home and com-
munity. The authors propose and describe a counterintui-
tive concept; patients who reported more sources of support
experienced more anxiety during their recovery from illness.
Abrief history and literature review examines the difficulties
in defining social support. There are many types of support
and different patients may need different types of support.
IAGG 2017 World Congress
353
Cultural perspectives will also be examined. For older adults
in particular, the ageist stereotypes of Western society can
make accessing social support difficult because asking for
help is viewed as admitting weakness. In contrast, other cul-
tures view older adults as respected sources of wisdom who
are entitled to social support. Three types of support-induced
anxiety are identified and described using case vignettes. The
importance of informed intervention by all the professionals
involved with older adults is highlighted and practical prac-
tice suggestions will be provided.
ANXIETY SYMPTOMS AND DRINKING
TRAJECTORIES IN LATER LIFE: PROSPECTIVE
EVIDENCE FROM THE MIUDS STUDY
S.Kim, C.Grella, University of California, Los Angeles, Los
Angeles, California
While literature suggests the higher prevalence of anxi-
examined the longitudinal relationship between anxiety
symptoms and alcohol consumption in later life. The aim of
this study was to determine the effects of late-life anxiety
symptoms on their subsequent 18-year alcohol use trajec-
tories. Data were drawn from three waves (wave1 [1995
1996], wave2 [20042006], and wave3 [20132015]) of
the MacArthur Foundation Survey of Midlife Development
in the United States (n=7,108; mean age= 46.8 at baseline).
Symptoms of generalized anxiety disorder (GAD) within the
previous 12 months were assessed by using the Composite
International Diagnostic InterviewShort Form (CIDI-SF)
scale. The amount of alcohol use was measured as the typi-
cal number of drinks that participants had on days on which
they drank during the past month. Covariates (age, gender,
race, income, education, and physical health) were assessed
at baseline. Latent growth curve modeling was used to iden-
tify the association between anxiety symptoms and longi-
tudinal changes in alcohol consumption adjusting for the
covariates measured at baseline. We found that individuals
with higher levels of anxiety symptoms tended to have an
increase in alcohol consumption over time (=0.07, p<0.05).
The results highlight the role of anxiety symptoms in deter-
mining the use of alcohol in later life. Therefore, our findings
indicate that on-going efforts to improve mental health, espe-
cially symptoms of anxiety, may help older adults to reduce
hazardous alcohol consumption.
SESSION 835 (POSTER)
DISABILITIES II
DETERMINANTS OF THE NEED TO CARE FOR
ELDERLY BRAZILIANS
D.Nunes1, T.Brito2, T.d.Alexandre3, L.P.Corona4,
Y.Duarte2, M.Lebrao2, 1. Nursing, Federal University of
Tocantins, Palmas, Tocantins, Brazil, 2. University of So
Paulo, SoPaulo, Brazil, 3. University of So Carlos, So
Carlos, Brazil, 4. University of Campinas, Limeira, Brazil
The presence of functional limitations in the elderly deter-
mines the need for care. This necessity represents challenging
demands for the family and the health services as it presents
a complex group. The objective of the study is to analyze
354
determinants of the need for care in elderly Brazilians. This
was a longitudinal and analytical home-based study, which
used the database of the SABE study (Health, Well-being and
Aging) in the years 2006 and 2010. The sample consisted of
459 elderly individuals independents ( 60years). It was con-
sidered as the need for care, the difficulty of the elderly in the
performance of basic and instrumental activities of daily liv-
ing according to aid demands in these activities. It was used
in the analysis Multiple Multinomial regression. Among the
independent elderly, the determining factors for minimum
need were female (RRR=1.81, CI95%:1.053.13), aged 80
and over (RRR=2.84, CI95%:1.176.86), impaired physical
mobility (RRR=2.94, CI95%:1.028.43); for moderate need,
aged 80years and over (RRR=5.58; CI 95%:1.5520.00) and
cognitive decline (RRR=7.83, 95% CI:1.6038.24); and max-
imum need, age between 70 to 79years (RRR=2.60; CI95%:
1.135.96) and 80 and over (RRR=5.59, CI95%:1.87
-16.62), multimorbidity (RRR=3.50; CI95%:1.329.30).
Identifying the factors determining the need for care will
allow family members, caregivers and health professionals to
develop strategies to prevent the establishment of the difficul-
ties in daily activities. Public policies should be developed for
caregivers, considering the health and social services as sup-
port for the providers of care.
MULTI-YEAR DISABILITY TRAJECTORIES AMONG
SURVIVORS AND DECEDENTS
S.M.Albert1, J.R.Lunney1, L.Ye1, D.G.Ives1, S.Satterfield2, disability. The prevalence of disability was significantly lower
A.Newman1, 1. Behavioral and Community Health
Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania,
2. University of Tennessee Memphis, Memphis, Tennessee
Investigators have identified varying trajectories of dis-
ability before death, but it is unclear if disability trajectories
among decedents and survivors differ among older adults.
We examined self-reported disability in walking a quar-
ter mile at 6-month intervals beginning 3years before death
among 1020 decedents in the Health, Aging and Body
Composition Study (Health ABC). Survivors matched for age
and gender were identified and self-reports for each pair were
tracked over the same 3-year period (total n=2040). Survivor
and decedent reports of disability over the 6 assessments
were compared using mixed models to calculate the odds of
disability for each group adjusted for race, site (Memphis vs.
Pittsburgh), and time. In a sensitivity analysis, we assumed
that respondents missing self-report status were disabled.
Decedents increased in disability from 48.6% 3 years
before death to 78.1% 6months before death. Among survi-
vors, disability increased from 32.3% to 43.6%. In a logis-
tic regression model the odds of having disability showed a
significant month by group (decedents vs. survivors) interac-
tion (p < .0001). The monthly increase in odds of having
disability was 6.3% among decedents compared to 2.6%
among survivors. The two groups did not differ in volatility,
that is, switching between disabled and non-disabled status;
but African-American respondents showed greater volatility
than whites (p < .0001).
Trajectories of self-reported disability differ between sur-
vivors and decedents. Older adults who died after 3 years
were more disabled at the start of follow-up and also had
a greater risk of increasing disability over each subsequent
6-month assessment.
Innovation in Aging, 2017, Vol. 1, No. S1
CORRELATES OF DISABILITIES AMONG
COMMUNITY-DWELLING ELDERLY INDIVIDUALS
FROM BRAZIL
T.de Andrade1, F.Bof de Andrade2, 1. Faculty of Medical
Sciences, Belo Horizonte, Brazil, 2. Oswaldo Cruz
Foundation - FIOCRUZ, Belo Horizonte, Brazil
Objective: Assess the prevalence of disability and evalu-
ate its association with sociodemographic and general health
factors among a representative sample of community-dwell-
ing elderly individuals from Brazil. Methods: This was a
cross-sectional, population based study, with a probabilistic
household sample from Brazil. Sample comprised 11,177
individuals, representing 26,407,830 older adults aged
60 years or more. All participants answered a structured
questionnaire informing on disabilities on basic activities of
daily living (BADL) and covariates on sociodemographic, life
style, general health and use of health services. Individuals
reporting difficulty in one or more BADL (bathing, dressing,
walking, using the toilet, feeding and moving in and out of
bed) were considered disabled. Associations between vari-
ables were evaluated by means of prevalence ratios estimated
by Poisson regression model. Results: The prevalence of disa-
bility in BADL was 6.1%. According to the adjusted analysis,
the prevalence of disability increased with increasing age and
was lower among individuals with more years of education.
Elderly individuals with chronic diseases and hospitalization
in the previous year had significantly higher prevalence of
among individuals reporting physical activities. Conclusion:
There were socioeconomic inequalities in the prevalence of
disability in BADL which was also significantly associated
with factors related to life style, general health, use of health
care.
GREATER PERI-AORTIC ADIPOSE TISSUE IS
ASSOCIATED WITH INCREASED TRUNK MUSCLE
FAT IN MEN AND WOMEN
R.McLean1,2,3, L.J.Samelson1,2,3, A.Lorbergs1,2,3,
D.Anderson3,2, U.Hoffmann4,2, C.Fox5, M.Bouxsein3,2,
D.P.Kiel1,2,3, 1. Hebrew SeniorLife Institute for Aging
Research, Boston, Massachusetts, 2. Harvard Medical
School, Boston, Massachusetts, 3. Beth Israel Deaconess
Medical Center, Boston, Massachusetts, 4. Massachusetts
General Hospital, Boston, Massachusetts, 5. Merck
Research Laboratories, Boston, Massachusetts
Age-related muscle fat accumulation and loss of muscle
mass, contributors to mobility problems in older adults, may
result from ectopic fat producing cytokines that promote sat-
ellite cell differentiation into adipocytes. Whether this occurs
via systemic or local paracrine effects is unknown. We deter-
mined the association of peri-aortic adipose tissue (PAAT)
volume with size and fat content of adjacent trunk muscles
among 948 participants (56% women) in the community-
based Framingham Study. Multidetector CT measured PAAT,
and cross-sectional area and attenuation (marker of fat con-
tent) of trunk muscles (averaged left and right erector spinae,
transversospinalis, and trapezius muscles at T7/T8 levels).
Linear regression was used to calculate associations () of
PAAT with cross-sectional area and attenuation, adjusting
for sex, age, height, body mass index (BMI) and physical
activity, and further adjustment for abdominal visceral (VAT)
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and subcutaneous adipose tissue (SAT) volumes. Mean age
was 58years (range 4581), mean BMI was 28kg/m2 (range
1853). PAAT was not associated with cross-sectional area
(=-0.96, P=0.37), but was inversely associated with attenu-
ation (=-0.31, P<0.01), indicating higher muscle fat con-
tent with increasing PAAT. The association remained after
adjustment for VAT and SAT. We found that increased fat
surrounding the thoracic aorta was associated with greater
fat content in nearby trunk muscles, independent of over-
all obesity and ectopic abdominal fat, suggesting that age-
related skeletal muscle fat accumulation may result mainly
from local paracrine effects of adjacent fat depots. Cross-talk
between neighboring fat and muscle is a potential target for
novel muscle function-promoting therapies in older adults.
SARA-OBS CLINICAL TRIAL: BASELINE
CHARACTERISTICS OF SARCOPENIA/SARCOPENIC
OBESITY IN THE ELDERLY
W.Dioh1, S.Del Signore1,2, L.Daudigny1, S.Veillet1, 1.
Biophytis, Romainville, France, 2. Bluecompanion ltd,
London, United Kingdom
Sarcopenia is a key underlying cause of physical frailty,
a reversible condition in older subjects, which may lead to
mobility disability and dependency. Sarcopenia is charac-
terized by the loss of muscle mass and function. Sarcopenic
obesity (SO), an emerging condition affecting older obese
individuals, can be defined by fat mass increase associated
with the loss of muscle mass and function.
SARA-OBS is a 6-month observational, multicenter,
clinical trial aiming to enroll 300 community-dwelling per-
sons aged 65 years at risk of mobility disability, within
8 investigational sites across Europe and USA. SARA-OBS
main objective is to characterize sarcopenia including sarco-
penic obesity, by using DXA, according to the criteria of the
Foundation of NIH (Studenski etal., 2014)and of the Short
Physical Performance Battery (SPPB; Guralnik J etal., 1994).
Patients with SPPB 8/12 and DXA ALM/BMI correspond-
ing to FNIH criteria (< 0.789 in men and 0.512 in women)
will be included. The primary endpoint will be the 6-min-
ute distance or the 400 m walking test. Secondary endpoints
include muscle strength, physical activity through an activ-
ity monitoring device; muscle mass and fat mass (measured
by DXA). Patient-Reported Outcomes (PROs) will also be
collected.
Patients enrollment will start by the fourth quarter 2016
through a 7-month screening and recruitment phase fol-
lowed by an observational phase with two visits at inclusion
and at 6months. SARA-OBS data (baseline characteristics,
demographics, body composition and functional tests) will
pave the way for SARA-INT, the interventional Phase2 trial
for the candidate drug Sarconeos (BIO101).
COLLABORATION BY AHEALTHCARE TEAM TO
IMPROVE MOBILITY IN HOSPITALIZED OLDER
ADULTSGET UP AND GO
U.Ohuabunwa1,2, R.Walton Mouw2, J.Brandi2, J.Turner2,
Q.Jordan2, T.Dumas2, L.Perdue2, C.Osuji2, 1. Emory
University, Atlanta, Georgia, 2. Grady Hospital, Atlanta,
Georgia
Older adults who are hospitalized are prone to multiple
hazards such as falls, and significant functional mobility
IAGG 2017 World Congress
355
decline often resulting in institutionalization, and readmis-
sion to the hospital after discharge. Patients are often mobi-
lized late in their hospital stay due to Nursing Sraff awaiting
clearance from physical therapy. We sought to determine the
effectiveness of an early mobilization protocol established to
improve mobility and function in hospitalized older adults
Project Setting was a 953 Bed academically affiliated
safety net hospital.
Participants included older adults 75yrs and older or
patients 65years and older identified to have 1 or more geri-
atric syndromes admitted to the Acute Care for the Elderly
Service.
All patients were evaluated by Nursing Staff on admission
to determine their Get up and Go score ranging from a score
of 1(patient able to get up and go without assistance) to 9
(bed rest ordered). Patients were mobilized early by Nursing
based on their Get up and Go scores following the proto-
col on amount of mobilization required. Physical Therapy
and Occupational Therapy also saw the patient early in their
hospital stay to evaluate for further functional and mobility
needs and implement physical and occupational therapy as
needed.
Initial data show a significant improvement in mobility
scores for patients based on the Get Up and Go scores on
admission and at the time of discharge with lower scores
indicating improved mobility. Pre Intervention, the mobil-
ity scores on admission were 4.4 and increased to 4.53 at
discharge. Post intervention, mobility scores were 4.37 on
admission and 3.65 at discharge.
In conclusion, the Get up and Go protocol is a useful
mobilization program to improve functional mobility in hos-
pitalized older adults.
COMPARISON OF STATIC BALANCE BETWEEN
INSTITUTIONALIZED AND COMMUNITY-
DWELLING OLDER ADULTS
M.Scheicher2, L.Moreira1, L.Faber1, 1. Physiotherapy and
Occupational Therapy, UNESP, Marlia, So Paulo, Brazil,
2. UNESP, Marlia, So Paulo, Brazil
Falls are common among older people and are a serious
public health problem in this population. Studies indicate that
about 30% of people over 65years who live in the commu-
nity fall annually. For individuals in nursing homes, 5066%
fall each year. One specific condition for risk of falling is the
gait/balance disability. Often, institutionalized older patients
have fewer opportunities to independently participate in
activities and tasks of daily living, having higher deleterious
effects in the physiological losses from aging, compromis-
ing gait and balance. There are fewer studies showing the
balance by a force platform in institutionalized elderly. The
aim of the study was compare the static balance between
institutionalized and community-dwelling older. Forty two
older volunteers participated in the study (21 community-
dwelling and 21 institutionalized). The static balance was
assessed using a force platform (eyes open and closed base).
The parameters used to measure the subjects stability were:
total path length (cm), mean velocity (cm/s) and 95% of the
ellipse area (cm2). The age of participants was 75.47.3
for institutionalized and 72.57.1 for community-dwelling
older (p=0.20). The results showed a significant difference
between institutionalized and community-dwelling older:
356
total path length (77.925.05 and 52.712.59, p=0.0002), for ambulation assistance, identified a negative correlation
mean velocity (2.600.84 and 1.880.86, p=0.001) and between the slope of cumulative number of steps with age
95% of the ellipse area (6.53.3 and 4.62.4, p=0.04). The (r = -0.42, p = 0.013), and male (rpb = -0.336, p = 0.026).
results showed that the static balance assessed by a force
platform of institutionalized older is significantly different
of community-dwelling elderly, explaining the greater risk of
falls of this population.
SIT TO STAND ACTIVITY: ALITERATURE REVIEW
U.D.Wisnesky, W.Duggleby, S.Slaughter, Nursing,
University of Alberta, Edmonton, Alberta, Canada
It is common for older adults to have many age related
problems such as muscle weakness, slowed performance,
fatigue and poor endurance. Focusing on exercises to improve
older adults mobility is a potential mechanism to assist their
physical capability and performance of activities of daily liv-
ing. Using Arksey and OMalley framework a scoping review
was conducted to: (1) to explore the breadth of literature on
the current state of knowledge about the sit-to-stand activity
to improve mobility in the older adult population and (2) to
identify gaps for future research. Of 1639 papers, 14 studies
met the inclusion criteria, with study dates ranging from 1993
to 2015. The target population of the majority of studies was
post-stroke patients. A range of sit-to-stand interventions
were described with duration of interventions ranging from
two to 24 weeks. The frequency of the sit-to-stand activity
ranged from three to seven times/week lasting 15 to 45 min-
utes on each occasion. Also, the activity was prompted mostly
by rehabilitation professionals. Three themes were identified
in the studies: (1) positive impact of sit-to-stand activity on
patient outcomes; (2) absence of long term follow up in study
designs; and (3) gap of theoretical framework guiding the stud-
ies. Across most of the studies, participants showed significant
improvements in performance of sit-to-stand and motor func-
tion, yet most studies lacked adequate methodological rigor
and/or experimental design. There was an absence of explicit
theoretical frameworks guiding the studies. More research is
needed to assess whether the sit-to-stand could benefit groups
beyond the post-stroke population.
AMBULATION OF HOSPITALIZED OLDER PATIENTS
F.Kuo, B.King, L.Steege, H.Wang, UW-Madison, received a booklet with information on exercises targeting
Madison, Wisconsin
About 65% of older adults will experience functional
decline or loss of independent ambulation during their hospi-
tal stay. Loss of independent ambulation has been identified
as a hospital-associated disability (HAD). Patients at risk for
HAD are those with decline in 1 or more ADLs, female, over
the age of 75 and use of an assistive walking device. Limited
ambulation has been identified as the most preventable cause
of HAD. Older adults infrequently walk during their hos-
pital stay. An exploratory study was conducted on an adult
medical unit in a Midwest academic hospital. Thirty-seven
older adults (mean age=80.73) consented to wear a research-
grade accelerometer during their hospital stay (mean stay=
61.46 hours). Growth mixture modeling identified the tra-
jectories of cumulative number of steps into two classes,
classI(n=29, mean growth slopes= 33.4) and classII (n=8,
mean growth slope=130.1). T-test indicated lower body
weight (BW) was statistically significant in the group with
high slopes (p=0.037). Partial correlation test, controlling
Innovation in Aging, 2017, Vol. 1, No. S1
Pattern of ambulation within the sample identified 3 time
periods of greatest activity, 10am-1pm, 4-6pm and 8-9pm.
Decrease in ambulation activity occurred during shift change
3pm, 7pm and after 10pm. High BW, male and need for
assistance were correlated with low levels of ambulation.
Future intervention studies should target high risk patients
who may be at greater risk for HAD.
MANAGING MOBILITY IN VULNERABLE SENIORS
(MMOVES) WITH AN INDIVIDUALIZED, HOME-
EXERCISE PROGRAM
S.Figueiredo3,1, J.A.Morais2,4, N.E.Mayo5,3,4, 1. Center for
Outcomes Research and Evaluation, Research Institute,
McGill University Health Centre, Montreal, Quebec,
Canada, 2. Faculty of Medicine, McGill University,
Montreal, Quebec, Canada, 3. School of Physical and
Occupational Therapy, McGill University, Montreal,
Quebec, Canada, 4. Division of Geriatrics, McGill
University Health Center, Montreal, Quebec, Canada,
5. Division of Clinical Epidemiology, McGill University,
Montreal, Quebec, Canada
After hospitalization, further disability among seniors
could be prevented through exercise. Nonetheless, a one-on-
one rehabilitation is not realistic for the volume of seniors that
are experiencing disability. Currently available educational
material for improving disability is so vast and non-specific
that passive dissemination may pose a barrier to behaviour
change. The aim of this pilot study was to estimate the extent
to which an individualized, exercise-focused, self-management
program (MMOVES), in comparison to exercise information,
is more effective in improving mobility after 6months among
seniors recently discharged from hospital.
The physiotherapy-facilitated intervention consisted of
1)evaluation of mobility capacity; 2)setting short and long
term goals; 3)delineation of an exercise treatment plan. In
addition, MMOVES participants received an educational
booklet to enhance mobility self-management skills and were
followed-up with monthly telephone calls. Control group
mobility limitations in seniors.
Mobility, pain, and health status were assessed at base-
line and at 6months using multiple indicators drawn from
DASH, LEFS, SF-36. After imputing missing data, gener-
alised estimating equations (GEE) estimated the odds of
response for people receiving the intervention in comparison
to the odds of response in the control group. Each person
was classified as having made a response, deterioration, or
no change on each measure based on change of one level on
the ordinal scale.
26 people were randomized to the intervention (mean
age 818; 39% women), 23 were randomized to the con-
trol (mean age 797; 33% women). The OR for the mobil-
ity outcomes combined was 3.08 and the 95%CI excluded
1 (1.65 5.77). The ORs for pain and health perception
favoured the MMOVeS group; but, the 95%CI included the
null value. Our individualized, exercise-focused, self-man-
agement program was more effective than exercise informa-
tion in improving mobility outcome for seniors.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 357

THE SHORT VERSION OF THE ACTIVITIES-SPECIFIC BMI of less than 20. 63% of them considered that they had
BALANCE CONFIDENCE SCALE FOR OLDER ADULTS a good to excellent health. Upon assessing their functional
WITH DIABETES conditions, it is clear that 32% of them are completely inde-
P.Hewston, N.Deshpande, Queens University, Kingston, pendent in Basic Daily Activities. Their instrumental activi-
Ontario, Canada ties were positively affected by hypercholesterolemia, in that
The Activities-specific Balance Confidence scale (ABC-6) their degree of independence was higher when this condition
is advantageous in busy clinical or research settings as it can was present (p=0.088). These findings should allow better
be administered in significantly less time than the original measures to be taken for the early detection of risk factors.
16-item ABC scale (ABC-16). The purpose of this study was
PROPHYLAXIS PROTOCOL FOR SURGICALLY
to examine the convergent, discriminant and concurrent
TREATED HIP-FRACTURED ELDERLY IN REDUCING
validity of the ABC-6 in older adults with diabetes mellitus
VENOUS-THROMBOEMBOLISM
(DM) with and without diagnosed diabetic peripheral neu-
C.Cheong1, S.Su1, Y.Wan1, C.Tan2, Y.Chen2, Y.Kang3,
ropathy (DPN). Thirty older adults (aged 65) were age- and
M.Ullal1, 1. Department of Geriatric Medicine, Khoo Teck
sex-matched in 3-groups: 10 with DM (DM-group), 10 with
Puat Hospital, Singapore, Singapore, 2. Department of
diagnosed DPN (DPN-group), and 10 without DM (noDM-
Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore,
group). Balance confidence was quantified with the ABC-16
Singapore, 3. Department of Pharmacy, Khoo Teck Puat
which includes the six items of the ABC-6. Potential correlates
Hospital, Singapore, Singapore
were evaluated in physical and psychological domains. Our
Venous-thromboembolism(VTE) risk is high in surgically
results indicated the ABC-6 and ABC-16 balance confidence
treated hip-fractured patients and could still be 19% despite
scores were strongly correlated (r=0.969, p<0.001; conver-
being on pharmacological prophylaxis. There was no routine
gent validity). The ABC-6 revealed significant differences
practice of giving pharmacological prophylaxis in elderly
in balance confidence between the noDM- and DM-groups
due to the concern of bleeding risk and lower risk(8.6%) of
(p<0.001; discriminant validity) whereas the ABC-16 did not
VTE in Asian populations.
(p>0.05). The ABC-6 was moderately but significantly corre-
We developed a VTE prophylaxis protocol via inter-
lated with physical activity level (r=0.528, p=0.017), mobility
departmental collaboration for all hip-fractured elderly
(r=-0.520, p=0.027), balance (r=0.633, p=0.003) and depres-
admitted to the Hip Fracture Unit. We studied 256 patients
sive symptoms (r=-0.515, p=0.020) in the DM study-groups
with surgically treated hip fractures (mean age 78.68.9)
(concurrent validity). In conclusion, the ABC-6 and ABC-16
who were admitted from November 1, 2014 till October
had excellent convergent validity and both ABC-scales had
31, 2015. Mechanical calf-compressors and anti-embolism
similar concurrent validity. However, the ABC-6 was more
stockings were used as mechanical methods whereas low-
sensitive to detect subtle differences in balance confidence
molecular weight heparin or unfractionated heparin were
in older adults with diabetes without diagnosed DPN than
used as pharmacological methods. Prophylaxis was started
the ABC-16. Overall the ABC-6 is a valid assessment tool
from the first day of admission except those with absolute
that may provide a means for early detection of balance and
contraindications. DVT and pulmonary embolism(PE) were
mobility-related declines in older adults with DM without
confirmed by ultrasonography and CT pulmonary angiogra-
diagnosed DPN.
phy respectively. We aimed to study the compliance of VTE
protocol and VTE risk with appropriate prophylaxis.
IDENTIFICATION OF FACTORS THAT
All 256(100%) of the patients were given mechanical
INFLUENCE INDEPENDENCE OF COSTA RICAN
prophylaxis, with 238(88%) of them on concurrent phar-
NONAGENARIANS AND CENTENNIALS
macological prophylaxis. Seven(2.7%) had DVT and two
X.Ramirez-Ulate, M.Bolaos-Sanchez, Hospital Nacional
(0.8%) had PE. One(0.004%) mortality was associated with
de Geriatra y Gerontologa, San Jose, Costa Rica
the VTE-positive group. No complications were reported
Costa Rica is now dealing with a demographical transi-
from the mechanical methods. One(0.004%) heparin-
tion in which it is common to see healthcare users aged 90+.
induced thrombocytopenia and one(0.004%) rectal bleeding
The goal of this study is to document the sociodemographic
secondary to undiagnosed sigmoid tumour were reported.
characteristics, and the medical and functional condition of
No bleeding complications of the wound.
the ninety and hundred-year-old senior citizens within the
VTE is a serious complication and often underestimated
sample, as well as to document the most important factors
in Asian patients with hip fracture. VTE prophylaxis proto-
affecting their independence, both in their basic and instru-
col could improve the compliance and safety of prophylaxis
mental activities. The information used was gathered from
initiation and is effective in reducing VTE occurrence in hip
the CRELES (Costa Rica, Longevity and Healthy Aging
fracture patients.
Study, as per its Spanish acronym). In this study a survey was
administered to a nationally representative sample of 8,000 SELF-REPORTED HEALTH AS APREDICTOR OF
senior citizens. This is a descriptive and analytical cross-sec- FUNCTIONAL DECLINE IN ACOMMUNITY-
tional study. In total 278 people over ninety years of age were DWELLING ELDERLY POPULATION
studied, representing 9.8% of the individuals included in the S.Kim1,2, D.Shin3, B.Cho4, C.Won2, Y.Hong2, K.Son4, 1.
CRELES study. Among the most important findings was the Seoul National University Bundang Hospital, Gyunggi-do,
fact that most participants are female and that 30.9% of them Korea (the Republic of), 2. Kyung Hee University, Seoul,
were illiterate. The most frequent pathologies were sleep dis- Korea (the Republic of), 3. Samsung Medical Center, Seoul,
orders (51%) and hypertension (44%); 14% reported hav- Korea (the Republic of), 4. Seoul National University
ing no previous pathologies. 24.9% of the individuals had a Hospital, Seoul, Korea (the Republic of)

IAGG 2017 World Congress

358
Purpose: As elderly population is increasing, prediction
and prevention of functional decline in the elderly are of
great concern. This study aimed to evaluate whether poor
self-reported health status (SRHS) could predict functional
decline after two years in the elderly population.
Methods: Data from the KLoSA panel, a national repre-
sentative sample of the aging Koreans, were used. Subjects
of investigation were the elderly population aged 65 or
more without disability in carrying out activities of daily liv-
ing (ADL) at baseline. The survey asked respondents about
their subjective health status. Setting the respondents who
stated their health status very good or good as the refer-
ence group, multivariable logistic regression analysis was
performed to compare functional decline according to the
baseline SRHS.
Results: A total of 2,824 subjects were included in the
analysis. Among them, 138 (4.9 %) reported functional
decline of at least one of the 7 ADL components after two
years. In multivariable logistic regression analysis, SRHS was
significantly associated with subsequent functional decline
in respondents who chose Bad (odds ratio (OR), 3.32; 95
% confidence interval (CI), 1.71 6.44) or Very bad (OR,
4.75; 95 % CI, 2.12 10.66). Moreover, poorer SRHS was
significantly associated with subsequent impairment in each
ADL components. Also, SRHS predicted overall subsequent
impairment in the instrumental ADL.
Conclusions: SRHS predicted functional decline after two
years in the elderly without baseline disabilities. SRHS can
be a good predictor of future functional decline in the elderly
population.
LOSS OF INDEPENDENCE IN ACTIVITIES OF DAILY
LIVING IN OLDER ADULTS HOSPITALIZED
P.J.Villas Boas, A.P.do Valle, A.F.Jacinto, V.F.Mayoral,
M.Garuzi, T.Carvalho, D.Veiga Antonangelo, Internal
Medicine, Sao Paulo State University - Unesp, BOTUCATU,
Sao Paulo, Brazil
Objectives: To describe the changes in activities of daily liv-
ing (ADL) function occurring before, after hospital admission
and discharge in inpatients elderly with medical illness and to
assess the effect of frailty on loss of ADL function.
Design: Prospective observational study.
Setting: Brazilian university hospital.
Participants: One-hundred ninety-five patients (mean age
74years, 59% men).
Measurements: At the time of hospital admission, patients
were interviewed about their independence in ADLs (Katz
index) 2 weeks before admission (M0), at admission (M1),
discharge (M2) and 15days after discharge (M3) and about
frailty (M0) (Cardiovascular Health Study index). Outcome
measures included functional decline between M0-M1,
between M0-M2, between M0-M3 and between M2-M3.
Results: Eighteen percent of patients were dependent
(Katz index < 3) and 38.4% were frailty in M0. The ADL
function of 31% of the patients did not decline between
M0-M2. Thirty-five percent declined between M0-M3.
This included the 17.1% of patients who declined between
M0-M1 and failed to recover to baseline function. Fifty-nine
percent declined between M1-M2. Twenty four percent
recovered between M2-M3.
Innovation in Aging, 2017, Vol. 1, No. S1
The frequency of ADL decline between M0-M3 varied
markedly with frailty (OR=5.77, 95% confidence interval
2.2314.96).
Conclusion: Many hospitalized older people are dis-
charged with ADL function that is worse than their baseline
function. Frailty was a risk for losses of ADL function during
hospitalization in elderly patients
ARE STATIC AND DYNAMIC BALANCE ABILITIES
CORRELATED WITH HANDGRIP STRENGTH IN
HEALTHY ELDERLY?
M.Pau, F.Corona, S.Caggiari, C.Fastame, P.Hitchcott,
G.Panu, M.Penna, University of Cagliari, Cagliari, Italy
Several studies report that basic motor abilities, including
muscular strength and static and dynamic balance influence
the risk of falls in elderly people. However, the relationship
between these features is not fully clear. In this study, we
measured static posturography and TUG (performed using
force platform and wearable inertial sensors) with handgrip
strength (HSG) and determined the correlation between bal-
ance and HSG performances.
Twenty-two healthy individuals (10M, 12F, age 68.0
SD 8.3) underwent a 30 s static posturography and instru-
mented TUG using an inertial sensor attached at the lower
lumbar level. The center-of-pressure (COP) time series
acquired with the force platform were processed to calcu-
late: sway area, COP path length, maximum COP displace-
ments and velocities in AP and ML directions. For the TUG,
acceleration data allows calculating: duration of the trial,
duration of sit-to-stand, intermediate turning, final turning
and stand-to-sit phases. HSG was measured using a vali-
dated dynamometer.
Pearsons product-moment correlations was calculated by
setting the significance level at p=0.05. We found significant
positive correlations of HSG with sway area (r=0.462), path
length (r=0.510) COP displacements and velocities in AP and
ML direction (r=0.576 and 0.422 for displacements, r=0.563
and 0.414 for velocities). Moreover HSG is negatively corre-
lated with TUG duration (r=-0.604) and final rotation phase
(r= -0.509). Such results suggest that HSG is a good predictor
of static balance, while muscular strength seems to be less of
an influence in dynamic balance tasks like TUG.
SESSION 840 (POSTER)
DISEASES OF AGING AS MEANS TO UNDERSTAND
THE AGING PROCESS
PROTEIN MALNUTRITION AFFECTS CARTILAGE
QUALITY AND COULD CONTRIBUTE TO
OSTEOARTHRITIS DEVELOPMENT
P.Ammann, C.Lavet, Division of Bone Diseases, Geneva,
Switzerland
Elderly patients frequently suffer from protein malnutri-
tion leading to major alteration of the somatotropic axis as
well as IGF-I local production. IGF-I is a major anabolic
agent for cartilage homeostasis. Indeed a decrease of IGF-I
induced by protein malnutrition could affect both cartilage
and subchondral bone and may contribute to osteoarthritis
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
development. To address this question, 9 months old rats
were pair fed a normal or an isocaloric low protein diet
(LP) for 2months (n=6/group). All animals were euthanized
and femurs were collected. Micro-computed tomography
allows determination of trabecular and cortical subchon-
dral bone (SB) morphometric parameters as well as hyaline
and calcified cartilage thickness, and proteoglycan content
estimation. Bioindentation with Bioindenter equipment
(CSM Instrument, Switzerland) allows determination of
cartilage material level properties (indentation depth and
Youngs modulus). Systemic IGF-I was decreased in LP
group (-18%,p<.001). As expected, in LP group, SB com-
partment was altered: trabecular SB mass was decreased
(-10%,p<.01) as well as SB cortical plate thickness of the
medial condyle (-12%,p<.05). Despite no morphologic
changes of the cartilage of the medial condyle (thickness
tended to decrease by 8% but not significantly), hyaline car-
tilage biomechanical properties (force, elastic modulus and
working energy) were respectively decreased by -47, -58
and -41% (p<.01). We did not observed alterations of pro-
teoglycan. These cartilage degradations are similar to what
is observed in early osteoarthritis.We suggest that alteration
of the somatotropic axis induced by protein malnutrition
could predispose to osteoarthritis. Since protein malnutri-
tion is frequent in elderly this mechanism could be relevant
in human.
REDUCTION OF NFAT1 EXPRESSION IN ARTICULAR
CHONDROCYTES LINKS TO THE AGING OF
ARTICULAR CARTILAGE
J.Wang, Orthopedic Surgery, Kansas University Medical
Center, Kansas City, Kansas
Aging is an independent risk factor for osteoarthritis
(OA), for which the biological mechanisms are poorly
understood. NFAT1 (NFAT c2) known to be expressed in
cartilage is a member of nuclear factor of activated T cells
(NFAT/Nfat) family of transcription factors. This study
aimed to investigate the age-related NFAT1 expression
pattern and the role of NFAT1 in regulating metabolic
activities of articular cartilage in mice. Nfat1 mRNA and
protein were highly expressed in articular chondrocytes
in young adult but were significantly reduced in aged
mice. The decreased NFAT1 expression was associated
with reduced proteoglycan staining, decreased expres-
sion of chondrocyte markers, and increased expression of
interleukin-1 in articular cartilage. Forced Nfat1 expres-
sion in chondrocytes from aged mice significantly reversed
the abnormal metabolic activities. Methylated DNA
immunoprecipitation and chromatin immunoprecipitation
assays revealed that reduced NFAT1 expression in artic-
ular chondrocytes of aged mice was regulated by epige-
netic histone methylation at the promoter region and was
correlated with increased DNA methylation at introns 1
and 10 of the Nfat1 gene. The present study suggests that
epigenetically regulated spontaneous reduction of NFAT1
expression results in imbalanced metabolic activities of
articular chondrocytes of aged mice, leading to aging-like
changes in articular cartilage. Articular cartilage of aged
mice, therefore, is an abnormal joint tissue that may pre-
dispose the joint to OA under mechanical stress. These
IAGG 2017 World Congress
359
findings may provide new insights into the mechanisms
underlying the aging of articular cartilage.
UNDERSTANDING ROLE OF 9P21 GENE DESERT
SNPS IN CANCER, AGING, DIABETES, AND CARDIO-
VASCULAR DISEASES
R.Jayani1,2, Q.Ma1, D.Notani3,1,2, M.G.Rosenfeld1,2,
1. University of California San Diego (UCSD), La Jolla,
California, 2. Howard Hughes Medical Institute, La Jolla,
California, 3. National Centre for Biological Sciences
(NCBS), Bangalore, Karnataka, India
Aging has been largely thought of as a manifestation of
metabolic malfunctions and physical and psychological
changes accumulating over time in the body. Recent years
have seen seminal research that indicates that changing epi-
genetic landscape of individual cells is also one of the main
contributors to the process of aging, that lead to the term
cellular aging. INK4/ARF locus on chromosome 9p21 has
been implicated in aging, diabetes, heart diseases and multiple
forms of cancer; making it an ideal model to study the basic
rules of cellular aging. We identified 33 enhancers in the 9p21
locus, which have been associated to aging-related diseases in
multiple GWAs studies. Using techniques like 5C and CRISPR,
we have discovered an intricate network of interplay between
some of the key enhancers in the locus. We observed that these
enhancers make contacts with the INK4/ARF locus by loop-
ing and in turn regulate the expression of ANRIL, p14 and
p16: important determinants of cellular aging. We also found
out that this is a local effect spread over a few adjacent TADs,
suggesting that multiple such regulator domains might be at
work in the genome, to check the cellular aging. The findings
of this study will shed light on how to develop new approaches
to impact the architectural events and could provide targets to
impede the aging process and development of diseases associ-
ated with aging, such as coronary artery disease, diabetes, and
neuro-degenerative disease.
GENOMIC AND FUNCTIONAL CELLULAR
RESPONSES IN HEAVILY TUBERCULOSIS-EXPOSED
OLDER ADULTS
D.H.Canaday1, B.Richardson2, J.Pyles2, P.Wilkinson2,
W.H.Boom2, H.K.Mayanja3, M.Cameron2, 1. GRECC,
Cleveland VA, Cleveland, Ohio, 2. Case Western Reserve
University, Cleveland, Ohio, 3. Makerere University,
Kampala, Uganda
Little known about changes in immune responses to TB
that occur with aging. We identified pulmonary TB index cases
and enrolled their heavily TB exposed household contacts in
Uganda. We studied 26 older (mean age 58, range 5078)
and 17 younger (mean age 23, range 1830) household con-
tacts. None had active TB. 11 Index cases with active TB
were examined also. PBMC were studied at time 0 by RNA-
seq transcriptomic analysis. Not surprisingly, pathway-based
analysis of young subjects with active TB versus contacts
showed upregulation of IL6, complement, and type Iinter-
feron response gene (IRGs such as OAS1/2, IFI6/27, IFIT2/3
and IRF7) pathways signifying a coordinated innate immune
response. Interestingly, many of the same IRGs expressed
in active TB in younger individuals were also upregulated
in older highly exposed versus younger highly exposed.
360
However, this IRG expression was in the context of type II
IRG (IFNG), IL12 and other proinflammatory cytokine sign-
aling consistent with higher activation of the inflammasome
upon TB exposure in the aged. PBMC were also stimulated
with TB and CMV for study by multiparameter flow cytome-
try. Surprisingly the magnitude and polyfunctional quality of
memory CD4+ T cells responding to TB antigens was similar
between the age groups measuring TNF, IFN, and IL-2. The
polyfunctional profile however was different between T cells
responding to TB and CMV supporting a specific phenotype
to TB responding cells. Several inhibitory receptors associ-
ated with exhaustion (CD160, 2B4,PD-1) have a trend or are
higher in CD4+ T cell memory subsets with age.
ALTERED MITOCHONDRIAL QUALITY CONTROL
IN MUSCLE OF OLD CACHECTIC PATIENTS WITH
GASTRIC CANCER
R.Calvani, M.Lorenzi, A.Picca, F.Landi, F.Tanganelli, per 1,000 person years). Raised SBP significantly increases
M.Bossola, R.Bernabei, E.Marzetti, Catholic University of
the Sacred Heart, Rome, Italy
Mitochondrial dysfunction has been involved in mus-
cle wasting associated with cancer cachexia (CC). Whether
mitochondrial quality control (MQC) is altered in skeletal
myocytes during CC is still unclear. The present investiga-
tion sought to preliminarily characterize MQC pathways in
muscle of gastric cancer patients with cachexia. The study
followed a case-control cross-sectional design. Intraoperative
biopsies of the rectus abdominis muscle were obtained from
18 old patients with gastric adenocarcinoma (nine with CC
and nine non-cachectic) and nine controls, and assayed for
the expression of a set of MQC mediators. Mitofusin 2
(Mfn2) expression was reduced in cancer patients compared
with controls, independent of CC, while fission protein 1
(Fis1) was up-regulated in CC patients relative to the other
groups. As a result, the fusion index (Mfn2/Fis1 ratio) was
lower in patients with CC. The mitophagy regulators PTEN-
induced putative kinase 1 and Parkin were down-regulated
in cancer patients compared with controls. The ratio between
the protein content of the lipidated and non-lipidated forms
of microtubule-associated protein 1 light chain 3B was lower
in CC patients relative to controls and non-cachectic can-
cer patients. Finally, the expression of autophagy-associated
protein 7, lysosome-associated membrane protein 2, peroxi-
some proliferator-activated receptor- coactivator-1, and
mitochondrial transcription factor Awas unvarying among
groups. In gastric cancer patients, cachexia is associated with
derangements of the muscular MQC axis at several check-
points: mitochondrial dynamics, mitochondrial tagging for
disposal, and mitophagy signaling. Further investigations
are needed to corroborate these preliminary findings and
determine whether MQC pathways they may be targeted for
interventions.
ESTIMATION OF CAUSAL EFFECTS ON HAZARDS OF
MAJOR AGE-RELATED DISEASES USING MENDELIAN
RANDOMIZATION
L.He, I.Culminskaya, Y.Loika, K.Arbeev, O.Bagley, vs 49.03.9nM, p<0.05) and contractions (5.70.7 vs
A.I.Yashin, A.Kulminski, Social Science Research Institute,
Duke University, Durham, North Carolina
Elucidating the causal effects of common intermedi-
ate phenotypes on the onset of age-related diseases such
Innovation in Aging, 2017, Vol. 1, No. S1
as cardiovascular diseases (CVD), diabetes mellitus (DM),
Alzheimers disease and cancer is indispensable for develop-
ing prevention and intervention procedures. We conducted
a Mendelian randomization study to investigate the causal
effects of cardiovascular risk factors including body mass
index (BMI), systolic blood pressure (SBP), and lipids on
the age-of-onset of various age-related diseases using three
large-scale longitudinal cohorts (ARIC, CHS and MESA). We
performed a two-stage time-to-event analyses using additive
hazard models followed by a meta-analysis using a fixed-
effects model, in which we constructed weighted polygenic
scores based on genetic markers from previously reported
genome-wide association studies as instrumental variables to
estimate the causal effects. Our results show that elevated
BMI at the baseline increases the hazard of stroke with a
meta-analysis p-value of 1.82e-02 (beta=3.11e-04, i.e., one
unit increase of BMI is associated with 0.311 extra cases
the hazards of coronary heart diseases (beta=3.66e-04,
p=1.44e-03) and CVD (beta=4.17e-04, p=2.51e-02). We
confirm that the association between low-density lipopro-
tein cholesterol and onset of Alzheimers disease is due to
the pleiotropic effect in APOE. Surprisingly, we observe that
triglycerides have a significant negative causal effect on the
hazard of DM consistently across the three cohorts (beta=-
1.88e-05, p=9.93e-03). These findings have important impli-
cations in guiding effective intervention strategies to reduce
the incidence of these diseases.
INFLUENCE OF ACE INHIBITORS ON FRAILTY AND
CARDIAC FUNCTION IN MIDDLE-AGED FEMALE
C57BL/6 MICE
A.E.Kane, K.Keller, S.E.Howlett, Pharmacology,
Dalhousie University, Halifax, Nova Scotia, Canada
ACE inhibitors improve exercise capacity in older adults
without cardiovascular disease and in aged rodents. We
hypothesised that chronic ACE inhibitor treatment may
attenuate frailty through changes in cardiac function.
Female C57BL/6 mice (12 months) were given enalapril
(40mg/kg/day; n=10) or control (n=10) for 3 months.
Frailty was quantified with the mouse clinical frailty index
(FI). Blood pressure (BP) was measured with a tail-cuff and
in vivo cardiac function was measured using echocardiog-
raphy. Cardiomyocytes were isolated for field-stimulation
and voltage clamp experiments (2 Hz). FI scores were sig-
nificantly lower in the enalapril group when compared
to control mice (0.140.01 vs 0.210.03, p<0.05) after
3months. BP, heart structure and contractile function were
not significantly different between the enalapril and control
groups. Field stimulation experiments showed that enalapril
treatment increased cell shortening (1.60.2 vs 3.00.5
%, p<0.001), velocity-to-peak contraction (0.0680.005
vs 0.133 0.016 m/ms, p<0.001) and relaxation
(0.0440.005 vs 0.1000.016 m/ms, p<0.001), with
no change in underlying calcium transients. Under volt-
age clamp conditions both calcium transients (37.63.2
8.90.9 %, p<0.05) were increased by enalapril treat-
ment. Calcium current and sarcoplasmic reticulum (SR)
calcium content were unchanged. These results show that
enalapril attenuates frailty in middle-aged animals, even in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
the absence of cardiovascular disease, and suggest that ACE
inhibitor treatment may increase calcium release from the
SR.
SARCOPENIA AND MORTALITY IN COMMUNITY-
DWELLING ELDERLY INDIVIDUALS IN RIO DE
JANEIRO, BRAZIL
V.G.Moreira, J.S.Nascimento, R.A.Loureno, Internal lites and lipids. Our results suggest that metabolic changes,
Medicina, Universidade do Estado do Rio de Janeiro, Rio
de Janeiro, Rio de Janeiro, Brazil
Sarcopenia is a health problem related to aging and changes
in body composition, and are associated with poor prognosis
for several clinical outcomes. The European Working Group
(EWGSOP) define sarcopenia as loss of muscle mass, plus
low muscle strength and/or low physical performance. The
aim of this study was to determine the association of sarco-
penia and mortality in elderly. The sample was composed by
745 community-dwelling individuals, 65years old and older,
living in Rio de Janeiro, Brazil, who participated in FIBRA
study. Their health habits, functional capacity, and anthropo-
metric measures were analyzed. The present study diagnosed
sarcopenia assessing usual gait speed, grip strength and mus-
cle mass measured through anthropometry. Other covariates
were assessed in order to test the independent association
of sarcopenia with mortality. 70.3% were female, 61.9%
Caucasian; average age: 76.6 (SD6.9) years. In total, 222
individuals died during the seven years of follow-up (25.0%).
Univariate analyses, Kaplan-Meier curves and log-rank test
were significantly associated with mortality from sarcopenia
(p< 0.001). However, in cox-regression multivariate model,
after adjustment for other variables, only age, Instrumental
Activities of Daily Living and health self-perception were
associated with mortality [OR: 9.4 (CI95% 3.624.2; p <
0.001); 1.7 (CI95% 1.013.1; p=0.043); 3.1 (CI95% 1.26 PCR (Q-RT-PCR) was performed using Taqman probes with
7.59; p=0.013), respectively. In conclusion, in the present
study sarcopenia was not associated with mortality.
METABOLIC BIOSIGNATURES OF FRAILTY IN AN
ELDERLY SPANISH POPULATION
D.Monleon1, C.Borras2, F.Garcia-Garcia3, A.Pellin- copenia in this cohort was 16%. Myostatin mRNA expres-
Carcelen2, M.Ingles2, M.Dromant2, J.Via2, 1. Health sion tended to be lower (29%) in those without sarcopenia
Research Institute INCLIVA, Valencia, Spain, 2. University
of Valencia, Valencia, Spain, 3. Hospital Virgen del Valle,
Toledo, Spain
Increase in life expectancy actually represent an increased
burden of disability. Frailty involves a decreased capacity to
respond to demands because of diminishing of functional
reserves and precedes disability in most of the cases. Frailty
encompasses changes associated with ageing, life styles,
chronic diseases and the interactions among them. Recent
findings suggest that changes associated with sarcopenia and
with the balance between production and use of energy may
be among the most relevant factors associated with frailty.
Early detection of subclinical changes is key to prevent-
ing or delaying the development of frailty. Metabolomics
is the systematic study of the unique chemical fingerprints
that specific cellular processes leave behind. By measuring
metabolic reagents and end products, metabolomics repre-
sents a unique molecular phenotype integrating the influ-
ence of genotypes, lifestyle and environment. In the present
study, we present blood serum metabolomic biosignatures
IAGG 2017 World Congress
361
of robustness, pre-frailty and frailty in a Spanish elderly
population from Toledo cohort. Poly and mono unsaturated
fatty acids, branched-chain amino acids, trimethylamine and
derivatives, and total creatine contribute the most to these
specific biosignatures. In addition, inter-metabolites cor-
relations in the frailty subgroup show dramatic differences
with respect robustness especially in mitochondrial metabo-
detectable by NMR metabolomics, precede the clinical onset
of frailty. This represent a robust, cheap, reproducible and
rapid approach that may help in early detection of frailty,
better therapeutic and preventive strategies and personalized
management of the patient.
THE ROLE OF SKELETAL MUSCLE MYOSTATIN IN
SARCOPENIA IN OLDER ADULTS
A.S.Ryan1,2, M.C.Serra1,2, O.Addison1,2, 1. University of
Maryland School of Medicine, Baltimore, Maryland, 2.
Baltimore VA Geriatric Research, Education and Clinical
Center, Baltimore, Maryland
Myostatin is a key negative regulator of muscle mass in
humans and animals, having direct and indirect influences
on molecular regulators of atrophy and hypertrophy, thus
may impact fitness and physical function. We have shown
that myostatin is elevated in conditions of chronic disability
(e.g. paretic limb of stroke). Our hypothesis is that myostatin
would be elevated in older adults with sarcopenia The pur-
pose of this study was to examine the role of skeletal muscle
myostatin in sarcopenia. Thirty-eight normal-weight to obese
(BMI: 335kg/m2, XSEM, range 2145kg/m2) men (n=21)
and women (n=17) aged 4581years underwent a VO2max
test, DXA scan to determine appendicular lean tissue (ALM),
and vastus lateralis muscle biopsy. Quantitative real time
36B4 as a reference to determine myostatin mRNA expres-
sion. Rates of sarcopenia were determined using (ALM/BMI)
and sarcopenia was defined as < 0.789 in men and < 0.512
in women. Subjects had low fitness (VO2max: 241ml/kg/
min) and on average 411% body fat. The prevalence of sar-
than those with sarcopenia (686 vs. 9618 AU, P=0.09).
Myostatin expression was not related to age or VO2max.
While myostatin may be important in muscle atrophy and
sarcopenia, further work could address its implication in
other aging cohorts of disability and chronic disease.
INCREASED CORTICAL POROSITY IN WOMEN WITH
HIP FRACTURES
M.Lorentzon, D.Mellstrm, A.Nilsson, D.Sundh, Geriatric
Medicine, University of Gothenburg, Mlndal, Sweden
Background: Hip fractures cause increased mortality and
disability and consume enormous health care resources. Only
46% of hip fracture patients have osteoporosis at the total
hip according to dual energy X-ray absorptiometry (DXA)
measurement. Cortical porosity increases with ageing and is
believed to be important for bone strength.
Objective: To investigate if older women with hip fracture
have higher cortical porosity than controls and if this differ-
ence is independent of clinical risk factors and areal bone
mineral density (aBMD).
362
Methods: From an ongoing population-based study,
we identified 46 women with a prevalent x-ray verified
hip fracture and 361 controls without any fracture. Areal
BMD was measured with DXA. High-resolution periph-
eral quantitative computed tomography (HR-pQCT) was
used to measure bone microstructure at the manufacturers
standard (ultradistal) site and at 14% (distal) of the tibia
length.
Results: Women with a previous hip fracture had lower
aBMD at the femoral neck (-11.8%) and total hip (-14.6%)
as well as higher cortical porosity at the ultradistal (32.1%)
and distal (29.3%) tibia than controls. In multivariable logis-
tic regressions, with covariates (age, height, weight, smok-
ing, physical activity, calcium intake, current treatment with
bisphosphonates, oral glucocorticoids, rheumatoid arthritis,
heredity for hip fracture, alcohol consumption and femoral
neck aBMD), cortical porosity at the ultradistal (Odds Ratio
per SD increase (95% confidence interval) 2.70 (1.843.95);
p<0.001) and distal (1.57 (1.132.17); p=0.01) site was asso-
ciated with prevalent hip fracture.
Conclusion: Cortical porosity was independently of fem-
oral neck aBMD and clinical risk factors associated with
prevalent hip fracture in older women.
AGING AGGRAVATES ALCOHOLIC LIVER INJURY
AND FIBROSIS BY DOWNREGULATING HEPATIC
SIRTUIN1 EXPRESSION
S.Yin1,2, H.Wang3,2, 1. Anhui Provincial Hospital, Hefei,
China, 2. NIH/NIAAA, Bethesda, Maryland, 3. The First
Affiliated Hospital,Institute for Liver Diseases of Anhui
Medical University, Hefei, China
Alcoholic liver disease (ALD) is one of the most preva-
lent liver disease worldwide. The spectrum of ALD includes
fatty liver, steatohepatitis, fibrosis/cirrhosis and hepatocel-
lular carcinoma. The role of chronic ethanol consumption
and aging in ALD still remain unclear. We hypothesized that
aging may have an interaction effect with ethanol exposure
that may down-regulates hepatic SIRT1 protein expression,
inducing liver fibrosis and ALD. For our studies, these mice
were fed with control or Lieber DeCarli liquid diets contain-
ing 5% ethanol for 10 days, followed by a single ethanol
binge or fed up to 8 weeks, which included multiple ethanol
binges. Liver injury and fibrosis were measured using histol-
ogy, protein and gene-expression levels. Hepatic stellate cells
and hepatocytes were isolated for in vitro studies. Results
from liver histology from multiple binges revealed that there
was more steatosis and fibrosis in the livers from ethanol-
fed old mice when compared to the single binge mouse
model. Results showed that the chronic ethanol feeding plus
one ethanol binge, levels of hepatic protein of SIRT1 were
reduced in old mice. Chronic multiple binge ethanol exposed
old mice demonstrated more steatosis, neutrophil infiltration
and fibrosis when compared to young mice, correlating to
the characteristics of ALD. The current results suggest that
aging down-regulates hepatic SIRT1 protein expression in
hepatocytes from old mice, consequently inducing alcoholic
liver injury and fibrosis. These findings will help us to better
understand the importance of how aging and alcohol greatly
affects the elderly population, and develop ways to help pre-
vent further injury.
Innovation in Aging, 2017, Vol. 1, No. S1
AGEING AND DRUG-INDUCED LIVER INJURY:
INSIGHTS FROM ANIMAL STUDIES
J.Mach1,2,3, A.Huizer-Pajkos1,3, S.Mitchell4, L.Phillips1,
A.E.Kane7, R.de Cabo4, D.G.Le Couteur2,5,6, S.N.Hil
mer1,2,3, 1. Kolling Institute of Medical Research, Sydney,
New South Wales, Australia, 2. University of Sydney,
Sydney, New South Wales, Australia, 3. Royal North Shore
Hospital, Sydney, New South Wales, Australia, 4. National
Institute of Aging, Baltimore, Maryland, 5. Centre for
Education and Research on Ageing and Anzac Research
Institute, Sydney, New South Wales, Australia, 6. Concord
Hospital, Sydney, New South Wales, Australia, 7. Dalhousie
University, Halifax, Nova Scotia, Canada
Elders are thought to be at increased risk of drug induced
liver injury (DILI), however there is little empirical evidence
to prove it. We aimed to determine the effect of ageing on
DILI in male Fischer 344 rats. Young and old rats were
treated via intraperitoneal injection with toxic regimens of
either acetaminophen (single dose of 800mg/kg) or isoniazid
(4 doses daily; low dose regimen: 100, 70, 70, 70mg/kg or
high dose regimen: 150, 105, 105, 105mg/kg (3 hours apart)
over 2days) or vehicle controls. After euthanasia, sera and
livers were collected for testing. With acetaminophen treat-
ment, higher serum drug levels were observed in old than in
young animals, but conversely serum hepatotoxicity markers
were elevated in young animals but not old. Hepatic DNA
fragmentation was increased in old animals treated with
acetaminophen when compared to all other groups. Similarly,
with isoniazid treatment, higher levels of hepatotoxic metab-
olites were observed in old than in young animals, and serum
hepatotoxicity markers were elevated in young animals but
not in old. Compared to age-matched controls, with isonia-
zid treatment there was a trend towards increased necrosis in
young rats and increased hepatic microvesicular steatosis in
old. Toxic isoniazid insults did not cause hepatic DNA frag-
mentation. In both studies, the activity of hepatic CYP2E1,
which generates toxic intermediates from acetaminophen
and isoniazid, was significantly reduced in old animals
compared to young. Old age affects the pattern and risk of
DILI from acetaminophen and isoniazid differently and age-
related changes in metabolism probably contribute.
SESSION 845 (POSTER)
ELDER ABUSE, NEGLECT, AND EXPLOITATION
EVALUATING OUTCOMES OF ADULT PROTECTIVE
SERVICES IN THE UNITED STATES: WHAT DO WE
KNOW?
J.S.Ernst1, A.E.Navarro2, 1. Wayne State University School
of Social Work, Detroit, Michigan, 2. University of Southern
California School of Medicine, Alhambra, California
To provide baseline knowledge to aid in development
of measurable outcomes and promote program evaluation
in Adult Protective Services (APS), a review of quantitative
and qualitative research published between 2005 and 2015
was conducted to examine outcomes of APS interventions in
the United States. Balancing the need to protect clients with
upholding their self-determination, APS investigates reports
of abuse, neglect, exploitation, and self-neglect of vulnerable
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
older adults and adults with disabilities, assesses situations,
and offers services to reduce risk for abuse, neglect, and
exploitation. In spite of APSs vital role in protecting vul-
nerable adults, evaluation research that uses clearly defined
and operationalized outcomes, which are necessary to exam-
ine program impact, is scarce. In addition to risk reduction
and increased client safety, other possible outcomes of APS
intervention include upholding self-determination for clients
capable of making informed decisions. Thirteen published
studies met the criteria. The majority were retrospective case
reviews that relied on case records, data collected by APS
workers, and case management systems. Eight studies used
measures of risk reduction or continuation of abuse. Others
identified outcomes related to case processes and included
investigation outcomes (confirmed or not confirmed), recidi-
vism, provision and refusal of services, and referral to the
court or criminal justice system. Based on these findings and
principles of program evaluation that encourage use of pro-
gram theory and logic models, recommendations are pro-
vided that aim to encourage APS research that determines
what works, for whom, and under what conditions.
ADVANCING POLICY AND PRACTICE IN ELDER
ABUSE: MESSAGE FROM STAKEHOLDERS IN HONG
KONG
S.Lo1, M.R.Nolan2, B.Penhale3, 1. The Hong Kong
Polytechnic University, Hong Kong, Hong Kong, Hong
Kong, 2. Sheffield University, Sheffield, Sheffield, United
Kingdom, 3. University of East Anglia, Norwich, Norwich,
United Kingdom
Elder abuse poses significant threats to older persons
well-being: physically, psychologically and socially, yet the
phenomenon has received relatively little attention in Hong
Kong despite its ageing population. Any measures intended
to address this issue are more likely to be effective if they
are informed by the perspectives of both older people and
practitioners.
A constructivist grounded theory approach was adopted
for this study involving personal interviews and 3 focus
groups with seniors, community-nurses and social workers.
Participants were initially selected purposively and then the-
oretical sampling was employed as categories emerged from
the data analysis. Data collection ceased when saturation
was reached.
Implications for policy and practice changes were
derived: 1) The ways in which financial assistance and hous-
ing policies currently operate were found to be insensitive to
older recipients dignity and unresponsive to their concerns
thereby potentially increasing their risk of being abused; 2)
Filial piety appears to be declining and policy-makers need
to seriously consider if legislation is needed to ensure that
older peoples needs are met; 3) New policies are needed that
enhance the integration of seniors into society and family
life; and 4) The older population, families and practitioners
need more education and awareness about elder abuse if pre-
ventative measures are to be put in place.
The perspectives unearthed by the study are of poten-
tially great value in the development of strategies to counter
this problem, thereby helping older people to age with ever
greater dignity.
IAGG 2017 World Congress
363
PUBLIC HEALTH AND ELDER ABUSE
C.Thomas, Committee on National Statistics, National
Academies of Sciences, Engineering and Medicine,
Washington, District of Columbia
A dynamic and multidimensional conceptualization of
elder abuse--its causes, manifestations, and consequences-
-can be grounded in a public health framework. A pub-
lic health model of elder mistreatment is proposed which
includes elements of public awareness (including educa-
tion, training, amd media campaigns), detection (processes
by which relevant authorities learn that an alleged incident
has taken place), and the development of laws and regua-
tions that support intervention and treatment strategies.
This model is used as a framework for assessing progress
in addressing and preventing elder abuse in selected coun-
tries in five regions around the world, according to informa-
tion provided by key informants in each country. Informants
provided detailed information on ongoing activities in iden-
tifying and reporting instances of abuse or neglect in their
countries, how official entities learn about abuse when it
occurs, laws and regulations, if any, and their enforcement.
Afinding of the study is that in these countries the primary
focus has been on promoting public awareness, and to some
extent in detecting abuse after it occurs. There has been lim-
ited attention to the development of laws and regulations
to address elder abuse, and insufficient enforcement of regu-
lations already on the books. The severe consequences for
health and well being of elderly victims of abuse are outlined
in a review of the literature on the impact of abuse on older
adults, including mortality, physical or emortional harm, and
institutionalization.
THE STRUGGLE AGAINST THE ABUSE AND
MISTREATMENT OF THE ELDERLY IN ISRAEL IN
2016
A.Bitchur, Or Yehuda Academic Center College, Or
Yehuda, Israel
Surveys held in Israel in 2015 by the Central Bureau of
Statistics and the Public Security Ministry found that the
number of elderly Israelis defined as age 65 and over
suffering from violence (by a third party), abuse and mis-
treatment (by relatives and individuals in their immediate
environment) and neglect (by caregivers, service providers,
and the public and governmental systems), was higher and
graver than in previous years.
Some 830,000 people were included in this national
survey and over 60% expressed concern for their physical
safety: They said they were afraid to be out at night, and con-
cerned they would be mugged when collecting their monthly
social security benefits. The findings also showed a growing
concern among the elderly that someone in their immediate
surroundings would neglect, mistreat, or abuse them. This
is a phenomenon no normative society should be willing to
tolerate.
This essay explores this phenomenon, and tries to deter-
mine the nature of potential assailants, and where and when
they are most likely to strike against the elderly; as well as
introduce the Inverted Focus model, that seeks to counter
this phenomenon on multiple levels, with the goal of eradi-
cating elderly abuse.
364
ELDER ABUSE AMONG SEXUAL MINORITY OLDER
ADULTS IN THE U.S.
Z.D.Gassoumis1, P.Nash2, 1. Leonard Davis School
of Gerontology, University of Southern California, Los
Angeles, California, 2. Swansea University, Swansea, United
Kingdom
Elder abuse is a serious concern for global public health
and for the health and well-being of victimized older adults. To
date, there is a paucity of research on the experience of elder
abuse among those who identify as lesbian, gay, or bisexual
(LGB) or who have engaged in same-sex sexual relationships
(SSSRs). Older sexual minorities have been subjected to high
rates of lifecourse victimization due to their sexual orienta-
tion, and certain sexual minority groups are at heightened
risk of intimate partner violence; however, concepts of elder
abuse are rarely explored in this population. This paper uses
a U.S.-based dataset from the National Social Life, Health,
and Aging Project (NSHAP; n=3,005) to investigate this phe-
nomenon. Although NSHAP does not ask participants about
sexual orientation, it records whether they have ever engaged
in SSSRs. While this group does not wholly encompass LGB
individuals, it provides initial insights into the elder abuse
experiences of a sexual minority population. In total, over 1
in 10 older adults in NSHAP were victims of verbal, finan-
cial, or physical abuse. The rates of abuse for those who had
engaged in SSSRs, though not significantly different from the
overall population, differed qualitatively from the rates of
abuse in non-SSSR individuals, both at large and within sub-
groups. These differences point to populations that might be
appropriate targets for elder abuse education and prevention
efforts and highlight the importance of collecting informa-
tion on both sexual minority status and elder abuse experi-
ences in large aging surveys.
AGE EFFECTS ON CONSUMERS EVALUATION OF
RISK AND BENEFITS IN SWEEPSTAKES SCAMS
S.Wood1, L.Klapatch2, P.Xi2, M.Liu3, 1. Psychology,
Scripps College, Claremont, California, 2. Claremont
Graduate University, Claremont, California, 3. U California,
San Fransisco, San Fransisco, California
Advance-fee fraud schemes are based on the concept that
the victim will be promised a substantial benefit, such as a
sweepstakes winning, but must pay a fee before the victim
can receive the benefit. With the global population grow-
ing older, sweepstakes scammers have been targeting older
adults wealth, and the scam becomes one of the top 10
senior scams. A laboratory-based approach was developed
to study the very initial steps of the advance fee scam with
an emphasis on evaluation of risk and benefit assessment.
Three-hundred-and-two adults (age range 1883), recruited
on Amazons Mechanical Turk, were randomly assigned into
one of the three conditions (low, medium, or high activa-
tion fee), informed to read a lottery-winning letter, then
were asked to answer some questions about its content.
Overall, we found 27.2% participants indicating willing-
ness to contact the sweepstakes company in order to acti-
vate the winnings. Age and activation fee amount predicted
contact likelihood in the same regression model, such that
older adults were less likely to comply (b=-.032, p=.001),
while high activation fee deterred participants from calling
(b=-.384, p=.010). However, both effects disappeared when
Innovation in Aging, 2017, Vol. 1, No. S1
quantitative ratings of risk and benefits were entered into the
model. Assessment of higher risk discouraged contact (b=-
.583, p<.001), but higher benefit assessment was associated
with contact (b=.407, p<.001). Participants were often aware
that many of these pitches are scams, but unaware that the
main goal of the scammers is to obtain contact information
for future requests.
SCREENING AND ASSESSMENT OF ELDER ABUSE:
AN EVALUATION OF NICE TOOLS
L.McDonald1, A.Hussain1, R.M.Mirza1, E.Relyea1,
M.Beaulieu2, G.M.Gutman3, C.Klinger4, B.MacDonald4,
1. Social Work, University of Toronto, Toronto, Ontario,
Canada, 2. Universite de Sherbrooke, Montreal, Quebec,
Canada, 3. Simon Fraser University, Vancouver, British
Columbia, Canada, 4. Institute for Life Course and Aging,
University of Toronto, Toronto, Ontario, Canada
Elder abuse (EA) has various dimensions, includ-
ing physical, sexual and psychological abuse, which
make screening and assessment challenging. As part of a
larger project, the National Initiative for the Care of the
Elderly (NICE) developed evidence-based tools to address
these challenges. However, as no formal evaluation of
these instruments has been conducted, the current study
examines and evaluates the impact of NICE EA tools.
Participants with NICE membership were randomly sam-
pled (n=438: 79.7% practitioners; 7.5% students; 4.5%
older adults/informal caregivers; and 8.2% other) and
asked to complete a telephone survey to assess the instru-
mental impact (use of tools), conceptual impact (impact
of knowledge in tools), and symbolic impact (whether the
tools confirmed actions/decisions) of the tools. Of 438 par-
ticipants, 74 reported using EA tools the most, with 46%
of these users indicating that the tools had an instrumental
impact (i.e., information in the EA tool changed their daily
work practices and/or they adopted ideas/actions from
the tool). Additionally, 31% indicated that the tools had
a conceptual impact, as the tools increased their knowl-
edge of EA and influenced their work practices. Finally,
45% reported the EA tools confirmed their actions at work
and helped justify their decisions to co-workers and clients.
These results suggest that NICE EA pocket tools have a
conceptual, instrumental, and symbolic impact on improv-
ing knowledge and practices related to EA among multiple
stakeholders. Screening tools, such as the ones developed
by NICE, may help raise awareness to the possibility of
elder abuse.
SYSTEMATIC REVIEW AND META-ANALYSIS OF
ELDER ABUSE AMONG WOMEN
Y.Yon1, C.Mikton2, Z.D.Gassoumis1, K.H.Wilber1, 1.
Gerontology, University of Southern California, Langley,
British Columbia, Canada, 2. World Health Organization,
Geneva, Switzerland
Elder abuse among older women is a significant prob-
lem. Developing a better understanding of the extent of the
problem is an important step to violence prevention. We
conducted a systematic review and meta-analysis of all exist-
ing prevalence studies to determine the extent of the abuse
against older women and to disentangle the wide variations
in prevalence estimates by investigating the associations
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
between prevalence estimates and the studies demographic
and methodological characteristics. A total of 50 studies
were included in the meta-analysis. The combined preva-
lence for overall elder abuse in the past year was 14.1%
(95% CI: 11.018.0). Pooled prevalence for psychological
abuse was 11.8% (95% CI: 9.214.9%), neglect was 4.1%
(95% CI: 2.76.3%), financial abuse was 3.8% (95% CI:
2.55.5%), sexual abuse was 2.2% (95% CI: 1.63.0%),
and physical abuse was 1.9% (95% CI: 1.23.1%). The
studies included for meta-analysis for overall abuse were
heterogeneous indicating that significant differences among
the prevalence estimates do exist. Significant associations
were found between prevalence estimates and the follow-
ing covariates: WHO regions, countries income classifi-
cation and studies sample size. Together, these covariates
explained 37% of the variance. More work is needed to
understand the variation in prevalence rates and implica-
tions for prevention.
RISK AND PROTECTIVE FACTORS FOR ELDER
FINANCIAL EXPLOITATION BY FAMILY POWER OF
ATTORNEY AGENTS
B.A.Steinman1, A.E.Betz-Hamilton6, C.R.Bolkan2,
C.Jasper3, M.S.Stum4, P.B.Teaster5, V.Vincenti1, 1. psychological abuse is 11.6% (95% CI: 8.116.3%), finan-
Human Development and Family Science, University
of Wyoming, Laramie, Wyoming, 2. Washington State
University, Vancouver, Washington, 3. University of
Wisconsin, Madison, Wisconsin, 4. University of Minnesota,
St. Paul, Minnesota, 5. Virginia Polytechnic Institute &
State University, Blacksburg, Virginia, 6. Eastern Illinois
University, Charleston, Illinois
Elder Financial Exploitation (EFE) by a family member
POA agent is a form of elder mistreatment perpetrated by
family members appointed by an older adult to manage
health care, financial decisions, or both. Survey and inter-
view data from 60 participants compared POA agent experi-
ences from two types of families: those with successful POA
experiences absent EFE and those experiencing EFE by a
POA agent. Prior to the identification of EFE, the majority
of older adults experienced declines in physical and cognitive
functioning; many exhibited poor financial practices prior
to invoking POA authority. The majority of exploiting POA
agents were financially dependent upon the older adult and
exhibited narcissistic behaviors. Experiences of participating
family members (typically an adult child of elder/non-perpe-
trator) suggested risk factors for exploitation, including an
elders declining physical and cognitive health, POA agents
financial dependence on the older adult, heightened sense of
entitlement to the elders resources, geographic proximity to
the elder, and low quality family relationships and function-
ing. Protective factors included the POA agents integrity and
accountability and communication with family members,
high levels of family functioning, and positive family rela-
tionships. Findings suggest the importance of estate planning
considering personality, values, and family relationships in
selecting POA agents, and inclusion of accountability and
checks and balances as early as possible as well as mainte-
nance of clear communication to all family members pertain-
ing to the appointment and accountability of the POA agent.
These findings provide insight into factors to target in needed
EFE prevention and intervention efforts.
IAGG 2017 World Congress
365
SYSTEMATIC REVIEW AND META-ANALYSIS OF
ELDER ABUSE PREVALENCE
Y.Yon1, C.Mikton2, Z.D.Gassoumis1, K.H.Wilber1, 1.
Gerontology, University of Southern California, Langley,
British Columbia, Canada, 2. World Health Organization,
Geneva, Switzerland
Background. Elder abuse is a public health problem and
gaps remain in estimating its prevalence. We conducted a sys-
tematic review and meta-analysis with the aim to quantify
the extent of the problem and to disentangle the variations
in prevalence estimates by investigating the associations
between prevalence estimates and the studies demographic
and methodological characteristics.
Methods. We employed a 4-step comprehensive search
strategy including a 14 electronic database search to identify
studies that reported elder abuse prevalence. For the analysis,
we examined studies reporting abuse occurring within the
past year.
Findings. Of the 38,544 studies initially identified, 52
were eligible for inclusion. These studies were geographically
diverse in 28 countries. Prevalence rates for overall elder
abuse were reported in 43 studies with the pooled preva-
lence of 15.9% (95% CI 12.819.5%). Pooled estimates for
cial abuse was 6.8% (95% CI: 5.09.2%), neglect was 4.2%
(95% CI: 2.18.1%), physical abuse was 2.6% (95% CI:
1.64.4%), and sexual abuse was 1.6% (95% CI: 1.12.2%).
The studies included for meta-analysis on overall abuse were
heterogeneous with significant associations between preva-
lence estimates and the following covariates: sample size,
income classification and method of data collection. No gen-
der difference was found in the prevalence estimates.
Interpretation. Findings showed that elder abuse is a
major problem. Robust studies are absent for most regions
of the world, particularly in low- and middle-income coun-
tries. Gender symmetry of abuse prevalence is discussed and
intervention programs need to be focused on both genders.
FINANCIAL EXPLOITATION: LESSONS LEARNED
FROM ASTUDY OF PEOPLE HOLDING LASTING
POWERS OF ATTORNEY
M.L.Gilhooly1, G.Dalley1, K.J.Gilhooly1,3, P.Harries1,
M.Sullivan1, M.Levi2, 1. Department of Clinical Sciences,
Brunel University London, Uxbridge, England, United
Kingdom, 2. Cardiff University, Cardiff, Wales, United
Kingdom, 3. University of Hertfordshire, Hatfield, England,
United Kingdom
Financial exploitation of older and vulnerable people
appears to be increasing in the UK. The aim of this study
was to investigate the nature and extent of financial abuse of
individuals lacking mental capacity. There were three com-
ponents to the study, (1) a case study of a London borough,
(2) an online survey and (3) an analysis of cases referred
to the Court of Protection in which people holding lasting
powers of attorney were thought to have been financially
exploiting the donor. This paper is concerned with the third
component of the study. The Court of Protection cases were
obtained from public records. Sixty three cases were analysed
in relation to (a) Applicant to the Court, (b) Respondent to
the case, (c) Grounds for making the application, (c) Object
of the application e.g. appointment of deputy; revocation,
366
(d) Evidence of possible financial abuse, (e) Evidence of
intra-family dispute, (f) Outcome. Triggers for suspicion of
financial abuse included care home fees arrears and failure
to provide personal allowance, failure to submit account to
the Office of the Public Guardian, and co-mingling of funds.
This paper will, in addition, describe cases. For example,
a son holding a lasting power of attorney not only gifted
himself large sums of his mothers money, but charged her
estate 400 every time he visited. The senior judge hearing
the case made his view clear by describing this behaviour as
repugnant.
NEW FORMS OF ELDER ABUSE FROM RURAL AND
URBAN ZAMBIA
I.Kabelenga1,3, R.K.Sishimba2, 1. University of Zambia,
Luska, Zambia, 2. Senior Citizens Association of Zambia
(SCAZ), Lusaka, Zambia, 3. University of Lapland,
Rovaniemi, Finland
Aim: The aim of this paper is to add new forms of elder
abuse to the existing scientific literature on elder abuse.
Philosophical foundation of the study: Social construc-
tionism guided this study.
Methodology: The study utilized qualitative research
that included 31 one-on-one in-depth interviews and 7 focus
group discussions. This was undertaken for the period of
five months (August to December, 2014)in two districts of
Zambia one rural and one urban with community leaders.
The data were analyzed using a grounded theory methodol-
ogy to determine recurring themes that were mentioned by
the informants.
Results: The study results indicate that besides physical,
financial/material, verbal and neglect abuses as widely shown
in the available literature on elder abuse, two additional
types of elder abuse are also taking place in Zambia. These
are spiritual abuse and political abuse.
Conclusions: The study concludes that elder abuse
does not exist in six many forms as widely reported in
world reports such as those produced by World Health
Organization. Rather, it exists in many forms which differ
from society to society. On the basis of this, the study argues
that besides the common typologies of elder abuse that have
dominated existing literature, two typologies of elder abuse
should be added to the existing literature. These are spiritual
abuse and political abuse. This is because they suggest new
ways of thinking about the problem of elder abuse.
RECENT DEVELOPMENT OF OMBUDSMAN
PROGRAMMES FOR THE ELDERLY CARE FACILITIES
IN KOREA
J.Kim2, S.Lee1, T.Park 1, K.Kwon1, 1. Seoul Cyber cesses. Policy implications include impacting entitlement
University, Dept. of Social Welfare, Seoul, Korea (the
Republic of), 2. Catholic University of Pusan, Busan, Korea
(the Republic of)
Recently, the Ombudsman program has been introduced
to prevent elder abuse in elderly care facilities. However, the
program has no coercive powers in Korea. As a result, many
care workers and elderly people witness and experience elder
abuse cases(mainly verbal aggression, ignoring requests and
threatening communication) in the long term care facili-
ties. Thus, this study is to review the policy development of
Innovation in Aging, 2017, Vol. 1, No. S1
Ombudsman programs in long term care facilities in East-
Asia countries. Secondly, this paper investigates care work-
ers experiences of Ombudsman programmes and elder abuse
cases where some elderly care facilities have already operated
the program. Thirdly, the research examines the Ombudsman
system in terms of official approval, mandatory implemen-
tation, the right of investigation, professionalism, and the
functions of coordination, guidance and recommendation.
To collect data to develop the Ombudsman programs we
conducted FGIs, using the Delphi technique, with 45 experts
in geriatric social work institutions and long term care facili-
ties. Finally, this research suggests that Elderly Ombudsman
Agency, as an state organization, should be established to
investigate elder abuse screening affairs.
WHEN ITS FAMILY: EXAMINING ENTITLEMENT
AS ARISK FACTOR FOR ELDER FINANCIAL
EXPLOITATION
M.S.Stum1, R.Kilderia1,3, M.Peterson2, 1. Family Social
Science, University of Minnesota, St. Paul, Minnesota, 2.
Minnesota Elder Justice Center, St, Paul, Minnesota, 3.
School of Social Work, St. Paul, Minnesota
Elder family financial exploitation (EFFE) is widely recog-
nized as the fastest growing and most common form of elder
abuse internationally. A sense of entitlement to an elders
resources has been identified as a motivator for exploitation,
but remains relatively unexplored. This study contributes
needed conceptual and practical clarity and understanding
of entitlement within the context of diverse intergenerational
families and societies. An innovative three point spectrum of
entitlement norms, beliefs, and behaviors is proposed inte-
grating concepts from social exchange and interpersonal
social justice theories, and findings from a systematic review
of empirically based international EFFE literature (2000+).
At one end of the spectrum, normative entitlement includes
a range of intergenerational resource sharing and exchange
obligations and expectations (money, time, housing). On the
other end of the spectrum, exploitative entitlement includes
identifiable financial exploitative behaviors, and narcissistic
personality disorders. The middle of the spectrum includes
justified entitlement, when entitlement beliefs serve as
excuses for misuse of resources and inappropriate behaviors.
Two common justification examples include feeling entitled
to an inheritance (just taking whats mine now), and to com-
pensation for caregiving or other types of support (its only
fair).The entitlement spectrum can be used to help conceptu-
ally inform EFFE research agendas, train practitioners, and
develop family-focused prevention tools for assessing a range
of entitlement norms and beliefs during estate planning pro-
social norms and practices (e.g. remove incentives for a sense
of inheritance entitlement in United States Uniform Probate
Code and state statutes).
ELDER FINANCIAL EXPLOITATION: PERSPECTIVE
FROM THE FINANCIAL SERVICES INDUSTRY
S.Skees, M.Tucker, Wells Fargo Advisors, St. Louis,
Missouri
The Elder Client Initiatives (ECI) team at Wells Fargo
Advisors (WFA) is dedicated to addressing suspected
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Innovation in Aging, 2017, Vol. 1, No. S1
financial abuse of WFA clients in all 50 states who are older
adults (age 60+) and vulnerable adults (1859). It is an inter-
disciplinary team with backgrounds in law, social work and
risk management. The ECI team determines whether cases
are appropriate for referral to Adult Protective Services and/
or other authorities.
Much of the current research on elder financial abuse is
based on self-reported measures. The nature of the ECI team
has allowed for the collection of a unique dataset contain-
ing over 2,000 cases. Three Chi Square tests were conducted.
The analysis of case type versus gender and case type versus
assets under management yielded no statistically significant
results. However, in the third analysis of case type and age,
statistically significant results were found. Results revealed
that those WFA clients w referred to the team who were
between the ages of 6069, while less likely to be victims
of exploitation by their family members, were more likely
to be victims of scammers. Individuals between 7079 were
more likely to be referred concerns about diminished capac-
ity, and those between 8089 were more likely to be victims
of exploitation by a family member.
These findings shed light on the complex issues facing the
financial services industry. The findings of this research will
inform further research efforts as ECI continues to engage
in evidence-informed practice and to coordinate efforts with
aging services providers.
A STUDY OF DIFFERENCES IN PERCEPTIONS OF
ELDER ABUSE AMONG PROFESSIONAL STAFF
MEMBERS
A.Katsumata1, N.Tsukada2, 1. Rehabilitation Institution,
Tokyo, Japan, 2. Nihon University, Tokyo, Japan
The purpose of this study was to examine differences in
perceptions of elder abuse among older couples between
professional staff at the Community Comprehensive Support
Centers (CGSCs) and DV counseling staff at DV Support
Centers and Womens Support Centers and to identify effec-
tive supports for the victims of elder abuse. Two datasets col-
lected in 2010 were merged and used for this study: (1) Data
for professional staff were collected from nationwide survey
of 4,042 CGSCs where a structured questionnaire survey
was provided to a randomly selected 1,282 CGSCs (N=621).
(2) Data for DV staff were collected from nationwide sur-
vey where a structured questionnaire survey was provided to
all 358 DV Support and Womens Support Centers (N=237).
The responses to the same 10 questions were analyzed.
Preliminary analyses revealed statistically significant dif-
ferences in perceived causes of elder abuse and important
supports to solve elder abuse among the two different sets
of staff. For example, elder abuse professional staff tend to
see causes of elder abuse among older couples as caregiving
stress, victims personality, and dementia of the victims, literatures.
on the other hand, DV staff perceived causes of elder abuse
as abusers tendency to control with power. Moreover,
while 74.5% of the DV staff felt coordination among the
two staff was important, 25.5% of DV support staff did so.
Thus, it is imperative that both professional staff recognize
differences in their perceptions and that their knowledge and
resources through coordination be exchanged to solve elder
abuse cases effectively and efficiently
IAGG 2017 World Congress
367
SESSION 850 (POSTER)
END OF LIFE
CARE NEEDS BY END-OF-LIFE STAGE AMONG NON-
CANCER PATIENTS AT HOME
J.Lee1, H.Lee1, Y.Park2, J.Jang2, J.Choi2, K.Lim2,
W.Choi2, J.Lee1, 1. The Catholic University of Korea,
Seoul, Korea (the Republic of), 2. Seoul St.Mary Hospital,
Seoul, Korea (the Republic of)
This study aimed to explore multidimensional care
needs for non-cancer patients by end of life stage and
palliative performance scale (PPS). A retrospective study
design was used. Home care nurses were asked to review
medical and nursing records and to respond structured
questionnaire. 115 participants who were at the ages
of 40 or over, continuously received home care nursing
throughout stable (between the beginning stage and one
week before the death) and near death (one week before
to the death) at Seoul St. Mary Hospital in Korea, and
died from September 1, 2014 to December 31, 2015 were
analyzed. Care needs for coordination among family or
relatives and support for fundamental needs areas were
significantly more important in the stable stage than in
the near death stage. The Loss, grief care area was sig-
nificantly more important in the near death stage than
in the stable stage. As patients initial PPS was lower, the
level of importance for care needs was higher especially
on management of physical symptoms and psychological
support areas in the stable stage and coordination among
family or relatives area in both stages. Future palliative
intervention need to develop based on patients-centered
assessment of PPS and care needs to ensure quality of life
for non-cancer patients who receive home care. Moreover
health care professionals should focus on continuous and
holistic tailoring end of life care through advance care
planning for non-cancer patients.
PALLIATIVE CARE FOR TERMINALLY ILL OLDER
PATIENTS IN NORTHEAST THAILAND
A.Nuttamonwarakul, Institute of Geriatric Medicine,
Department of Medical Services, Nonthaburi, Thailand
Aim: The aim of this study was to explore the existing
palliative care of terminally ill older patients in Northeast
of Thailand.
Material and methods: The study consisted of a cross-
sectional quantitative with questionnaire to survey in the
government hospitals with over of 120 beds and qualitative
interviews with a group of practitioners discussion to explore
care model of terminally ill older patients. Include the review
of current situation on terminal care of Thai elderly from the
Results: In quantitative interviews, the total number of
completed and returned questionnaires showed 43% suffer
from cancer, 57% suffer from non-cancer, 44% die in hos-
pital and 56% discharge to home. Percentages and mean
values were assessed using the Fishers exact test to deter-
mine the correlation of variables. Participants in qualita-
tive interviews using the content analysis, the work was in
Northeast areas. In Northeast of Thailand, palliative care of
368
older patients are part of regular health care in the hospitals.
Their services cover physical comfort, psychological wellbe-
ing, social functioning and spiritual wellbeing. In community,
the current results showed both formal and informal care of
terminally ill older patients.
Conclusions: The findings from the present study showed
difference types of palliative care for terminally ill older
patients between hospital-based and home-based care.
However, home care was proper in the elderly patients with
end stage who were in strong community and had network-
ing in each level of the hospital.
RESULTS FROM ASCOPING REVIEW ON END-OF-
LIFE NEEDS OF LGBT OLDER ADULTS
A.Stinchcombe5,6,1, J.Smallbone2, K.Kortes-Miller3,4,
K.Wilson2, 1. School of Psychology, University of Ottawa,
Ottawa, Ontario, Canada, 2. Adult Development and Aging
within the Department of Family Relations & Applied
Nutrition, University of Guelph, Guelph, Ontario, Canada,
3. Centre for Education and Research on Aging and Health
(CERAH), Lakehead University, Thunder Bay, Ontario,
Canada, 4. School of Social Work, Lakehead University,
Thunder Bay, Ontario, Canada, 5. Department of Health
Sciences, Lakehead University, Thunder Bay, Ontario,
Canada, 6. International Longevity Centre (Canada),
Ottawa, Ontario, Canada
Lesbian, gay, bisexual, and transgender (LGBT) older
adults face a number of challenges with respect to access to
healthcare especially towards end-of-life. Using a systematic
search and scoping review approach, the purpose of this
review was to determine the healthcare needs of LGBT older
adults nearing end-of-life as well as the factors that contrib-
ute to a good death experience among older adults who iden-
tify as LGBT. Asystematic search of electronic databases for
articles published between 2005 and 2016 as well as screen-
ing for relevance resulted in 25 results. The data were charted
and grouped according to the themes of: social support and
chosen family, intimacy, health status, fear of discrimination
and lack of trust, lack of knowledge and preparedness, and
cultural competence in the healthcare system. The results
suggest a role for health and social service workers in con-
tributing to a positive care experience for LGBT older adults
by becoming knowledgeable about the unique needs of this
population and being unassuming and accepting of individu-
als sexuality.
STATUS OF IMPLEMENTING GRIEF CARE IN
NURSING HOMES IN JAPAN
N.Morisaki, Himeji University, Himeji, Hyogo, Japan
The purpose of this research was to clarify the implemen-
tation status of grief care in nursing homes in Japan.
The subjects of this research were nurses who work in
nursing home in Japan. It was investigated using a question-
naire. The question items included sex, age, years of nurs-
ing experience, participation in grief care study sessions, and
implementation status of the grief care.
Responses were obtained from 120 nurses. The break-
down of subjects sexes was 5.0% men and 95.0% women.
Those in their 40s and 50s comprised 67.5%. Those with
10 to 20 years of nursing experience comprised 33.3%.
Innovation in Aging, 2017, Vol. 1, No. S1
Of respondents, 54.2% of nurses had participated in grief
care study sessions. Regarding implementation of grief care,
respondents answered in the following ways: The mental
process of mourning is explained to the family of the person
who passed away 50.0%, When the family of the deceased
person leaves the nursing home, words of consolation are
offered 96.4%, I attend the funeral 37.8%, Spiritual
care is given to the family thought to have elevated need for
it 11.9%, I feel a sense of achievement in the current status
of grief care 67.0%, and It is necessary to perform a fam-
ilys mental care as an organization 76.9%.
The result of the analysis shows that The mental process
of mourning is explained to the family was related to age
(p<0.01), and I feel a sense of achievement in the current
status of grief care was related to participation in grief care
study sessions (p<0.05).
AGREEMENT ON SEVERITY OF DEMENTIA AND
PRESENCE OF ADVANCE CARE PLAN IN NURSING
HOME RESIDENTS
N.J.Van Den Noortgate1,2, R.Piers1, R.Botterman1, L.Van
den Block2, 1. Ghent University, Ghent, Belgium, 2. End-of-
Life Care Research VUB-UGent, Brussels, Belgium
Background: Dementia and especially the stage of demen-
tia is often underdiagnosed. The white paper on dementia of
the European Association on Palliative Care identified the
recognition of severe dementia as a pitfall for high quality
palliative care.
Methodology: Data from a retrospective cross-sectional
study at 241 deceased residents in a random clustered sample
of 134 NH in Flanders. Clinical judgment of nurses (n=228)
and physicians (n=127) as well as the Global Deterioration
Scale (GDS) and Cognitive Performance Scale (CPS) was
investigated. Analyses were made using SPSS version 21.
Results: Nurses were more aware of the diagnosis of
dementia than physicians (OR = 5,39; CI: 1.8915.30).
There was a significant correlation between the GDS stage 7
and clinical judgement of the nurse (r=0.76, CI: 0.690.83)
and the physician (r=0.64, CI: 0.510.76). The correlation
between nurses and physicians regarding the stage of demen-
tia was 0.42 (p<0,001) at admission and 0,23 (p<0,050) at
death. Care planning was done with 18.7% of the residents
and with 70.1% of the relatives. There was no significant
correlation between the agreement on the stage of dementia
and the presence of an advance care plan.
Conclusion: The stage of dementia is not always recog-
nized by physicians visiting nursing home residents resulting
in a low agreement between nurses and physicians on the
stage of dementia. The agreement on the stage of dementia
seems not to be related with the presence of a care plan at
the end of life.
SPEECH-LANGUAGE PATHOLOGISTS VIEWS ABOUT
ASPIRATION RISK AND FEEDING IN ADVANCED
DEMENTIA
C.Berkman1, C.Vitale2, 1. Graduate School of Social
Service, Fordham University, New York, New York, 2.
University of Michigan, Ann Arbor, Michigan
Recent dementia practice guidelines recommend against
feeding tubes and use of thickened liquids in patients with
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
advanced dementia. Speech-language pathologists (SLPs)
often evaluate swallowing problems in such patients. The
study aim was to characterize circumstances under which
SLPs recommend continued oral feeding in patients with
advanced dementia at high risk of aspiration. A national
probability sample (n=731) completed a mail survey.
Participants who responded there were circumstances in
which they recommend oral feeding despite high aspiration
risk (N=509, 70.0%) were asked to describe the circum-
stances under which they do this. Two main categories of
reasons were given: 1)patient or family wishes; and 2)SLP
judgment. Reasons in the first category were: patient previ-
ously expressed preference to continue eating; patient has
advance directive opposing tube feeding; family opposes
tube feeding and/or wants to feed patient; family under-
stands risks involved and/or is willing to be educated about
safe diet and swallow guidelines. Reasons in the second cate-
gory included: patients medical status makes him/her a good
candidate for oral feeding; patient is at the end of life and
safety is not a major concern; reasonable risk if specified pro-
tocol is followed and staff are trained in safe feeding; pleas-
ure of feeding maximizes quality of life; family understands
risks of feeding; patient is a poor candidate for feeding tube;
consulting physician approves. Continued education about
palliative approaches, including comfort feeding, avoidance
of long-term use of thickened liquids and tube feeding in
advanced dementia is needed to increase use of evidence-
based practices by SLPs.
THE MEANING OF EXISTENTIAL LONELINESS AS
NARRATED BY FRAIL OLDER PEOPLE
M.Sjberg1,3, I.Beck1,2, B.Rasmussen2,4, A.Edberg1, 1. suggest experience discussing ACP and EOL increases learn-
Department of Health and Society, Kristianstad University,
Kristianstad, Sweden, 2. The Institute for Palliative Care,
Lund University and Region Skne, Lund, Sweden, 3. The
Faculty of Health and Society, Department of Care Science,
Malm University, Malm, Sweden, 4. The Faculty of
Medicine, Department for Health Sciences, Lund University,
Lund, Sweden
Aging often bring about several losses, such as loss of bod-
ily functions but also losses of significant others who pass
away. Older people being in the last period in life are particu-
larly vulnerable as they often live with complex symptoms
and problems and are dependent on others. Existential lone-
liness, a deeper sense of loneliness, seems to occur in relation
to threatening life events and losses, but there is still limited
knowledge about frail old peoples experience of existential
loneliness. The aim of the study was to illuminate the lived
experience of existential loneliness as narrated by frail old
people. The study had a qualitative descriptive design based
on 21 interviews with persons 75years and older receiving
long-term care and service, using a phenomenological her-
meneutical analysis. The interviews were rich of narratives
about situations that was connected with a deep feeling of
loneliness. The findings showed that existential loneliness
meant Being trapped in the own body, Not being able to
share, Being invisible, Lacking purpose and meaning and a
Longing for serenity. The findings are important in order to
highlight older peoples existential needs and to guide health
professionals to discover and encounter existential loneliness
among their patients.
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369
ADVANCE CARE PLANNING: PSYCHOSOCIAL
TRAINING TARGETS TO ENHANCE END-OF-LIFE
COMMUNICATION
B.A.Bensadon, Integrated Medical Sciences, Charles E
Schmidt College of Medicine, Florida Atlantic University,
Boca Raton, Florida
The urgent need to improve the quality of death and dying
in America is well documented. Historically, physicians have
learned how to approach these topics on their own, often
as senior medical students or interns. Advance care planning
(ACP) has been offered as a potential solution but related
physician communication is not yet standard in terms of
frequency or optimal in terms of quality. While the Centers
for Medicare and Medicaid have recently approved financial
reimbursement of ACP discussion, related training remains
rare, highly variable, and institution-specific, causing some to
warn the nation has put the proverbial cart before the horse.
To evaluate ACP training needs, 3rd year medical students
and 1st year medical residents completed a survey measur-
ing their personal experiences, comfort level, and self-efficacy
all psychosocial factors-- relevant to ACP communication.
Data from 120 surveys (49 medical students, 71 interns) were
analyzed. Student and intern responses were similar. Less
than half (n=51) of respondents knew whether their parents
had advance directives and only 8 reported completing their
own. 87 believed physicians must always inform patients
of limited prognoses (< 6months) but only 14 believed this
occurs. Frequency of prior experience delivering bad news to
patients was significantly correlated with their comfort level
doing so (r =.48, p<.001) and their confidence in discussing
end-of-life(EOL) care preferences (r=.37, p<.001). Results
ers comfort and confidence, and thus may enhance their skill
in such communication. Related biopsychosocial training is
imperative.
MEDICAL INTERVENTIONS AND PALLIATIVE CARE:
WHAT TO DECIDE IN ADVANCED DEMENTIA?
A.Loizeau1, S.Eicher1, N.Theill1, M.Martin2,1, F.Riese3,2,1,
1. Universtiy of Zurich, Center for Gerontology, Zurich,
Switzerland, 2. University of Zurich, University Research
Priority Program Dynamics of Healthy Aging, Zurich,
Switzerland, 3. Psychiatric University Hospital Zurich,
Division of Psychiatry Research and Psychogeriatric
Medicine, Zurich, Switzerland
About two-thirds of people with dementia die from pneu-
monia and one-third from dehydration. The DemFACTS
study aimed to develop and test decision supports called
fact boxes, in order to inform decision-makers, who have to
make burdensome treatment decisions at the end-of-life of
people with dementia and either pneumonia or insufficient
fluid intake.
The study employed a randomized, controlled, pre-/
post-intervention design. Relatives of people with demen-
tia (n = 103), professional proxies (n = 77) and physicians
(n=74) evaluated the newly developed fact boxes. At pre-
test, participants were asked to make two fictional decisions
concerning burdensome medical interventions in advanced
dementia based on case vignettes. Four weeks later, at post-
test, the intervention group received two fact boxes in addi-
tion to the two case vignettes, whereas the control group
370
only received the case vignettes. The fact boxes effect on
decisional conflicts (primary outcome), additional decision
outcomes, knowledge transfer, and the appropriateness of
the fact boxes (secondary outcomes) were assessed. Notably,
an expected pre-post reduction in decisional conflicts consti-
tuted the central hypothesis of this study.
The fact boxes could reduce the decision-makers deci-
sional conflicts and enable them to better understand the
treatment decisions. Improving knowledge transfer in pallia-
tive care decision-making could have a major impact on how
decision-making aids in this field will be shaped in the future.
ASSOCIATIONS BETWEEN TIMING OF PALLIATIVE
CARE CONSULTS AND FAMILY EVALUATION OF
CARE AMONG VETERANS
M.McDarby2,3,1, J.Carpenter2,3, M.T.Ersek2,3, J.Thorpe2,4,
D.Smith2,3, M.Johnson2,3, 1. Washington University in
St. Louis, Department of Clinical Psychology, Clayton,
Missouri, 2. Corporal Michael J.Crescenz VA Medical
Center, Philadelphia, Pennsylvania, 3. University of
Pennsylvania School of Nursing, Philadelphia, Pennsylvania,
4. University of Pittsburgh School of Pharmacy, Pittsburgh,
Pennsylvania
Palliative care consultations (PCC) improve end-of-
life (EOL) care but often occur late in an illness trajectory.
There is limited evidence about the optimal timing of PCC to
enhance patient outcomes. The purpose of this analysis was to
examine the associations between PCC timing and bereaved
families evaluation of care in the last 30 days of life. The
retrospective, observational analysis included 5,592 patients
whose first PCC occurred before admission to and death in
a Veterans Administration (VA) inpatient hospice unit. Data
were collected between October 2011 and September 2014.
Outcomes included an overall rating of care and three fac-
tor scores (Respectful Care and Communication, Emotional/
Spiritual Support, Information about Death Benefits) from the
Bereaved Family Survey (BFS), a national, validated quality
improvement measure used in the VA. We used multi-variate
logistic regression models clustered by facility and controlled
for potential confounding variables found to be associated
with the outcomes. Family members of Veterans whose
first PCC occurred 31180 days prior to death were more
likely to rate overall care as excellent compared with those
whose PCC occurred 03 days prior to death (AOR=1.56;
95%CI, 1.251.95). Respectful Care and Communication
and Emotional/Spiritual Support also were significantly
higher when the first PCC occurred 31180days prior to the
Veterans death (=0.53; 95%CI, 0.290.76 and =0.31; 10 qualitative studies, and 1 pilot study.
95%CI, 0.040.57, respectively). Earlier PCC is associated
with greater family satisfaction with EOL care. Strategies
aimed at conducting PCC earlier in life limiting illness are
needed.
TIL DEATH DO US PART: THE INFLUENCE OF ONE
SPOUSES DEATH ON THE SECOND SPOUSES DEATH
E.Abdoler1, A.Kelley2, K.Ornstein2, L.Diaz-Ramirez1,
J.Boscardin1, A.K.Smith1, 1. Medicine, University of
California, San Francisco, San Francisco, California, 2.
Mount Sinai School of Medicine, New York City, New York
It is unknown how the medical intensity of a spouses death
impacts the widowed spouses preparation for and intensity
Innovation in Aging, 2017, Vol. 1, No. S1
of death. We examined the end-of-life experiences of spousal
pairs in the Health and Retirement Study, a nationally rep-
resentative (US) longitudinal survey. Measures of medical
intensity were: (1) low medical intensity death (hospice for
3+ days before death); (2) high medical intensity death (ICU
hospitalization during last 30days of life); and (3) prepara-
tion for death (engagement in advance care planning [ACP]).
We examined how the medical intensity of the first spouses
death affected the medical intensity of the widowed spouses
death using multivariable logistic regression, adjusted for age
at death, months between spouses deaths, year of death, gen-
der, race/ethnicity, comorbidities, ADL dependence, educa-
tion, and net worth. There were 2126 spousal pairs. Hospice
use in the first spouse increased the odds of hospice use (aOR
1.63, 95% CI 1.202.20) and decreased the odds of ICU
use (aOR 0.69, 95% CI 0.510.92) in the widowed spouse.
However, ICU use in the first spouse increased the odds of
ICU use in the widowed spouse (aOR 1.78, 95% CI 1.29
2.46) but had no effect on the widowed spouses use of hos-
pice. The first spouses engagement in ACP, and not manner
of death, increased the widowed spouses odds of engaging
in ACP (aOR 2.94, 95% CI 2.084.15). Widowed spouses
tend to experience deaths with similar medical intensity to
their spouses. Physician engagement in ACP and end-of-life
decision-making may have impact beyond that of individual
patients.
A LITERATURE REVIEW ON THE DECISION-
MAKING PROCESS OF OLDER ADULTS FOR END-OF-
LIFE CARE
H.K.Park, C.C.Hendrix, Duke University, Durham, North
Carolina
The increasing number of chronically-ill older adults
makes it mandatory to understand how personal values
and preferences interplay in the patients decision-making
for end-of-life (EOL) care. Therefore, a systematic literature
review was conducted on the process of how older adults
navigate through their internal preferences and external
influences in EOL decisions.
Method: The following search engines were used: ABI,
CINAHL, PsycINFO, PubMed, and SocINDEX. Search
terms included terminal care, terminally ill patients,
decision-making, choice behavior, process, mecha-
nism, and communication. Age group 65 and above was
used as a search filter. Overall, 1,324 articles were selected, of
which 256 articles were duplicates. After review of titles and
abstracts, 15 articles were finally selected: 4 review papers,
Findings: Selected articles described the factors affect-
ing EOL decision-making rather than the process. Studies
focused on varied terminal diseases as well as aspects in
EOL care such as physical, psychological, or religious sup-
port. Studies have also defined decision-making in var-
ied ways. Majority of the studies identified concepts to
describe the complexity of EOL decision-making such as
double effect of ethic principle, moral responsibility,
cascade of decisions. The wide variability in the defini-
tion of decision-making, management preferences in EOL
care, and terminal diseases in the articles reviewed made it
difficult to synthesize the process in EOL decision-making
for older adults.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Conclusion: Further studies are needed to explore how
varied factors interplay in the decision-making process of
older adults in EOL care.
MEASURING STAFF PERCEPTION OF END-OF-LIFE
EXPERIENCE OF OLDER ADULTS IN LONG-TERM
CARE
N.Cornally1, A.Coffey1, D.W.Molloy1, R.OCaoimh1,2, 29.41%, p-value=0.023) but ESS (5.9 vs 4.9, p-value=0.275)
R.OSullivan1, C.McGlade1, 1. University College Cork,
Cork, Ireland, Ireland, 2. NUI Galway, Galway, Ireland
Background: Quality of dying and death receive far less
attention than quality of life. Measuring the quality of care
at end-of-life (EOL) in long-term care (LTC) is essential, to
ensure high standards.
Methods: Aquestionnaire measuring Staff Perception of
their patients End of Life Experience (SPELE) was devel-
oped. Content Validity (CVI) was assessed by a panel of
experts and piloting was conducted with dyads of healthcare
assistants (n=15) and nurses (n=15).
Results: The SPELE captures facets of the quality of the
death and dying experience from healthcare staffs perspec-
tive. Good group inter-rater reliability was observed among
subscales. One exception was the pain and symptom experi-
ence scale. Kappa values showed little agreement between
nurses and healthcare assistants for certain symptoms,
including pain.
Conclusion: Further testing of the questionnaire is under-
way in a large multi-centre randomised control trial in
Ireland. To date the tool is described as a useful mechanism
to enable researchers and clinicians to explore quality of care
at EOL.
SESSION 855 (POSTER)
FALLS I
SLEEP APNEA, FALLS AND SARCOPENIA IN OLDER
ADULTS: PRELIMINARY RESULTS FROM FALL-
AGING- SLEEP STUDY
A.Monti1, M.Doulazmi, A.Breining4, V.Nguyen-Michel1,
E.Pautas1, J.Mariani1, K.Kinugawa1, 1. AP-HP, DHU
FAST, GH Pitie-Salptrire-Charles Foix, Paris, France,
2. Sorbonne Universits, UPMC University Paris 6, Paris,
France, 3. CNRS, UMR 8256 Biological Adaptation and
Aging, Paris, France, 4. Assistance Publique des Hpitaux
de Paris, Acute geriatric care, Piti-Salptrire-Charles-Foix
Hospita, Ivry Sur Seine, France, 5. Assistance Publique des
Hpitaux de Paris, Functional explorations laboratory,
Piti-Salptrire-Charles-Foix Hospital, Ivry Sur Seine,
France
Objectives: Sleep disturbances increase the risk of falls
among older people. We aimed to examine prevalence of falls
and sarcopenia among older patients with and without sleep
apnea (SA).
Methods: Acute care setting patients aged 75 were
proposed to participate to the FALL-A-SLEEP Study since
March 2015. Subjective sleep questionnaires (e.g Epworth
Sleepiness Scale (ESS)), nocturnal polygraphy (SA defined
by AHI>15/hr), handgrip strength and short physical
IAGG 2017 World Congress
371
performance battery (SPPB), Dual Energy X-ray absorpti-
ometry (skeletal muscle mass (SMI)), were performed in a
stabilized medical situation.
Results: Complete evaluation was available for 45 patients
(mean age 81.9 years, 33 women). Between SA (n=28, mean
AHI=39.7/hr) and non-SA (n=17, mean AHI=4.6/hr) patients,
nap was more frequent among SA patients (65.51% vs
was not different. ADL (5.56 vs 5.71, p=0.883), Charlson
score (1.7 vs 2.47, p=0.301), and Rockwood score (4.37 vs
4.29, p=0.861) were not different. Falls (77.7% vs 56.25%,
p-value = 0.137), mean SPPB score (5.3/12 vs 7.3/12,
p-value=0.0771), SMI (7.03kg/m2 vs 6.17, p-value = 0.603),
mean handgrip (17.83kg vs 17.97, p-value = 0.799) and sar-
copenia defined by EWGSOP (60.9% vs 61.5%, p-value =
0.96) were not statistically different between SA and non-
SA patients. CRP level at the entrance to the hospital (47.44
vs 31.53, p-value= 0.016), duration to get up and sit down
5 times (21.15s vs 12.73s, p-value= 0.05), were statistically
different.
Conclusions: These preliminary data showed that older
SA patients do not present more falls and sarcopenia.
Inclusion is ongoing.
FALLS AND SUBSEQUENT ADVERSE DRUG EVENTS
AMONG ELDERLYA REGISTER-BASED MATCHED
CASE-CONTROL STUDY
C.Rausch3,2, L.Laflamme3, S.E.de Rooij1, U.Bltmann2,
J.Moller3, 1. University Medical Center Groningen,
Department of Internal Medicine Groningen, University
Center for Geriatric Medicine, Groningen, Netherlands,
2. University of Groningen, Unviersity Medical Center
Groningen,Community and Occupational Medicine,
Groningen, Netherlands, 3. Karolinska Institutet,
Department of Public Health Sciences, Stockholm, Sweden
Epidemiological studies on the association between
geriatric conditions like falls and subsequent adverse
drug events (ADE) remain scarce among unselected com-
munity dwelling populations. This study investigates the
sequential association between serious injurious falls and
ADEs among older people, considering co-morbidity and
prescribed medications.
A matched case-control study of Swedish residents
60 years and older was conducted. Cases with ADE were
extracted from the National Patient and Death Registers
from January 2006 to December 2009. Each case was
matched with four controls by sex, age and residential
area. Episodes of injurious falls were extracted from the
NPR and information on dispensed medications during the
four month period prior to index date from the Swedish
Prescribed Drug Register. Effects were estimated with odds
ratios (OR) and 95% confidence intervals (CI) using con-
ditional logistic regression and adjusting for confounders,
including comorbidity.
We found a three-fold increased risk of a new ADE in
the six-month period after an injurious fall (OR 3.03; 95
% CI, 2.54 3.74). This increased risk was highest in the
one to three week period after the fall injury, but remained
high over the whole period. The risk was higher among the
6079year olds than 80+ year olds. Those with an ADE one
372 Innovation in Aging, 2017, Vol. 1, No. S1

to three weeks following a fall injury tended to be more co- Lubben Social Network Scale (LSNS-6), and scores of less
morbid and have a higher number of medications. than 12 points indicated social isolation. Participants were
Severe injurious falls increase the future risk of new ADEs divided into 4 groups depending on pre-frail/frail status
among older people, marking injurious falls as potential and social isolation, and experiences of multiple falls
point for the prevention of ADEs. over the past year were compared between the groups.
Participants were classified into control (n=202), physi-
FLUID SHIFTS IN OLDER WOMEN AT HIGH cal frailty (PF; n=122), social isolation (SI; n=45), and
ALTITUDE PROMOTE HYDRATION AND MAINTAIN PF with SI (PF+SI; n=39) groups. Atotal of 46 (11.3%)
POSTURAL BLOOD PRESSURE participants reported multiple falls. Logistic regression
M.J.Benton1, M.Schlairet2, A.L.Silva-Smith1, 1. Nursing, analysis showed that PF and SI were not independently
University of Colorado Colorado Springs, Colorado Springs, associated with falling (PF: OR 1.91, 95% CI 0.824.45,
Colorado, 2. Georgia Baptist College of Nursing of Mercer SI: OR 2.45, 95% CI 0.896.75), and PF+SI had a signifi-
University, Atlanta, Georgia cant association with falling compared with the control
Worldwide, approximately 32 million older adults live group (OR 2.94, 95% CI 1.038.41) after controlling for
at high altitude, placing them at risk for dehydration that confounding factors. Our findings support the assertion
can dangerously lower blood pressure and increase risk for that physical frailty and social isolation are concurrently
falls. To evaluate this risk, 17 older women living at high associated with falling.
altitude (1800 m) were pair matched with 17 women living
at low altitude (75m). Hydration, body composition, and COACHING TO REDUCE SEDENTARY TIME IN
postural blood pressure (lying, sitting, standing) were meas- OLDER PEOPLE WITH FAL.LS: RANDOMIZED
ured midday on Day 1 (well hydrated) and early morning CONTROLLED STUDY PROTOCOL
on Day 2 (fasting). There were no differences between HA K.Khow1,2, C.Smyth1,2, O.Theou3, M.Chehade4,
and LA in age, weight, BMI, body composition, and total R.Visvanathan1,2, 1. Aged and Extended Care, The Queen
body water. However, the relative amount of water in the Elizabeth Hospital, Woodville South, South Australia,
intramuscular compartment was greater in HA compared Australia, 2. Adelaide Geriatrics Training and Research with
to LA on Day 1 (26.50.4% vs. 24.80.3%, p0.01), Aged Care (G-TRAC) Centre, Adelaide, South Australia,
and again on Day 2 (26.20.3% vs. 24.70.3%, p0.01). Australia, 3. Dalhousie University, Halifax, Nova Scotia,
Furthermore, overnight changes in total water and relative Canada, 4. Discipline of Orthopaedics and Trauma, Royal
intramuscular water were greater for HA compared to LA Adelaide Hospital and University of Adelaide, Adelaide,
(-0.90.2L vs. -0.50.8L; -0.30.08% vs. -0.080.06%; South Australia, Australia
p0.05). On Day 2, postural systolic and diastolic blood Sedentary behavior, assessed by self-reporting, has been
pressures were higher in HA compared to LA in the sitting associated with increased risk of falls. Studies have shown
(SBP: 137.185.5mmHg vs. 123.195.0mmHg, p0.07; that among the oldest old, they are more likely to be sed-
DBP: 78.52.8 vs. 69.42.4mmHg, p0.05) and standing entary (>10 hours/day). Standardized supervised exercise
(SBP: 130.44.9 mmHg vs. 111.34.3 mmHg, p0.01; interventions do not necessarily reduce the level of seden-
DBP: 79.72.6mmHg vs. 67.92.4mmHg, p0.01) posi- tary behavior in daily life. The aim is to evaluate an indi-
tions. In this group of older women, those living at high vidualized coaching intervention based on accelerometer
altitude conserved greater amounts of body water within feedback to reduce sedentary behavior in older people (age
muscle. This intramuscular water may serve as a reservoir 65years) living in the community who had a recent fall.
that provides a physiologic buffer to maintain hydration Participants will be randomized to either the intervention
and blood pressure when intake is restricted and risk for or control groups in a 12-week feasibility study. In both
dehydration is elevated. groups, ActivPAL accelerometer (35x53x7mm, 15g) will
be attached to the mid-thigh of the participants (dominant
COMBINED ASSOCIATION OF PHYSICAL FRAILTY side) for 7-days at week 0, 6 and 12. To reduce sedentary
AND SOCIAL ISOLATION WITH FALLING IN OLDER time, the intervention group will be: (a) presented with
ADULTS the objective information regarding their physical activity
T.Hayashi1, T.Makino1, H.Umegaki1, X.Cheng1, levels based on the ActivPAL accelerometer recordings,
H.Shimada2, M.Kuzuya1, 1. Nagoya University, Nagoya, (b) educated about the benefits of exercise (using Choose
Japan, 2. National Center for Geriatrics and Gerontology, Health: Be Active booklet), (c) face-to-face goal-setting
Obu, Japan sessions (at weeks 1 and 6)and (d) fortnightly follow-up
The aim of this study was to examine the association phone calls. The intervention is based on self-determina-
of the combination of physical frailty and social isola- tion theory, which addresses psychological needs in order
tion with falling in community-dwelling older people. The to modify behavior. The control group will be given the
study used baseline data on participants in the Toyota Choose Health: Be Active booklet. Primary outcome is
Prevention Intervention Cognitive decline and Sarcopenia change in sedentary duration. Secondary outcomes assessed
(TOPICS). Participants in this cross-sectional study were include gait speed, Short Physical Performance Battery and
408 older adults (52% male, mean age=72.34.7years). Falls Efficacy Scale. The effect of the intervention on sed-
Physical frailty status was categorized as non-frail and entary duration and secondary outcomes will be assessed
pre-frail/frail based on the Fried frailty criteria (slow by 2-sided t-test. Primary analyses will be performed by
walking speed, muscle weakness, exhaustion, low activity, intention-to-treat principle.
and weight loss). Social isolation was examined using the

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS,
RECURRENT, AND SINGLE FALLS FROM
PREVQUEDAS BRAZIL
A.Passos, M.Z.Magalhes, E.Y.Ishigaki, S.Paschoal, INTERDISCIPLINARY APPROACH TO FALL
M.Perracini, L.E.Gracez Leme, Hospital das Clinicas USP,
Sao Paulo, Brazil
Introduction: Depressive symptoms are associated with
falls in a variety of studies in developed countries. Objectives:
1) To examine the association between abnormal 15-item
GDS score, single and recurrent falls in community-dwelling
older adults in a developing country. 2)To check if recurrent
fallers have greater scores in 15-item GDS, examining if it
has any association with age, ethnicity, genre, and numbers
of medications used.
Methods: Transversal data analyzed was extracted from
Prevquedas Brasil, a Multicenter parallel-group randomized
controlled trial that evaluates the effectiveness of a multifac-
torial falls prevention program in reducing the rate of falls
in community-dwelling older people. Statistical Analysis:
Pearson Chi-square test used to compare positive screening
for depressive symptoms (GDS >5) and fall events (single or
recurrent). Sociodemographic variables were analyzed by
logistic regression. Stata software was used.
Results: 402 participants (mean age 73.8
7.1years;
88.1% women; 59.8% white). Recurrent falls have associa-
tion with GDS >5 (92 vs. 28, p=0.008). The mean GDS score
is greater for recurrent fallers than to non-recurrent fallers
(p<0,001). After logistic regression for sociodemographic
variables and medications, elderly with GDS >5 had twice
more chance to be a recurrent faller (OR 2.0, 95%IC 1.2
3.3; p=0.007), compared to GDS 5.
Conclusions: Abnormal 15-item GDS and its greater
scores are associated with recurrent fallers in elderly from a
developing country.
30-SECOND SITTING PAUSE IMPROVES BALANCE
E.Johnson, N.Daher, A.Albalwi, F.Al-Dabbak, Loma medic care within 30days. The purpose of this study was to
Linda University, Loma Linda, California
Background and Purpose: Falls in older adults are com-
mon and often take place in the home when getting up at
night to use the restroom. Longer sitting pause times, prior
to standing, might improve postural stability after standing
from a supine position. The purpose of this investigation
was to measure the effects of sitting pause times on standing
postural sway velocity immediately following a supine-to-
standing transfer in a dimly lit room in older adult females.
Methods: Eighteen females aged 6575 participated in the
study. On each of 2 consecutive days, study participants lay
on a mat table with their eyes closed for 45 minutes prior to
performing a supine-to-standing transfer in a dimly lit room.
Randomly assigned sitting pause times of 2 seconds and 30
seconds preceded the transfers. Results: Mean standing pos-
tural sway velocity was significantly less after a 30 second
pause time compared to a 2 second pause time (p=.001).
Conclusions: Total mean standing postural sway velocity
was less when study participants performed a sitting pause
of 30 seconds prior to standing in a dimly lit room. These
results support our previous pilot study findings published
in the Journal of Geriatric Physical Therapy and provides
evidence that longer sitting pause times improve standing
IAGG 2017 World Congress
373
postural stability and may contribute to reduced fall risk
after waking at night in older adults.
PREVENTIONRESEARCH, PRACTICE, AND POLICY
M.Wingood1, M.Renfro2,3, K.Cameron4, 1. University
of Vermont-Medical Center Inpatient Rehab, Colchester,
Vermont, 2. University of Montana, Missoula, Montana,
3. MonTECH/ Rural Institute for Inclusive Communities,
Missoula, Montana, 4. National Council on Aging,
Arlington, Virginia
Research demonstrates that falls are multifacto-
rial and require an interdisciplinary treatment approach.
Interdisciplinary evidence-based fall prevention (EBFP) pro-
grams are effective with a great return in investment. This
presentation will educate the participants about the evidence
in interdisciplinary EBFP, how to implement it in your prac-
tice, and what policy changes are needed to ensure that our
older adults are supported to successfully age-in-place. We
will examine interdisciplinary EBFP around the United States
and identify strengths and opportunities for improvements
in each. Success is reflected in reducing fall risk, falls, fall
injuries, and assuring sustainability of the clinic through
financing options. Organizational structure, payer systems
and public policy will be reviewed and an outline provided
to assist the professional with developing an action plan.
CHARACTERISTICS OF LIFT-ASSISTS PROVIDED TO
OLDER ADULTS BY PARAMEDIC SERVICES
A.Zecevic1, D.Carter2, M.A.Bauer1, 1. Western University,
London, Ontario, Canada, 2. Middlesex-London EMS,
London, Ontario, Canada
Lift-assist is defined as a paramedic response to an emer-
gency (9-1-1) call that resulted in patients refusal of transporta-
tion to the hospital. Lift-assists represent 5% of all EMS calls
and often involve recurrent fallers requiring additional para-
determine characteristics of lift-assists provided by paramed-
ics to older adults. Anonymized data was extracted from the
Ambulance Call Reports database for a Regional Paramedic
Centre in Ontario, Canada for one year (2015). Inclusion crite-
ria were: refusal of services, lift-assists, patients 65years, and
multiple choice responses only; paramedics written comments
were excluded. Data was analyzed using descriptive statistics,
regression and cluster analysis. Atotal of 798 lift-assists were
identified (50% male). We found that: The greatest number of
calls occurred on Friday (18%), Saturday (15%) and Monday
(15%); Two thirds (68%) of lift-assists happened during the
day (06:00-21:00) and 32% at night (21:-06:00); Most frequent
locations were apartment/condo (46%) and house/town-
house (45%), while 5% of calls came from nursing homes;
On average, paramedics spent 32 minutes on scene. In 2015,
paramedics spent almost 24days responding only to lift-assists.
Four clusters with seven attributes best described the sample.
These results suggest that paramedic lift-assists are used equally
by both genders, in specific areas of the city, and during peak
activity hours. Alternative models of care, such as community
paramedicine should be considered for the management of
non-urgent, low-acuity illnesses and injuries to minimize non-
essential health care spending.
374
RELIABILITY AND VALIDITY OF HEALTH IN
MOTION FALLS SCREENING TOOL
B.Walker2, S.Flynn1, R.Johnson1, 1. Blue Marble Game
Company, Los Angeles, California, 2. University of
Indianapolis, Indianapolis, Indiana
Falls are costly, affect independence, and are a leading
cause of injury in adults over the age of 65. Awareness of
fall risk and engaging with healthcare systems prior to the
first fall, annual visit, or hospital stay could have a signifi-
cant impact on quality of life and healthcare costs. Clinicians
use the FRQ, 30STST, and OLST to measure balance and
lower extremity strength, predict falls and increase fall risk
awareness. This randomized trial design study measured the
validity and reliability of the FRQ, 30STST and OLST when
performed by a clinician using standard methods and by
using self-report and sensor tracking versions of Health In
Motion (Blue Marble Game Co, Altadena, CA) a guided
software program for fall prevention. Fifteen community-
dwelling adults aged 6380 completed the study. Compared
with clinician 1) the self-report and sensor FRQ, 30STST
and OLST had statistically significant moderate to excellent
concurrent validity; 2)the self-report PHQ2 had statistically
significant excellent concurrent validity; 3) the self-report
and sensor FRQ, 30STST an OLST were statistically signifi-
cantly reliable. Health in Motion was found to be a reliable
and valid screening tool for identifying falls risk and could
provide early detection of fall risk if used in the home prior
to a fall.
GAIT SPEED, COGNITIVE IMPAIRMENT, AND DUAL
TASK CONDITIONS IN FALLERS AND NON-FALL
CONTROLS
L.Minet1,2,3, K.Thomsen1,2, J.Ryg1,2, L.Matzen2,
C.Ytterberg4,5,1, K.Andersen-Ranberg2, T.Masud6,2, 1.
Institute of Clinical Research, University of Southern
Denmark, Odense, Denmark, 2. Odense University
Hospital, Odense, Denmark, 3. University College
Lillebaelt, Odense, Denmark, 4. Karolinska Institutet,
Stockholm, Sweden, 5. Karolinska University Hospital
Huddinge, Stockholm, Sweden, 6. Nottingham University
Hospitals NHS Trust, Nottingham, United Kingdom
Abnormal gait is an established falls risk factor and gait
speed (GS) of <0.6m/s is associated with falls (Quach, JAGS,
2011). Cognitive impairment (CI) and dual task conditions
(DT) have been linked to impaired gait. This case-con-
trolled study in women explored the relationship between
GS, CI and DT in a group of fallers recruited from a falls
clinic [FALLCLIN] (n=114) and from age matched faller
(FALLCON] (n=97) and non-faller [NOFALL] (n=90) com-
munity controls.
The overall median age (range) was 80 years (7586)
and 74/301 (24.6%) had CI. In the cognitively normal
women (MMSE25) the median (IQR) GS (m/s over 4m)
in the FALLCLIN, FALLCON and NOFALL groups were
0.86 (0.631.06), 1.11 (0.871.33) and 1.30 (1.061.58)
[p0.001], and under DT conditions (counting backwards)
were 0.67 (0.460.80), 0.79 (0.630.98) and 1.04 (0.82
1.28) [p0.001] respectively. In the CI women (MMSE<25)
the median GS in the FALLCLIN, FALLCON and NOFALL
groups were 0.66 (0.560.79), 0.68 (0.621.04), 1.12
(0.851.35) [p0.001]; and under DT conditions were
Innovation in Aging, 2017, Vol. 1, No. S1
0.46 (0.380.65), 0.49 (0.360.79) and 0.72 (0.530.89)
[p=0.006] respectively.
In conclusion, GS was slower in the faller groups, in
those with CI and when DT conditions were present. In the
presence of both CI and DT conditions, the GS in the faller
groups were very low and in the range known to be associ-
ated with increased falls risk. GS in normal and under DT
conditions may be useful biomarkers for falls risk in cogni-
tively impaired older people and further research is needed to
explore if DT training can improve GS.
EXERGAME TECHNOLOGY AND INTERACTIVE
INTERVENTIONS FOR ELDERLY FALL PREVENTION:
ALITERATURE REVIEW
S.Xiong1, L.Guo1,2, 1. Korea Advanced Institute of Science
and Technology (KAIST), Daejeon, Korea (the Republic of),
2. China University of Geosciences, Wuhan, China
Falls and fall related injuries present a substantial health
problem among the older population. Training balance and
promoting physical activities in the elderly can contribute
to fall-prevention. Due to the low adherence of conven-
tional physical therapy, fall interventions through exergame
(exercise+game) technologies are emerging. This study syn-
thesizes the available research reported on exergame tech-
nology and interactive interventions for fall prevention in
the elderly population. Twenty-five relevant publications
identified from five major electronic databases (Scopus,
ScienceDirect, PubMed, Web of Science and Proquest) were
critically reviewed and analyzed. Results showed that the
most common exergaming device for fall intervention was
the Nintendo Wii, followed by Xbox Kinect. Even though the
exergame intervention protocols and outcome measures for
assessing the intervention effects varied, the most frequently
used outcome measures were the score of Berg Balance Scale
for the postural balance performance, the time to com-
plete Timed Up and Go Test for human gait and mobility
performance, and the rating of Falls Efficacy Scale for self-
perceived risk of falling. This study revealed that the interac-
tive exergame interventions improved physical or cognitive
functioning in the elderly. However, it remains inconclusive
whether or not the exergame-based intervention for elderly
fall prevention is superior to conventional physical therapy.
The effect mechanism of the exergaming on elderlys balance
ability is still unclear. Further studies are needed to establish
a standardized test protocol, to define the optimal interven-
tion treatment, and to design tailored exergame interventions
to the elderly for enhanced intervention effectiveness, enjoy-
ment, and safety.
NUTRITIONAL STATUS AND MOBILITY IN ELDERLY
FALLERS FROM PREVQUEDAS, BRAZIL
E.Y.Ishigaki1, M.Zambone1, A.Passos1, S.Paschoal2,
M.Perracini3, L.Leme1, 1. Orthopedic Geriatric, University
of Sao Paulo, So Bernardo do Campo, So Paulo, Brazil, 2.
Prefeitura de So Paulo, So Paulo, Brazil, 3. UNICID, So
Paulo, Brazil
Introduction: Obesity has recently been thought as a risk
factor for falls in elderly. The relative risk of fall is 1.4 times
greater in obese elderly. This is partly explained by the neg-
ative influence of obesity in mobility. Objective: To check
whether the obese elderly fallers have worse mobility in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
comparison with non obese ones and find the probability of
obese elderly fallers have worse mobility than the non obese
ones after analysis of covariance. Methods: Transversal
data was extracted from Prevquedas Brasil which is a
Multicenter parallel-group randomized controlled trial that
evaluates the effectiveness of a multifactorial falls preven-
tion program in reducing the rate of falls in community-
dwelling older people. Obesity was determined using Body
Mass Index (BMI) formula. All those with BMI >27kg/m2
were considered obese. Mobility was checked by Gait Speed
Test (GST) and Timed up and go Test (TUGT). Statistical
Analysis: Obese and non-obese mobility were compared
using Test t- logistic regression as used to measure associa-
tion between obesity and mobility, adjusted for gender, age
and depression, using STATA 14, P-value < 0.05 was con-
sidered statistical relevant. Results: Transversal Analysis of
403 people, 355 women and 48 men, mean age 73,597,14
and 756,85, respectively. Prevalence found was 3.14 falls/
person/year. BMI 39,0810,30kg/m2, 61,1% were obese. cally in most industrialized countries. The possibility to stay
The score time to the TUGT was higher in obese (p=0.018)
and the probability of being obese elderly slowest is 70%
(OR 1,77, 95%IC; p=0.031).
Conclusion: There is correlation between obesity and
functional impairment and worse mobility.
SESSION 860 (POSTER)
FAMILY AND INTERGENERATIONAL
RELATIONSHIPS II
IMPACT OF CARING FOR GRANDCHILD ON
DEPRESSION FOR KOREAN OLDER ADULTS:
HEALTH AND INCOME AS MODERATOR
Y.Shin, J.Ha, Seoul National University, Seoul, Korea (the
Republic of)
This study considers role enhancement and role strain
theory as complementarity hypotheses and hypothesizes that
the effect of caring for grandchildren on depression for older
adults depends by the level of health and income.
Analyses were based on data from the 2010(Time 1,
T1) and 2012(Time 2, T2) waves of Korean Longitudinal
Study of Ageing(KLoSA). This study used an analytic sam-
ple of 5,018 older adults who are aged 49 through 85 and
had one or more grandchild, in order to examine how (1)
caring for grandchildren at an earlier time point(T2, 2011
October 2012 September) affects older adults depression at
a later time point(T2, 2012 September), controlling for the
outcomes at T1. Also This study investigated (2) whether the
level of health (perceived health status, the number of chronic
health conditions) and income moderated the effect of car-
ing for grandchildren on older adults depression. This study
used multivariate regression models (lagged effect models)
controlling for older adults depression at time 1(T1), includ-
ing interaction terms.
The results showed that the effect of caring for grandchil-
dren on older adults depression was not significant. Whereas
the effect of taking care of grandchildren on depression level
of grandparents was significantly moderated by perceived
health status and the number of chronic health conditions,
IAGG 2017 World Congress
375
that was not significantly moderated by income level of older
adults.
These findings enhance our understanding of older adults
caring for grandchildren. The results of this study indicate
that older adults caring for grandchildren are not one group.
They differ by level of health, but not by income level of
them. So there should be support for older adults taking care
of grandchildren with weak health conditions to prevent
their depression.
VERY OLD ADULTS AND THEIR CHILDREN:
QUALITATIVE FINDINGS ON SUPPORT EXCHANGES
C.Meystre1, D.S.Jopp1, J.Darwiche1, K.Boerner2,
C.Salan1, C.Lampraki1, D.Spini1, 1. Institute
of Psychology, University of Lausanne, Lausanne,
Switzerland, 2. University of Massachusetts Boston, Boston,
Massachusetts
The number of very old people is increasing dramati-
at home is of key importance for this population, and their
children often make this possible. However, little is known
about the nature of the relationship between very old par-
ents and their old children, and the implication of the quality
of this relationship. The present study drew on data from a
Swiss sample of 20 of dyads, composed of very old people
(aged above 95 years) and the child involved in their care.
To examine the quality of the relationship and the sup-
port the members of the dyads provide to one another, they
were asked to participate in an interaction task (e.g., Suhr,
Cutrona, Krebs, & Jensen, 2013). Specifically, the very old
parent had to describe a difficult everyday life situation and
to discuss it with the child for 10 minutes. Then roles were
reversed. The videotaped dyadic interaction was analysed
using the Social Support Behavior Code (SSBC; Suhr etal.,
2013), which assesses 25 individual support behaviors. The
results indicate various support types, ranging from positive
(e.g., emotional, information) to negative (e.g., criticism). We
also found that dyads ranged in the amount to which the sup-
port was reciprocal; yet, with poorer health and increasing
age, support exchange became more unbalanced. Findings
suggest the usefulness of the chosen task for the assessment/
coding of dyadic interactions in very advanced age. Future
studies should investigate the relationship between support
exchange and well-being/mental health outcomes.
MARITAL ATTACHMENT AND SPOUSAL SUPPORT
AMONG OLDER COUPLES
W.Ye, D.Wang, T.Wu, School of Psychology,Beijing
Normal University, Beijing, Beijing, China
This longitudinal study mainly explored the relationship
between marital attachment and spousal support experi-
ence among older couples. There were 95 older couples
from communities of Beijingwith age ranging from 60
to 83years old at the first time of investigation, who were
assessed twice across two years. At the first wave (T1), the
participants completed the demographic information sheet,
Older Adults Marital Attachment Scale and some screen-
ing scales including the Geriatric Depression Scale and
Clock Drawing Test. At the second wave (T2), besides T1
measures, the participants reported the life events happened
during the two-year interval and various aspects of spousal
376
support while confronting those events. Results of Actor-
Partner Interdependence Model Analysis indicated that an
individuals spousal supports were affected by both the indi-
viduals and his/her partners attachment at T1. Both hus-
bands and wives spousal support benefited from their own
attachment security or were harmed by their own insecurity.
Furthermore, the spousal supports reported by wives were
mainly affected by their own attachment, while those of hus-
bands were mainly affected by their wives attachment. In
addition, the change of attachment across the interval was
affected by both the individuals and his/her partners spousal
support. Effective support of both sides could contribute to
individuals attachment security and vice versa. These results
provide evidence that marital attachment and spousal sup-
port are influenced by each other, thus forming a dynamic
cycle.
PARENTS PSYCHOLOGICAL PROCESS OF
CAREGIVER-RECIPIENT ROLE REVERSAL FROM
CHILDRENS PERSPECTIVES
N.Toyokawa1, N.Darling2, T.Toyokawa3, 1. California
State University San Marcos, San Marcos, California,
2. Oberlin College, Oberlin, Ohio, 3. Pacific Lutheran
University, Tacoma, Washington
The magnitude of intergenerational ambivalence tends to
increase when the expected roles of parents as a caregiver
and children as a care recipient become reversed as parents
age (Lscher, 2002). However, little is known about the psy-
chological process of this role reversal, particularly the nego-
tiation of parents autonomy and adult childrens authority
over parents autonomy. This pilot study explored the process
of parents information control about their everyday life to
maintain their autonomy. Sixteen adult children were invited
to focus groups (Mage=53, SD=6.1, Males=3) through ventions to empower migrant families in both sending and
local churches. Content analysis (Weber, 1990)revealed that
participants believed that their parents were unwilling to
disclose six kinds of issues: use of medication, new physi-
cal symptoms, financial aids to own children, the content of
their living wills, death preparation, and presence of debts.
For reasons for parents unwillingness to talk about these
issues, participants provided several points. First, their par-
ents wanted to maintain autonomy by strategically managing
information on their medication use and property manage-
ment to maintain autonomy. Second, parents did not want
to disclose their new disease symptoms until the symptoms
got serious to avoid being caregiving burden of their children
and/or disliked to go through extra-medical exams. Third,
because of death anxiety, certain topics were taboo for adult
children to talk about (e.g., death preparation). These find-
ings suggest that parents psychological process during role
reversal between aging parents and adult children include
not only parents information control but also parents anxi-
ety of aging and death.
MIGRATION AND INTERGENERATIONAL
RELATIONSHIPS IN CHINESE FAMILIES
J.Liu1, M.Guo2, L.Xu3, W.Mao4, I.Chi5, 1. School of ence of womens labor force participation on the occasional
Social Work, Columbia University, New York, New York, 2.
University of Iowa, Iowa City, Iowa, 3. University of Texas
at Arlington, Arlington, Texas, 4. University of Nevada at
Innovation in Aging, 2017, Vol. 1, No. S1
Reno, Reno, Nevada, 5. University of Southern California,
Los Angeles, California
Objectives: Internal and international migration influ-
ences family relations momentously by increasing geographic
distance and reshaping interactions between migrants and
their families in sending areas. This study examined how geo-
graphic distance (co-residence, in the same city, in different
cities, and in different countries) between older parents and
adult children is associated with intergenerational relation-
ships in Chinese families.
Methods: Data were derived from a cross-sectional survey
of 330 elders in Beijing who had child(ren) living in another
city or country. Information of 708 children was reported
by the respondents. Intergenerational support (physical care
provided by children for parents, monetary support between
parents and children, babysitting assistance from parents for
children) and emotional relationships (closeness and con-
flict) between the respondents and each child they had were
assessed. Socio-demographic characteristics of both older
adults and their children and elders health status were con-
trolled for in the two-level regression models.
Results: Transnational livelihood was associated with
lower probabilities of receiving both family care and mon-
etary support from children. Older parents perceived lower
levels of emotional closeness and conflict relationships with
the children migrated to other cities or countries than that
with proximate (co-residence and in the same city) offspring.
Physical care provided by children for parents and monetary
support from parents to children were related to higher level
of emotional closeness.
Conclusion: This study showed that geographic distance
across countries may weaken intergenerational support and
emotional bonds, indicating the needs of programs and inter-
receiving areas.
PREVALENCE AND PROFILE OF GRANDPARENTS
PROVIDING OCCASIONAL GRANDCHILD CARE IN
THE U.S.
Y.Lee, Syracuse University, Syracuse, New York
Objectives. This research draws from social contingency
theory to explain the relationship between womens labor
force participation and the prevalence of grandchild care
among grandparents with at least one grandchild in the U.S..
Particular attention is given to grandparent gender by child
gender interactions.
Methods. The data was collected from the Health and
Retirement (HRS) Study 2008 (wave 9). The source of the
data was both the University of Michigan HRS and RAND
HRS files. The analysis is based on the total number of
11,981 grandparents and 23,106 adult-children.
Results. Supporting the hypothesis, daughters receive the
most grandchild care from grandparents then sons, and more
grandmothers provide grandchild care to daughters than to
sons.
Discussion. The results highlight the important influ-
grandchild care prevalence and profile in the U.S.. In con-
clusion, contingency can influence grandparents, even in this
individualistic country, provide intergenerational support
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
when familys needs arise due to economic conditions or
employment.
LIVING ARRANGEMENTS AND SUBJECTIVE WELL-
BEING AMONG OLDER ADULTS IN CHINA
X.Ye1, D.Burnette2, Z.Cheng1, 1. Institute of Population
Research, Beijing, Beijing, China, 2. School of Social
Work,Virginia Commonwealth University, Richmond,
Virginia
As a result of demographic transition and society revolu-
tion, living arrangements of older adults in China showed
new characteristics. The research investigated the relationship
between living arrangements of the elderly and their subjec-
tive well-being. Data came from the Sampling Survey on the
Living Conditions of the Elderly in Urban and Rural Areas
in Beijing, China (2015), a representative sample of those 60
and older. The analytic sample size was 3289. The subjective
well-being was measured by a 5-point scale consisting of the
following responses: very happy, happy, so-so, unhappy, very
unhappy. We used ordered logistic regression. 78.43% of the
older adults felt happy or very happy with their life. Most
of the elderly only lived with spouse (44.01%), followed by
those lived in three-generation families (20.92%) and those
lived in two-generation families (18.31%). After controlling
the demographic and socioeconomic variables, compared to
living in two-generation families with adult children, older
adults only living with spouse or living in three-generation
families with grandchildren tended to have better subjective
well-bing. In the study, three-generation families could be a
better choice for the elderly, which is in line with Chinese
traditional value. But the elderly living only with spouse
may experience more privacy and independence that are
more highly valued in the aging process nowadays. Ongoing
research could explore more evidence of the variation trend
of living arrangements and how to build better household
context for the elderly.
ITS AN INTIMACY CRITERION: RELATIONSHIPS
IN LATE LIFE FROM APERSONAL COMMUNITIES
APPROACH
M.Torrejon, Sociology, University of British Columbia,
Vancouver, British Columbia, Canada
The literature on social capital, social support and
social networks usually describes the resources available
in the network of the older person. Although some of
that literature includes the concept of emotional support
or measures to recognize emotional closeness, the studies
rarely recognize the emotional nuances and the subjective
meaning of those relationships. This paper seeks to explore
the diversity of ties that form older peoples emotionally
close network of relationships or personal communities, as
defined by Pahl and Spencer (2010), and the meanings and
more subtle functions of these personal relationships in
late life. Idraw upon 40 qualitative interviews conducted
with Chilean men and women between 60 and 74 years
old to examine how they define and identify personal ties
considered important to them. The interviews were aided
by a method of mapping personal relationships that was
suitable to elicit the identification of people who were rel-
evant for reasons beyond the help exchanged. The inter-
views were analyzed using a thematic analysis and the
IAGG 2017 World Congress
377
personal communities were classified using a typology pro-
posed by Spencer and Pahl (2006). The personal communi-
ties approach proved useful to analyze the composition of
older peoples network of close relationships and to recog-
nize the different manners in which family members and
friends are relevant in late life. A particular contribution
of this paper is a proposed complementary typology based
on the distinction between clustered and hierarchical
personal communities. This distinction gives additional
information to depict and define emotional closeness and
represent suffusion of personal relationships.
LIVING ARRANGEMENTS, CARING FOR
GRANDCHILDREN, AND DEPRESSIVE SYMPTOMS
AMONG GRANDPARENTS IN CHINA
Z.Cheng, X.Ye, Institute of Population Research, Peking
University, Beijing, China
This paper investigated the relationship between liv-
ing arrangements, caring for grandchildren and depressive
symptoms among grandparents. Data came from the Chinese
Health and Retirement Longitudinal Study (CHARLS, 2011
2012) baseline data, a sample of those 45 and older. The
analytic sample contained 5,473 grandparents with grand-
children aged under 16. The CESD-10 was used to measure
depressive symptoms with a score from 10 to 40. We used
Multiple Linear Regression. 42.69% rural and 48.01% urban
grandparents provided care for their grandchildren. More
grandparents provided care of high intensity (>=48weeks/
year). After controlling demographic and socioeconomic
variables, rural grandparents co-residing with grandchildren
tended to have less depressive symptoms compared to rural
grandparents not co-residing with grandchildren. And rural
grandparents providing care tended to have less depressive
symptoms compared to rural grandparents providing no
care. But when co-residing with grandchildren and provid-
ing care of high intensity, rural grandparents were likely to
have more depressive symptoms. For urban grandparents,
co-residing with grandchildren compared to not co-residing
with grandchildren contributed to their less depressive symp-
toms. But after controlling frequency of visiting from adult
children and some other variables, the association between
caregiving intensity, interaction term for caregiving intensity
and co-residing living arrangements and depressive symp-
toms among grandparents were not statistically significant.
But urban grandparents living in skipped generation house-
holds had more depressive symptoms. Grandchildren could
be a critical emotion support to their grandparents. However,
grandparents co-residing with grandchildren and providing
care of high intensity or living in skipped generation house-
holds tend to have negative mental health.
UNION FORM IN LATE-LIFE INTIMATE
RELATIONSHIPS
T.M.Bildtgrd1, P.berg2, 1. Social work, Stockholms
Universitet, Stockholm, Sweden, 2. University of Gvle,
Gvle, Sweden
Family theory has suggested a radical transformation of
intimacy in large parts of the Western world over the last
50years. Given this development, how can we best explain
union form in older peoples relationships: In terms of the
traditional values they were brought up
378
with (cohort)? In terms of the historical context in
which the relationships were initiated (period)? Or in terms
of the life-phase in which the relationships were initiated
(age)? All of these hypothesis have been suggested by prior
research. The purpose of the paper is to test these hypoth-
eses empirically. The study is based on a quantitative survey
of 6090 year old Swedes (response rate 42%), focusing a
subset of respondents (n=702) who are currently either mar-
ried, cohabiting or LAT. The data are analyzed using logistic
regressions. The results showed no significant support for
the cohort hypothesis. The analysis gave strong support for
the historical hypothesis union form was significantly cor-
related with the year the relationship was initiated. It also
gave significant support for the life phase hypothesis older
people tend to prefer LAT relationships but only after they
were allowed by the normative historical context. The results
are discussed in relation to explanations suggested by earlier
research regarding union form in older couples.
GENERATIONAL SOLIDARITY IN EUROPE
A.Tur-Sinai1, D.Halperin2, R.Katz2, A.Lowenstein1, 1.
University of Haifa, Haifa, Israel, 2. The Max Stern Yezreel
Valley College, Yezreel Valley, Israel
This study explored various dimensions of generational
relationships between older parents and their adult children
using the latest waves of SHARE (Survey of Health, Ageing
and Retirement in Europe). Intergenerational solidarity
model served as the main conceptual framework. Analyses
yielded four family relationship types present in all countries,
albeit with different frequencies. Around half of the respond-
ents in the comparing countries were identified with close
ties and flow of support. Four conclusions were drawn: (1)
importance of personal resources; (2) cultural differences and
meanings for families; (3) highlighting within-country differ-
ence; and (4) strength of intergenerational solidarity. Using a
cross-sectional and longitudinal analysis among parents and
their adult children revealed the importance of understand-
ing generational relationships in the current era, character-
ized with higher longevity and changing family structures.
Implications for theory, research and policy are discussed.
CHANGES IN LIVING ARRANGEMENTS OF
VIETNAMESE OLDER ADULTS
Q.T.Trinh1,2, H.L.Kendig1,2, V.Yiengprugsawan1,2, 1.
Centre for Research on Ageing, Health and Wellbeing
(CRAHW), The Australian National University, Canberra,
Australian Capital Territory, Australia, 2. ARC Centre
of Excellence in Population Ageing Research (CEPAR),
Canberra, Australian Capital Territory, Australia
The living arrangements of older adults, which are cen-
tral to intergenerational support systems in Vietnam, are
changing as a result of rapid population ageing and evolv-
ing family structure, social norms and values, and socio-eco-
nomic development. This paper reports on the determinants
and consequences of changes in living arrangements of
Vietnamese people aged 60 and older using data from the
Vietnam National Ageing Survey 2011 and Regional Ageing
Surveys 1997 (n= 4,559). The results indicate that a major-
ity are living in multigenerational households but this has
declined from 56% to 45% between 1997 and 2011. There
have been increases of those living only with a spouse (7.5%
Innovation in Aging, 2017, Vol. 1, No. S1
to 18%) and living alone (4.3% to 9.4%). Those at more
advanced ages were more likely to live alone or in multigen-
erational households in 1997 but they tended to live with a
spouse or adult child in 2011. Having paid work was associ-
ated with living alone only in 2011. Additionally, having a
son increased the likelihood of living in a multigenerational
household, with a spouse, and/or with children in 1997.
Other significant influences were health status and urban
versus rural residence. The changes indicate overall stabil-
ity of households but a trend towards Western patterns of
modified extended families. This has significant implications
on patterns of intergenerational support exchange as well as
living standards and subjective well-being. While the fam-
ily remains crucial for older adults in Vietnam, the evolving
responsibilities of social welfare and care for them, especially
those living alone, will be increasingly challenging.
REASONS FOR LIVING WITH AND WITHOUT
CHILDREN AND LIFE SATISFACTION AMONG
KOREAN OLDER ADULTS
J.Kim1, S.Kim1, M.Lee2, J.Kang3, 1. Sungkyunkwan
University, Seoul, Korea (the Republic of), 2. Chung
Ang University, Seoul, Korea (the Republic of), 3. Yonsei
University, Seoul, Korea (the Republic of)
Living arrangements of Korean older adults have rapidly
changed, from 81% living with children in 1966 to 34% in
2010 and from 7% living without children in 1966 to 60%
in 2010. Using the 2013 Social Statistics Survey conducted
by the Korea National Statistical Office (N=7,020), we
examine how the reasons for living with or without children
may influence older adults life satisfaction. For those living
with children, their reasons include difficult health and eco-
nomic situations (47%) their childrens difficult health and
economic situation (25%), providing childcare and house-
work (11%), preference (14%), and their children being
students (1%). On the other hand, those who live without
children listed the following reasons: comfort (33%), feasi-
bility of living independently (26%), avoiding being a burden
to their children (23%), childrens work or studies (16%),
and conflict with their children (1%). Using logistic regres-
sion, of those who live with their children, those with reasons
other than preference and their children being students are
less likely to be satisfied. Of those who live without children,
compared to those who find it comfortable to live alone,
those who responded as being economically and physically
able to live independently are more likely to be satisfied,
but those who are avoiding burdening their children are less
likely to be satisfied. Our findings suggest the importance
of reasons for living arrangements, not living arrangements
itself on life satisfaction of older adults.
TIES WITH ADULT CHILDREN AND LONGITUDINAL
PARENT-CHILD RELATIONSHIP SATISFACTION OF
KOREAN RETIREES
H.Chai1, S.Joo2, 1. Human Development and Family
Studies, The Pennsylvania State University, University
Park, Pennsylvania, 2. Yonsei University, Seoul, Korea (the
Republic of)
Transition into retirement opens up an opportunity to
focus more on family relationships, and relationships with
adult children is considered an important contributor of
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
well-being after retirement. However, not many studies have
looked at the longitudinal association between ties with
children and well-being among the retirees. Therefore, using
four waves (2006, 2008, 2010, and 2012) of the Korean
Longitudinal Study of Aging (KLoSA), this study examined
how parent-child relationship satisfaction changes over time
after retirement and how ties with adult children are associ-
ated with the longitudinal change in relationship satisfaction.
The sample included in this study were Korean adults aged
45years or older who retired between 2005 and 2006 before
the baseline survey (N=233).
The results showed that parent-child relationship sat-
isfaction decreases over 6 years after retirement, and that
receiving support from children and having frequent contact
with children measured at Wave 1 have positive associations
with the initial level of parent-child relationship satisfaction.
Interestingly, the results also showed that income level mod-
erates the relationship between ties with children and parent-
child relationship satisfaction. For low-income retirees, those
with higher levels of contact and support had higher level of
parent-child relationship satisfaction across time. However,
for high-income retirees, the level of parent-child relation-
ship satisfaction did not differ by the levels of contact and
support. These results show that having strong ties with
adult children is important for Korean retirees parent-child
relationship satisfaction soon after retirement, especially for
low-income retirees.
INTERGENERATIONAL SOLIDARITY AND PARENT-
CHILD DISCUSSION ON END-OF-LIFE CARE IN
JAPAN
R.Hirayama, C.Shimada, T.Wakui, K.Nakazato, Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan
In Japan, because of the familistic climate surrounding the
institutionalized practices of end-of-life care, adult children
are expected to know about their parents wishes regarding
the end of their lives so as to fulfill the role of surrogate deci-
sion maker for parents. Guided by the intergenerational soli-
darity model, our aim in this study was to identify arrays of
the attributes of parent-child relationship, or dimensions of
solidarity, that might lead Japanese adult children to engage
in discussions with their aging parents about end-of-life
issues. Our data were from an online survey using a sample
of Japanese adult children who had at least one living par-
ent aged 65 or older. Of these, we focused on adult children
whose parents were not in need of care (N=849). Alatent
class analysis revealed four types of parent-child relation-
ships that varied in six dimensions of solidarity, and like-
lihood of end-of-life discussion differed significantly across
relationship types. In sum, results suggest that combination
of these dimensions, rather than isolated aspects of rela-
tionships, matters for parent-child discussion on end-of-life
issues. For example, residing with parents (i.e., greater struc-
tural solidarity) made it likely for adult children to engage in
such discussions only when they had a confidant relationship
with parents (i.e., a high level of affectional solidarity). Our
findings point to the need for a holistic approach to parent-
child relationships; that is, to understand how relationship
attributes combine to differentiate Japanese adult childrens
motivation to converse with their aging parents on end-of-
life issues.
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379
DIFFERENCES IN HEALTH OUTCOME AMONG
MARRIED, NEVER-MARRIED, AND SEPARATED OR
DIVORCED ELDERLY IN JAPAN
K.Nonaka1, M.Hasebe1, T.Koike2, H.Suzuki1, T.Fukaya1,
Y.Fujiwara1, 1. Tokyo Metropolitan Institute of
Gerontology, Tokyo, Itabashi-Ku, Japan, 2. Kyushu Sangyo
University, Fukuoka, Japan
The proportion of people who are never-married and
separated/widowed is rapidly increasing in Japan, and it will
increase to 42% of the total population by 2030. The pur-
pose of this study is to examine whether there are any differ-
ences in the probability of decline in IADL among married,
never-married, and separated/widowed elderly, in relations
with demographic characteristics, physical and cognitive
health status, and social networks.
We used survey data from a 4-year longitudinal study of
elderly aged 65 years and older living in A city, located in
a suburb of Tokyo, Japan. A sample of 1686 subjects who
answered both a baseline study (T1) conducted in 2008 and
a follow-up study (T2) conducted in 2012 were divided into
three groups: married (55%), never-married (13%), and
separated/widowed (32%).
One-way ANOVA showed that there were no differences
in IADL among the three groups at T1. Separated/widowed
subjects tended to have higher scores in intellectual activi-
ties (F=7.67, p<.01) and more frequent non-face-to-face and
face-to-face contacts with friends than the other two groups
(F=7.95, p<.01; 19.46, p<.01 respectively). Alogistic regres-
sion analysis revealed that separated/widowed subjects were
more likely to reduce IADL compared with never-married
persons (OR: 2.29; 95%CI: 1.314.01).
Previous studies have reported poorer health among
unmarried persons compare with married persons. The
result indicates that never-married persons may be able to
maintain IADL through managing their daily chores. On the
other hand, separated/widowed persons have higher risks
for reducing IADL despite their higher ability in intellectual
activity and larger social networks.
INDIVIDUALS, FAMILIES, OR THE STATE: WHO
SHOULD PROVIDE SINGAPOREANS LATER LIFE
INCOMES?
D.A.Street1, K.T.DAmuro2, Y.Yang1, 1. Department
of Sociology, SUNY at Buffalo, Buffalo, New York, 2.
SIM-UB, Singapore, Singapore
New challenges for individuals, families and the state are
emerging in Singapores rapidly changing and ageing pop-
ulation. Who should be responsible for meeting the needs
of future older Singaporeans? What roles will individuals,
families and the government play? Using data (N=421) from
a survey of purposively sampled Singaporeans aged 3064
in multivariate statistical models, we analyze factors shap-
ing working aged Singaporeans expectations about finan-
cial support in old age. Our models indicate that working
aged Singaporeans with traditional orientations/Asian val-
ues are significantly more likely to expect future financial
support from their families, while optimism about social
mobility prospects and preferences for private living arrange-
ments are significantly associated with expectations of self-
reliance. Finally, Singaporeans pessimistic about prospects
for social mobility and who worry that retirement will never
380
be possible are significantly more likely to respond that the
government should provide more support for future elderly
Singaporeans. Our findings show that both material and
cultural factors such as social mobility, individualism, and
Asian values that are responsive to the rapid social, cultural,
and economic changes in which they are embedded influence
which social entityindividual, family, or stateworking
Singaporeans believe should be most responsible for provid-
ing financial security in old age.
SATISFACTION WITH FAMILY RELATIONS AND
EXCHANGES OF SUPPORT OF ELDERLY THAT ARE
CARING FOR OTHER ELDERLY
A.S.Lins, A.L.Neri, L.D.Flesch, University State of
Campinas, So Paulo, So Paulo, Brazil
This study aimed to investigate relationships between
Satisfaction with family relations, household arrangements
and exchanges of support, as evaluation of elderly caregivers
of other elderly people. A convenience sample of 148 car-
egivers elderly were selected in health services (public and
private), 77% women, mean age 69.8 7.1, spouses, 62.2%
and 85.8% lived together. The sample with the target of
care was submitted to APGAR of family, questionnaire on
exchanges of support material, instrumental and emotional,
and items that assessed sufficiency of support received and
the ability to offer them. We used the chi-square test, Fishers
exact test and multivariate logistic regression, with discretion
of stepwise selection of variables. Among those who scored
higher in satisfaction with family relations, the majority were
women and spouses of the targets of care. Low emotional
support was associated significantly with low satisfaction
with family relations. Higher rates of reciprocity occurred
in emotional support and the smaller ones in support instru-
ments. The caregivers who consider that were able to provide
support instrumental, but with burden, they pointed down
liens with the family relationships than those who thought
they could do it without burden. Those who only offered and
dont received emotional support were four times more likely
to score for low satisfaction than those offered and received
emotional support. The results showed that the effectiveness
in the exchanges of support, especially the emotional sup-
port, influences the satisfaction with family relationships and
the act of caring. We use the convoy model to describe the
factors.
SESSION 865 (POSTER)
FRAILTY II
CLINICAL FACTORS ASSOCIATED WITH PHYSICAL
FRAILTY IN THE COMMUNITY-DWELLING OLDEST
OLD
J.A.Sousa1, M.H.Lenardt2, C.Grden1, 1. State University
of Ponta Grossa, Ponta Grossa, Paran, Brazil, 2. Federal
University of Paran, Curitiba, Paran, Brazil
This is a cross-sectional study that aimed to present a pre-
dictive model of physical frailty in the oldest old and investi-
gate the association between thise syndrome and the clinical
characteristics of this group. The research was conducted
Innovation in Aging, 2017, Vol. 1, No. S1
with 243 Brazilians aged 80 and older living in the local
community with the cognitive ability to participate in the
study. For those with cognitive impairment, we invited the
family caregiver to participate. Physical frailty was assessed
using structured forms, scales, and physical tests. Descriptive
statistics, and univariate and multivariate logistic regression
(forward stepwise) were used to create prediction models of
physical frailty for those living in the community. We evalu-
ated each model using deviance analysis, predictive value,
specificity and sensitivity, and presented the most parsi-
monious model. Of the 243 oldest old, 14.81% were frail,
63.79% pre-frail and 21.40% not frail. There was a signifi-
cant association between physical frailty and the variables
hospitalization (p=0.045) and antidiabetic drugs (p=0.024).
Relationships were found between fatigue/exhaustion and
number of diseases (p=0.056), fatigue/exhaustion and falls
(p=0.038), gait speed and falls (p=0.023), and hand grip
strength to hospitalization (p=0.023). The predictive model
of frailty elected for this study was composed of the follow-
ing variables: cardiovascular diseases, metabolic diseases,
musculoskeletal diseases, dyslipidemia, ear diseases, other
diseases, hospitalization, falls, medication use and number
of medications. It is inferred that clinical variables interfere
in the development of physical frailty syndrome in the oldest
old community.
PREDICTIVE ACCURACY OF FRAILTY MEASURES:
OVERVIEW OF REVIEWS
J.A.Apstolo1, C.Holland2, E.Bobrowicz-Campos1,
M.Vollenbroek-Hutten3, M.Marcucci4, S.Santana5,
R.Cooke2, A.Cano6, 1. Nursing School of Coimbra,
Coimbra, Coimbra, Portugal, 2. Aston Research Centre for
Healthy Ageing (ARCHA), Aston University, Birmingham,
United Kingdom, 3. University of Twente, Telemedicine
group, Eschedede, The Netherland and Ziekenhuisgroep
Twente, Almelo, Netherlands, 4. Geriatric Unit, Fondazione
IRCCS Ca Granda Ospedale Maggiore Policlinico & Dept.
of Clinical Science and Community Health, University
of Milan, Milan, Italy, 5. Department of Economics,
Management and Industrial Engineering, University of
Aveiro, Aveiro, Portugal, 6. Department Of Paediatrics,
Obstetrics, And Gynaecology, Universitat de Valncia,
Valencia, Spain
Frailty is an age-related state of high vulnerability to
adverse health outcomes after a stressor event, predispos-
ing individuals to progressive decline in different functional
domains. Ascoping search identified a large number of rel-
evant systematic reviews (SRs) on predictive ability of frailty
measures in older adults. Aiming to summarise this set of
evidence an overview of reviews, based on the Joanna Briggs
Institute (JBI) methodology, was conducted. This project
664367/FOCUS was funded under the European Unions
Health Programme (20142020). The studies considered as
eligible for inclusion were quantitative SRs including older
adults aged 60 years or more, recruited from any type of
setting. Timeframe for searching was from January 2001 to
October 2015. Of 420 records identified through searching
in databases, 20 full-texts were assessed for inclusion criteria
and 10 were included. Then 10 were assessed for risk of bias,
using JBI critical appraisal checklist for systematic reviews
and research synthesis. From those, three SRs conducted in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
community and emergency department settings and describ-
ing eight screening tools and eight frailty indicators were
included. Between frailty measures applied to community
dwelling older people, Frailty Index, gait speed and physical
activity were shown to be the most powerful predictors of
future adverse health outcomes. No suitable tool for assess-
ing frailty appropriately in emergency departments was
identified. Future research is required to investigate whether
psychometric properties of available frailty measures are
generalizable to health care settings other than primary care.
There is a need for tools for use in emergency departments.
VALIDATING AMEDICARE CLAIMS-BASED MODEL
TO CLASSIFY PHENOTYPIC FRAILTY IN OLDER
ADULTS
C.C.Cuthbertson1, J.L.Lund1, T.Sturmer1, K.R.Faurot1, Intervention effects on the CL15 score and frailty status were
K.J.Bandeen-Roche2, M.Jonsson Funk1, P.Palta1, examined for the two 3-month periods (Analysis 1). Apro-
A.Kucharska-Newton1, 1. Department of Epidemiology,
University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina, 2. Johns Hopkins University, Baltimore,
Maryland
Medicare claims are increasingly used for epidemiologic
studies in older adults. Claims capture longitudinal healthcare
utilization (diagnoses, procedures, and medication dispens-
ing), but lack clinical measures including frailty, which may
confound or modify observed associations. Researchers pre-
viously developed a Medicare claims-based model (MCBM,
20 diagnoses, procedures, and durable medical equipment
indicators) to predict severe dependence in activities of daily
living as a proxy for frailty. Using Medicare claims linked
with clinical data from Atherosclerosis Risk in Communities
(ARIC) cohort participants (20112013), we assessed the
validity of the MCBM to predict phenotypic frailty (PF),
derived from cohort data. We described the prevalence of
MCBM indicators (e.g., skin ulcer) among participants clas-
sified as frail, pre-frail, or robust and computed measures
of model discrimination (c-statistic), calibration (Hosmer-
Lemeshow test), and predictive validity (mortality using Cox
proportional hazards models). Of 3,146 participants (median
age: 75, 60% women, 22% Black), 7% were frail. The preva-
lence of MCBM indicators was highest among frail partici-
pants. The mean predicted probability of MCBM-derived
frailty was 6.9% (range: 0.4%-78.4%). Model discrimina-
tion for prediction of PF was fair (c-statistic=0.744), while
calibration was good (p-value=0.51). The crude hazard ratio
(HR) for mortality (n=71, maximum follow-up=18months)
comparing older adults with high (>20%) versus low (<5%)
predicted probability of MCBM-derived frailty was HR=8.9
(95%CI: 4.1,18.9) and was independent of age, sex, and race
(adjusted HR=8.9 (95%CI: 3.4,23.1). The existing MCBM
classifies PF with reasonable accuracy. Efforts to improve PF
classification using Medicare claims will enhance their valid-
ity for use in epidemiologic studies of older adults.
A MULTIFACTORIAL INTERVENTION FOR
IMPROVING FRAILTY STATUS: EXPLORING SHORT-
AND LONG-TERM EFFECTS
S.Seino1, A.Kitamura1, M.Nishi1, H.Murayama2, frailty and onset of frailty and of sarcopenia.
M.Narita1, Y.Yokoyama1, Y.Nofuji3, S.Shinkai1, 1.
Tokyo Metropolitan Institute of Gerontology, Itabashi,
Japan, 2. The University of Tokyo, Bunkyo, Japan, 3. Japan
IAGG 2017 World Congress
381
Association for Development of Community Medicine,
Chiyoda, Japan
This study examined the short- and long-term effects of
a multifactorial intervention on frailty using a randomized,
crossover trial with a follow-up survey within the Hatoyama
Cohort Study. Seventy-seven pre-frail or frail older adults
were randomly allocated to an immediate intervention group
(IIG, n=38) or a delayed intervention group (DIG, n=39). The
IIG participated in the twice-weekly multifactorial interven-
tion class consisting of resistance exercise, nutritional, and
psychosocial programs. The DIG was provided no inter-
vention for the initial 3-month period, and both groups
were crossed over for the latter 3-month period. Pre-frail
and frailty were determined by the Check-List 15 (CL15)
score, which was validated against Frieds frailty criteria.
pensity score-matched analysis was performed to balance the
baseline characteristics between the participants (IIG and
DIG) and non-participants of the intervention within the
same cohort, and follow-up was conducted 6 and 16months
after the intervention (Analysis 2). As compared with DIG,
IIG exhibited significant reductions in the CL15 score (-0.36;
95% confidence interval: -0.74, -0.03) and prevalence of
frailty (-23.5%; -40.4%, -6.7%), but not in pre-frailty at
3months, which persisted at 6months. The DIG exhibited
almost similar intervention effects in the latter 3-month
period. Analysis 2 showed that CL15 scores further reduced
significantly in participants who received the multifactorial
intervention, with a significant group-by-time interaction
(P=0.036). In summary, this multifactorial intervention was
effective in improving frailty status on a short- and long-term
basis.
SOCIAL FRAILTY: AMOST IMPORTANT RISK
FACTOR OF FRAILTY AND SARCOPENIA IN
COMMUNITY-DWELLING ELDERLY
T.Tanaka1,2, K.Takahashi2, U.Suthutvoravut1,
Y.Yoshizawa3, M.Fujisaki2, M.Akishita1, K.Iijima2, 1.
Geriatric Medicine, The University of Tokyo, Tokyo, Japan,
2. Institute of Gerontology, The University of Tokyo, Tokyo,
Japan, 3. School of Nursing, Tokyo Womens University,
Tokyo, Japan
Aim: To examine the association between social frailty
and new onset of frailty and sarcopenia, which are defined
by Cardiovascular Health Study index and Asian working
group of sarcopenia, respectively, in Japanese community-
dwelling older adults.
Methods: Large-scale longitudinal surveys were per-
formed in annually from 2012 to 2014. The inclusion crite-
ria consisted of randomly selected community-dwelling older
adults aged 65years who were non eligible for long-term
care and were robust group at baseline assessment. 1,211
elderly were included in this study. Social frailty were opera-
tionally defined using a deficit accumulation model referred
to previous study in Japan. Cox proportional hazard mod-
eling were used to identify the associations between social
Results: 9.7% of participants experienced having frailty,
and 5.5% experienced having sarcopenia during the follow-
up period. Baseline prevalence of social prefrailty (1/5score)
382
was 31% and it of social frailty (2/5) was 20%. Although
there were no significant association with social prefrailty,
those who with social frailty were found to be significantly at
risk of future frailty and sarcopenia (hazard ratio 2.25, 95%
confidence interval 1.33.9 for frailty; hazard ratio 1.55,
95% confidence interval 1.12.8 for sarcopenia, respec-
tively), although adjusted by confounding factors (such as
age, instrumental activity of daily living).
Conclusion: Our research showed strong impact of social
frailty on the risk of new onset of frailty and sarcopenia in
disability-free community-dwelling older adults. Therefore,
to prevent physical frailty in community setting, early inter-
ventions for social frailty via multi-dimensional approaches
may be indispensable.
LOW BODY MASS INDEX IS ASSOCIATED WITH
HIGHER COMPLEXITY OF CARE IN OLDEST OLD
MEN WITH DYNAPENIA
Y.Wang1, C.Liang1,2,3, M.Chou1,2, Y.Lin1,3, H.Lam1, Prevalences of sleep disorders were 20% (16.8 in men
1. Center for Geriatrics and Gerontology, Kaohsiung
Veterans General Hospital, Kaohsiung, Taiwan, 2. Aging
and Health Research Center, Institute of Environmental
and Occupational Health Sciences, National Yang-Ming
University, Taipei, Taiwan, 3. Division of Neurology,
Department of Internal Medicine, Kaohsiung Veterans
General Hospital, Kaohsiung, Taiwan
The association between BMI and health outcomes are
still controversial in oldest old people. However, there are
more evidence for the relationship between physical perfor-
mance or dynapenia and poor outcomes. We recruited 344
men aged over 80years old from a Veterans home in Taiwan
to examine the interrelationship between BMI, dynapenia
and complexity of care needs. Complexity of care was evalu-
ated by the Resident Assessment Protocol (RAP) triggers
derived from MDS. All subjects were classified into high or
low complexity of care needs groups based on our previ-
ous study (high complexity of care needs: 4 RAP triggers;
lower: < 4 RAP triggers). Dynapenia defined by the dynap-
enic components of EWGSOP (DEWGSOP) using the vari-
ables of lower handgrip or slower gait speed (Cutoff point
defined by Asian Working Group for Sarcopenia) without
muscle mass. Triggers of risk of delirium(P= 0.042), cognitive
loss(P= 0.032), poor communication(P= 0.002), poor psy-
chosocial well-being(P= 0.007), low mood states(P= 0.017),
and use of psychotropic drug use(P=0.013) had lower mean
BMI. Lower BMI is significantly associated with higher mean
of MDS-based triggers (residents with BMI<18.5: 5.42.4;
with 18.5BMI<25.0: 4.82.3; with 25.0: 4.12.1; P= Project was approved by the Research Ethics Committee.
0.022) among oldest old men with dynapenia. Comparing
to the residents with BMI25.0, the residents with BMI
between 18.5 and 25, and lower than 18.5 had higher com-
plexity of care needs (OR 1.793, 95% CI 1.041 3.091, P=
0.035 and OR 4.182, 95% CI 1.291 13.543, P= 0.017)
after adjusting for age, educational group and CCI.
SLEEP DISORDERS ARE ASSOCIATED WITH THE
PRESENCE OF FRAILTY IN OLDER ADULTS
B.Manrique-Espinoza1, A.Salinas1, K.Moreno-Tamayo1,
O.Rosas-Carrasco2, 1. Statistics, National Institute of
Public Health, Cuernavaca, Morelos, Mexico, 2. National
Institute of Geriatrics, Ciudad de Mexico, Mexico
Innovation in Aging, 2017, Vol. 1, No. S1
Frailty is a geriatric syndrome characterized by reduced
functional reserve, which results in adverse health out-
comes such as disability and premature death. Meanwhile,
sleep disorders are frequent in the elderly, and their pres-
ence is associated with poor physical health. The quality
of sleep is important for normal functioning of metabo-
lism and hormonal processes. The aim of this study was to
evaluate whether a low quality of sleep is associated with
the presence of frailty in a sample of older adults living
in rural areas. For this study, the follow-up measurement
(2013) of the longitudinal Rural Frailty Study in Mexico
was used. The analytical sample was composed of 591
older adults aged 70 and plus. Frailty was assessed using
the criteria of the Cardiovascular Health Study, and the
variable of sleep disorder was built through the scale of
Pittsburgh. Logistic regression model, adjusted for demo-
graphic and health covariates, in which an interaction term
was included between sleep disorder and sex, was used.
and 21.8 in women) and 11% for frailty. Sleep disorder
was significantly associated with the presence of frailty in
women (OR=3.24, p <0.01) but not in men (OR=0.76,
p = 0.66), after controlling for covariates. Sleep disorder
is an important risk factor to the presence of frailty. These
results highlight the need to consider sleep problems in
comprehensive geriatric assessment of the elderly. More
studies are needed to understand the mechanisms of this
association.
ASSOCIATION BETWEEN THE RISK OF VIOLENCE
AGAINST THE ELDERLY PERSON AND THE FRAILTY
SYNDROME
D.M.Tavares1, M.S.Belisrio1, F.A.Dias1, M.Pegorari2,
M.Mapelli3, P.C.Ferreira1, 1. Education in Nursing and
Community Health, Federal University of Triangulo
Mineiro, Uberaba, Minas Gerais, Brazil, 2. Federal
University of Amapa, Macap, Brazil, 3. North Institute of
Minas Gerais, Almenara, Brazil
This study had the objective of checking the association
between the risk of violence against the elderly person and
the frailty syndrome. This is a population-based study, with a
cross-sectional design, carried out with 705 Brazilian elderly
citizens living in Uberaba, Minas Gerais. We used a struc-
tured questionnaire to characterize the socioeconomic, clini-
cal and health data, besides the Fried frailty phenotype and
the Conflict Tactics Scale. Data were submitted to descrip-
tive analysis, chi-square test and logistic regression (p<0.05).
We have found that 15.9% of the elderly were frail, 52.2%
pre-frail and 31.9% non-frail. In relation to violence, 20.9%
reported episodes of verbal aggression, 7.9% physical aggres-
sion and 21.1% physical and/or verbal aggression. Regardless
of the type of aggression, there was a prevalence of pre-frails;
regardless of the type of aggression, the proportion of frail
elderly was greater than the one that did not report aggres-
sion. The frailty condition was associated with higher odds
ratios for physical and/or verbal (OR=1.82; 95%CI:1.08
3.07; p=0.024), physical (OR=2.52; 95%CI:1.225.20;
p=0.013) and verbal aggressions (OR=1.85; 95%CI:1.10
3.12; p=0.021), even after adjusting the variables related
to age, gender, diseases, medicines, and functional disability
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in basic and instrumental activities of daily living. The out-
comes of this study add knowledge to this issue, taking into
account the analysis of some variables poorly explored in
the scientific literature, frailty and violence against elderly
people, in addition to being able to support the proposition
of preventive interventions and behaviors directed for both
conditions.
FRAILTY AND ITS RELATION TO MORTALITY
IN ELDERLY WHO LIVED IN ABRAZILIAN
COMMUNITY
R.A.PartezaniRodrigues1, M.A.Diniz1, J.S.Fhon1,
V.J.Haas2, S.C.Fabricio-Wehbe1, V.C.Almeida1,
S.B.Giacomini1, 1. Ribeiro Preto College of Nursing,
University of So Paulo, Ribeiro Preto, So Paulo, Brazil,
2. Federal University of Tringulo Mineiro, Uberaba, Brazil
Frailty is a geriatric syndrome caused by multiple factors
and is associated with hospitalization, institutionalization
and death. Objective: to analyze the evolution of frailty and
its relationship with mortality in an elderly Brazilian commu-
nity. Methods: Prospective study with a sample of 515 elderly
living in the community were evaluated at two moments,
with a mean follow-up period of 5.6years. Results: During
the first moment, in 2007/2008, the prevalence of frailty was
17.6%, during the second moment, 50.4%. In this period,
24.7% died during follow-up and of these, 45.7% were frail
according to Edmonton Frail Scale (EFS). In survival analysis
we observed that the frail elderly had lower survival rate.
In the adjusted analysis the risk of death was significantly
higher among the elderly (HR=2.34, 95% CI 1.623.38)
and frail elderly (HR=2.21, 95% CI 1:37-3:58). Conclusion:
Frailty evaluated in 2007/2008 showed a significant predic-
tive value for death.
PREVALENCE OF FRAILTY IN OLDER ADULTS FROM
CURITIBA, PARAN, BRAZIL: COMPARISON OF TWO
INSTRUMENTS
J.Melo Filho1, A.S.Vojciechowski1, N.B.Moreira1,
S.Biesek2,1, A.L.Rodacki1, A.R.Gomes1, 1. Physical
Education Department, Federal University of Paran,
Matinhos, Paran, Brazil, 2. Centro Universitrio Autnomo
do Brasil UniBrasil, Curitiba, Brazil
Older adults frailty is marked by individuals vulnerabil-
ity to increase dependence and/or mortality when exposed
to stressors. The aim was to analyze the prevalence of frailty
in older adults from Curitiba, Parana, Brazil and to com-
pare two frailty assessment methods. This cross-sectional
study included 815 elderly (157 men 70.97.6 years-old; inexact scores due to reliance on self-report or proxy-report
27.64.4kg/m2 and 658 women 70.8
7.0 years-old;
28.45.3kg/m2). Frailty was assessed by the Fried Phenotype: would have limited time to accurately assess all objective
unintentional weight loss; exhaustion; low activity; slowness;
weakness; score 3 frail; 1 or 2 prefrail and 0 not frail; and
by the Clinical-Functional Vulnerability Index (CFVI-20):
age; health self-perception; activities of daily living; cogni-
tion; mood/behavior; mobility; communication and presence
of multiple comorbidities; maximum score 40 points; being
06 low vulnerability; 714 moderate vulnerability and 15
high vulnerability. The prevalence (absolute and relative) and
the correlation of Spearman was used to determine between
IAGG 2017 World Congress
383
the methods (p<0.05). The frailtys prevalence from Fried
Phenotype method was frail 6% (n=49); prefrail 55.8%
(n=455) and not frail 38.25% (n=311). Frailtys preva-
lence from CFVI-20 method was: high vulnerability 14.8%
(n=121); moderate vulnerability 34.75% (n=283) and low
vulnerability 50.4% (n=411). The correlation between the
methods was: frail and high vulnerability (r=0.2; p=0.0001);
pre-frail and moderate vulnerability (r=0.12; p=0.0001) and
not frail and low vulnerability (r=0.28, p=0.0001). Prevalence
of frailty observed was similar to the international literature,
although differences between methods were almost two-fold.
Frailtys assessment obtained from different methods showed
low correlation. Thus, caution is required while comparing
results derived from these approaches.
CHALLENGES OF MEASURING FRAILTY IN
EMERGENCY DEPARTMENTS AND PROPOSED
SOLUTIONS
Ebony Lewis1, M.R.Kristensen3, M.OSullivan2,
A.A.Ekmann4, H.Skjt-Arkil5, H.H.Nygaard4,
M.Cardona-Morrell1, 1. The Simpson Centre for Health
Services Research, The University of New South Wales,
Liverpool, New South Wales, Australia, 2. Cork University
Hospital, Cork, Ireland, 3. Odense University Hospital,
Odense, Denmark, 4. Bispebjerg og Frederiksberg Hospital,
Kbenhavn, Denmark, 5. Hospital of Southern Denmark,
Aabenraa, Denmark
Frailty is associated with longer length of stay and adverse
outcomes in elderly hospitalized patients, including early re-
hospitalization and 12-month mortality. Identifying these
risk levels on presentation at emergency departments is cru-
cial to deliver family education, plan care, arrange referrals,
and anticipate complications. Many instruments are availa-
ble covering objective and subjective parameters. Our multi-
center cohort study of 2,749 elderly patients in Australia,
Denmark and Ireland used Frieds, Rockwoods, SUHBs and
Rylances frailty scores to predict outcomes at hospital dis-
charge and 3-months. The exacerbation of chronic illness,
poor recall, different timeframes for the estimates before
presentation, absence of an informant for incompetent
patients, organizational limitations and stresses of the emer-
gency environment, and hospital policies about stretcher use
on transfer impacted on our ability to reliably measure some
of the parameters. Analysis showed substantial inconsisten-
cies in the classification into pre-frail, frail or robust by dif-
ferent instruments on admission. Telephone administration
of the frailty instruments at follow-up yielded incomplete or
rather than direct observation. We concluded that doctors
parameters during routine care. Emergency/aged care nurses
and physiotherapists are best placed to conduct these meas-
urements given their familiarity with the frailty components,
training in recognizing physical abilities of patients, ongo-
ing opportunity at the bedside, frequent visual assessment,
and communication with patients/ caregivers. Frieds and
Rylances instruments were affected by many practical lim-
itations. Telephone assessment on follow-up is not recom-
mended to document decline or improvement over time.
384
ANTHROPOMETRIC MEASUREMENTS OF
APPENDICULAR SKELETAL MUSCLE MASS IN OLDER
PEOPLE: ASCOPING REVIEW
K.Umapathysivam, C.Tufanaru, R.Visvanathan, S.C.Yu,
University of Adelaide, Adelaide, South Australia, Australia
Sarcopenia is an age-related loss of muscle mass and
strength, a highly prevalent issue for older people and con-
stitutes a major health problem. The measurement of appen-
dicular skeletal muscle mass (ASM) in diagnosing sarcopenia
can be challenging. Despite a clinical need to identify sarco-
penia, there is still a lack of bedside clinical tools to screen
for low appendicular skeletal muscle mass (ASM). The gold
standard tools used to determine ASM are expensive, invasive,
and complex requiring highly trained staff, therefore, anthro-
pometric prediction equations (PEs) were developed for usage
in a clinical and community environments, to estimate ASM.
Thus the objectives of this scoping review were as follows:
1) To map the disparate international literature on the
diverse anthropometric variable parameters included in pre-
dictive equationsfor estimating ASM.
2) To map the development of the anthropometric predic-
tion equations for used in estimating ASM.
This scoping review was undertaken in accordance with
the Joanna Briggs Institutes methodology. Ten studies were
included. Eight studies involved community dwelling healthy
older people and two studies focused on hospitalized older
patients. The most common anthropometric variable param-
eters included in PEs for ASM were body weight, height and
BMI. Regression analysis was used to determine predictive
equations for DEXA derived ASM. Included studies reported
the use of Bland-Altman analysis for measurement agree-
ment. It was concluded that it is possible to define the range
of anthropometric parameters used in estimating ASM and
to identify parameters that can be used with ease in clinical
practice.
SELF-REPORTED FRAILTY AT DISCHARGE IS
ASSOCIATED WITH READMISSION AND MORTALITY
IN OLDER PATIENTS
J.Andreasen1,2, M.Aadahl3,4, E.E.Sorensen2,5,
H.H.Eriksen6, H.Lund7,8, K.Overvad9,10, 1. Department
of Physiotherapy and Occupational Therapy, Aalborg
University Hospital, Hobrovej 1822, Aalborg, Denmark,
2. Department of Clinical Medicine, Aalborg University,
Sdr. Skovvej 15, Aalborg, Denmark, 3. Research Centre for
Prevention and Health, The Capital Region of Denmark,
Rigshospitalet- Glostrup Hospital, Ndr. Ringvej 57,
Afsnit 84/85, Glostrup, Denmark, 4. Department of
Public Health, Faculty of Health Sciences, University of
Copenhagen, Copenhagen, Denmark, 5. Clinical Nursing
Research Unit, Aalborg University Hospital, Sdr. Skovvej
15, Aalborg, Denmark, 6. Unit of Clinical Biostatistics
and Bioinformatics, Aalborg University Hospital, Aalborg,
Denmark, 7. Research Unit for Musculoskeletal Function
and Physiotherapy, Institute for Sports Science and
Clinical Biomechanics, University of Southern Denmark,
Campusvej 55, Odense, Denmark, 8. Centre for Evidence-
Based Practice, Bergen University College, Inndalsveien 28,
Bergen, Norway, 9. Department of Cardiology, Aalborg
University Hospital, Hobrovej 1822, Aalborg, Denmark,
10. Section for Epidemiology, Department of Public Health,
Aarhus University, Bartholins Alle 2, Aarhus, Denmark
Innovation in Aging, 2017, Vol. 1, No. S1
Frailty in elderly is associated with higher risk of rehospi-
talization and death. The objective of this study was to assess
whether self-reported frailty at hospital discharge in acutely
admitted older medical patients, using a multidimensional
questionnaire, was associated with unplanned readmission
or death within six months after discharge. Secondly, to
assess whether physical function was similarly associated.
A cohort study was conducted in seven medical depart-
ments and two acute medical units at Aalborg University
Hospital, Denmark, including acutely admitted patients aged
65+. The Tilburg Frailty Indicator (015 points), Timed-Up-
and-Go and grip strength were measured. Associations were
assessed by Cox Regression, with first unplanned readmission
or death as outcome and frailty as primary exposure vari-
able, including the covariates gender, age and comorbidity.
Of the 1,328 included patients, 50% were readmitted or
died within six months. When adjusted for gender, age and
comorbidity there was a 72% higher risk of readmission or
death if Tilburg Frailty Indicator scores were 813 points
compared to 01 points (Hazard ratio 1.72, CI 1.25;2.35).
A Timed-Up-and-Go score between 12.0 and 23.9 seconds
compared to 4.0 to 7.9 seconds was associated with a 83%
higher risk of readmission or death (Hazard ratio 1.83, CI
1.35;2.49). Grip strength was inversely associated with the
outcomes.
Self-reported frailty assessed by The Tilburg Frailty
Indicator at hospital discharge was directly associated with
risk of readmission or death within six months. Similarly,
higher Timed-Up-and-Go and lower grip strength scores
were associated with higher risk of readmission or death.
ESTIMATION OF PREVALENCE OF SARCOPENIA BY
USING BIA IN CHINESE COMMUNITY-DWELLING
ELDERLY PEOPLE
H.Wang1, S.Hai1, J.Zhou2, Y.Yang2, P.Liu1, B.Dong1, 1.
Center of Gerontology and Geriatrics, West China Hospital
Sichuan University, Chengdu, Sichuan, China, 2. Chengdu
Medical College, Chengdu, China
Sarcopenia is the loss of muscle mass as well as mus-
cle function (defined by muscle strength or physical per-
formance) with aging, but one of the major challenges in
research is the accurate measurement of body composition,
such as appendicular skeletal muscle (ASM). Although Asian
Working Group for Sarcopenia (AWGS) also established the
consensus on sarcopenia diagnosis, there has been no epi-
demiological survey that used AWGS definition to estimate
the prevalence of sarcopenia in China. Atotal of 944 com-
munity-dwelling elderly adults aged 60years or older were
recruited in the cross-sectional study. The appendicular skel-
etal muscle (ASM) was measured by using DXA as a crite-
rion method to validate a standing octapolar multifrequency
BIA (InBody 720), followed by a further estimation on the
prevalence of sarcopenia according to the AWGS definition.
There was no significant difference between DXA and BIA
measured ASM by Bland-Altman analysis. Therefore, BIA is
suitable for body composition monitoring (ASM) in elderly
Chinese as a fast, non-invasive and convenient way; it may
be a better choice in large epidemiological studies in Chinese
population. The prevalence of AWGS-defined sarcopenia
was 12.5% in elderly women and 8.2% in elderly men, and
increases with age in a sample of Chinese community-dwell-
ing elderly.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
PREVALENCE OF FRAILTY IN TAIWANESE ELDERLY:
ACOMPARISON OF TAIWAN URBAN AND RURAL
AREAS
W.Wu, S.C.Hu, College of Medicine, NCKU, Tainan,
Taiwan
Background: Frailty has begun to draw attention in recent
years because it predicts adverse health outcomes for aging
populations. However, the prevalence of frailty in Taiwan is
not yet completely confirmed. This study aimed to compare
the different prevalence of frailty among Taiwanese older
adults in two areas: urban and rural. Methods: Data were
obtained from Taiwan Longitudinal Study in Aging (TLSA)
2003. After excluding those who living in long-term care
institutions and unknown living area, a total of 2,653 older
adults (aged 65years, 48% female, 41% urban residents)
was recruited as the study sample. Frailty index (FI) was con-
structed by Rockwoods multiple-deficits approach, and the
presence of 36 criteria from 3 dimensions was used: 16 of
chronic disease history, 5 of functional assessment, and 15 of
geriatric syndromes. The FI was calculated as the proportion
of the number of deficits, and a cut point of 0.25 will be
defined as frail. Results: Among all the participants, 1,109
(42%) were classified as frail; over a half were female and
43% were from rural area. Without doubt, prevalence of
frailty increased with age in two areas. Compared with gen-
ders, female always had higher prevalence than male in three
age strata, and the highest was over 85-year female rural
population (n=108, 83.72%, FI mean=0.27). Conclusions: of morbidity.
This comparison illustrated the different frailty and severity
among gender, age, and area in Taiwan.
ADHERENCE TO THE MEDITERRANEAN DIET AND
FRAILTY STATUS IN SPAIN. DATA FROM THE TSHA
STUDY
C.Sanchez-Puelles, J.Carnicero, L.Rodrguez-Maas, Prevalence of frailty were statistically higher in women
University Hospital of Getafe, Getafe, Madrid, Spain
Nutrition is one of the main factors related to frailty,
but very few studies have assessed the association between
Mediterranean Diet-MD and frailty, although MD is dis-
cussed as one of the healthiest eating patterns and the
adherence to this type of diet is related to the prevention or
treatment of several diseases. The present study assesses the
potential association between adherence to MD and frailty
in a cohort composed by community-dwelling older adults,
the Toledo Study of Healthy Aging, Spain, whose charac-
teristics have been broadly described elsewhere. The sam-
ple consists of 2327 participant (mean age 76 years). The
incidence of frailty was assessed using three different crite-
ria: Fried (9.88%), Frailty Index (10.07%) and Frailty Trait
Scale (10.23%). Adherence to the Mediterranean diet was
determined by the Predimed questionnaire (06 points non-
adherence, 714 points adherence). The results show low
adherence to the Mediterranean Diet (91% of the sample got
a score between 24). Food pattern varied by: gender, being
men those with greater adherence (P-value < 0.05), and age,
where adherence to Mediterranean Diet declines with age
(P-value < 0.01). Overall the frail population had a different
nutritional pattern (P-value < 0.01) with a lower adherence
to Mediterranean Diet (P-value < 0.01), and a lower con-
sumption of foods rich in antioxidant in frail people. These
differences were independent of tool used toassess frailty.
IAGG 2017 World Congress
385
Accordingly, Mediterranean Diet is associated to frailty,
with an outstanding role for some of their components.
Supported by Grant RD12/0046; ISCIII, Ministerio de
Economa y Competitividad
PREVALENCE OF FRAILTY IN CHINESE OLDER
PEOPLE: ACROSS-CULTURAL STUDY
R.Yu1,2, W.Wu3, J.Leung4, S.C.Hu3, J.Woo1,2, 1.
Department of Medicine & Therapeutics, Faculty of
Medicine, The Chinese University of Hong Kong, Shatin,
Hong Kong, 2. The Chinese University of Hong Kong
Jockey Club Institute of Ageing, Shatin, Hong Kong,
3. Department of Public Health, College of Medicine,
National Cheng Kung University, Tainan, Taiwan, 4. The
Chinese University of Hong Kong Jockey Club Centre for
Osteoporosis Care and Control, Shatin, Hong Kong
Methods: Data were derived from two population-
based studies, the Mr Os and Ms Os (Hong Kong) stud-
ies (n=4000) and the Taiwan Longitudinal Study on Aging
(TISA, n=2653). Older people aged 65years and older living
in the community were invited to respond to a structured
questionnaire. Frailty Index (FI) was constructed from 36
variables covering medical and drug histories, geriatric syn-
dromes, assessment of physical and cognitive functioning,
psychological wellbeing, and nutritional status. Frailty was
defined as the index 0.25. The ratio of FI to life expec-
tancy at birth (LE) was used as an indicator of compression
Results: The weighted average prevalence rate of frailty
was 41.8% and the rates were more prevalent in Taiwan
urban and Taiwan rural areas (40.5% and 42.7% respec-
tively) compared to Hong Kong (15.2%, P<0.05). Frailty
increased with age: 6574years 9.6%-30.4%; 7584years
19.4%-48.8%; older than 85years 24.7%-77.0% (P<0.05).
(ranged from 21.1%-54.3%) than in men (ranged from
9.4%-31.7%, P<0.05) and the differences were found in
all age groups (P<0.05). The ratios of FI/LE were higher in
Taiwan urban and Taiwan rural areas (both 0.25) compared
to Hong Kong (0.17, P<0.05).
Conclusion: This comparison provides better understand-
ing of levels in the health of older people and provides use-
ful data to inform government policies. Further analyses
are needed to compare the role of personal, environmental,
and health and social care systems in contributing to frailty
across the study populations.
SESSION 870 (POSTER)
GERONTOLOGY AND GERIATRICS EDUCATION II
THE EFFECT OF AKOREAN FUNCTION-FOCUSED
CARE PROGRAM AMONG OLDER ADULTS IN LONG-
TERM CARE FACILITIES
D.Jung, J.Byun, M.Lee, Ewha Womans University, Seoul,
Korea (the Republic of)
The purpose of this study was to develop Korean
Function-Focused Care Program (K-FFCP) to manage older
adults functions in restorative care, ultimately, evaluate the
386
programs effectiveness. The study design was pretest-posttest
design with nonequivalent control group were assigned. Two
nursing facilities located in Seoul as a treatment group and
as a control group, respectively. The number of participants
in the experimental group was 23 and control group had 20
participants with a total 43 participants enrolled in the study.
The K-FFCP consisted of education for nurse and care work-
ers and self-training for older adults for 6 weeks. The details
about the developed K-FFCP include six components such
as eating, dressing, bladder training, walking, using adaptive
equipment, and exercise. The data of cognition (K-MMSE),
physical function (K-ADL), physical capability (PCS), depres-
sion (CSDD), anxiety (RAID), grip strength, fear fall were
collected. The K-FFCP effects for older adults were measured
a total of 3 times (before intervention, after intervention, 6
weeks after intervention). The collected data were analyzed
using Statistical Analysis System (SAS version 9.3 TS Level
1M0) program, which utilized Generalized estimating equa-
tions (GEE). According to the results, the K-ADL and PCS
in experimental group showed significant increase group-
time interaction. Thus, the K-FFCP showed its effectiveness
in managing and improving older adults physical function.
Ultimately, the results of this program can work as a corner
stone in increasing quality of life for older adults.
CAN MATURE-AGE NONTRADITIONAL STUDENTS
SUCCEED IN AN ONLINE BACHELOR OF DEMENTIA
CARE PROGRAM?
L.Goldberg, A.Canty, A.King, A.Price, A.Carr, patients aged 60years old and above. Frailty was diagnosed
J.Ziebell, J.Westbury, K.Elliott, Wicking Dementia
Research and Education Centre, University of Tasmania,
Hobart, Tasmania, Australia
An important strategy to increase knowledge, skills, and
confidence of the workforce providing a range of care to peo-
ple with dementia is access to contemporary evidence-based
education. This paper outlines the innovative, fully online
Bachelor of Dementia Care degree offered by the Wicking
Dementia Research and Education Centre at the University
of Tasmania (Australia). It presents an exploratory single-
case study of 65 students in the first degree cohort: 31 stu-
dents had previous university-level experience, 34 did not.
All passed the units in which they had enrolled. Students
with previous university-level experience showed signifi-
cantly superior performance (p <.05) in only 3 of the 15
units all students had completed to date. Further, the aver-
age across-unit grade for students in both groups was no
lower than a Credit (6070%). As judged from comments on
University surveys, discussion boards, and requests for help,
students with no previous university-level experience needed
time to adapt to the culture of university-level study, under-
stand the nuances of ethical academic writing, and learn how
to balance the intensity of studying over consecutive semes-
ters with work and family responsibilities. These differences
highlight the importance of scaffolding learning and provid-
ing step-by-step guidance for all students, but particularly
those with no previous university-level experience. Findings
give credence to the institutional and student support, curric-
ulum planning, unit structure, and methods of presentation
that are integral to this online degree to provide a success-
ful online learning experience for mature-age non-traditional
students.
Innovation in Aging, 2017, Vol. 1, No. S1
FRAILTY STATUS AND ITS ASSOCIATED FACTORS
AMONG INDONESIAN ELDERLY PEOPLE
S.Setiati1, S.Aryana2, E.Seto1, S.Sunarti3, N.Widajanti4,
L.Dwipa5, R.Istanti1, 1. Faculty of Medicine Universitas
Indonesia - Division of Geriatrics Internal Medicine
Department -Cipto Mangunkusumo National Hospital,
Jakarta, Jakarta, Indonesia, 2. Faculty of Medicine
Universitas Udayana - Division of Geriatrics Internal
Medicine Department, Bali, Bali, Indonesia, 3. Faculty of
Medicine Universitas Brawijaya - Division of Geriatrics
Internal Medicine Department, Malang, East Java,
Indonesia, 4. Faculty of Medicine Universitas Airlangga
- Division of Geriatrics Internal Medicine Department,
Surabaya, East Java, Indonesia, 5. Faculty of Medicine
Universitas Padjajaran - Division of Geriatrics Internal
Medicine Department, Bandung, West Java, Indonesia
Frailty puts the elderly in risk of getting adverse health
outcomes. Genetic factors, aging, life style, and commorbidi-
ties are important risk factors of frailty. It is important to
know other related risk factors of frailty in elderly, especially
in outpatient setting in order to prevent incidence of frailty.
Unfortunately, study about frailty among elderly population
in Indonesia is limited. The aim of this study is to obtain
prevalence of frailty status and its associated factors among
Indonesian elderly population.
This multicenter cross-sectional study was conducted at
Geriatric Clinic of several hospitals in Indonesia (Jakarta,
Malang, Surabaya, Bali, and Bandung) among 448 elderly
using questionnaire of Frailty Index-40 item. Data on social
demographic, functional status (ADL Barthel index), nutri-
tional status (MNA questionnaire), and polypharmacy of
each subject were collected. Logistic regression was used to
obtain factors associated with frailty status.
Frailty status of subjects were 13.2% robust, 61.6% pre-
frail, and 25.2% frail. Bivariat analysis showed that age (OR
2.83; 95% CI 1.69 4.73), nutritional status (4.55; 95% CI
2.887.20), functional status (OR 3.97; 95% CI 2.546.20),
and polypharmacy (OR 1.82; 95% CI 1.053.15) were asso-
ciated with frailty status. Logistic regression analysis showed
that age (OR 2.72; 95% CI 1.58 4.76), functional status
(OR 2.89; 95% CI 1.794.67), and nutritional status (OR
3.75; 95% CI 2.296.13) were asociated factors of frailty
status.
The conclusion of this study is that the factors associated
with frailty status were age, functional status, and nutritional
status.
FUNCTIONAL FITNESS, ANTHROPOMETRICS, AND
PHYSICAL ACTIVITY IN OLDER ADULTS FROM
AMAZONAS, BRAZIL
M.A.Faber2, A.B.Lima1, R.P.Lima1, D.L.Freitas3,4,
E.R.Gouveia3,5, 1. Science of School Health, University
of the State of Amazonas, Manaus, Amazonas, Brazil, 2.
Faculty Idaam, Manaus, Amazonas, Brazil, 3. University
of Madeira, Funchal, Portugal, Ilha da Madeira, Portugal,
4. University of Essex, Colchester, United Kingdom, 5.
University of Geneva, Geneva, Swaziland
This study aimed to describe the variation of functional
fitness (FF), external morphology and body composition
(BC) according to gender, age, and level of physical activity
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
(PA) in older adults from the city of Borba, Amazonas, Brazil.
The sample consisted of 233 participants (97 men and 136
women) distributed across 5 age cohorts (6064, 6569,
7074, 7579 and >80 years). The FF was assessed using
Senior Fitness Test. PA was estimated by the modified Baecke
questionnaire. Anthropometric measures followed the ISAK
protocol. Independent sample t-test showed no statistically
significant differences in FF between men and women, except
in upper limbs strength (favoring men) and shoulder flex-
ibility (favoring women). Men were higher, heavier and had
higher bone diameters, circumferences, and fat-free mass
than women. Opposite results were found for fat mass (FM).
One-way between-groups ANOVA revealed in both sexes,
age cohorts differences in all FF components, favoring the
younger cohorts, except for flexibility. Similar results were
seen for anthropometric measures and FFM. No statistically
significant differences were seen in FF components, neither
in the anthropometric measures nor BC, between PA groups
(low, medium and high), with one exception: flexibility in
women. These results can be used as a general health index
for this group/sub-population from a specific environment.
Longitudinal studies, as well as, more objective measures, are
badly needed to achieve a deeper understanding of these rela-
tionships in this specific population.
FEASIBILITY, SAFETY, AND OUTCOMES OF PLAYING
KINECT ADVENTURES GAMES FOR ELDERLY:
APILOT STUDY
J.R.Bacha, T.B.Freitas, K.G.Silva, G.Gomes, L.Viveiro, EDUCATIONAL NEEDS OF HEALTHCARE
E.M.Varise, C.Torriani-Pasin, J.Pompeu, Department
of Physical Therapy, Speech Therapy and Occupational
Therapy, School of Medicine, University of Sao Paulo, So
Paulo, So Paulo, Brazil
Objective: To evaluate the feasibility, safety and outcomes
of a training based on Kinect Adventures games in community
dwelling elderly. Methods: We selected 18 community dwelling
elderly, mean age 70.41 (5.43) years. Participants underwent 14
training sessions of training of one hour of duration, twice a
week, in which they played four Kinect Adventures games. The
subjects were assessed before and after training. The feasibility
was assessed through a satisfaction questionnaire. Security was
evaluated by recording adverse events during interventions. The
outcomes of postural control and gait were the Mini-Balance
Evaluation Systems Test (Mini BESTest) and the Dynamic Gait
Index (DGI), respectively. Results: All participants scored the
higher level of the satisfaction questionnaire. There were no
adverse events during interventions. The intervention pro-
moted improvement on postural control (Mini BESTest median
before training=28 and after training=30.5; Wilcoxon test,
p=0.013) and gait (DGI median before training=23 and after
training=24; Wilcoxon test, p=0.033).Conclusion: The train-
ing based on Kinect Adventures Games was feasible, safe and
promoted improvement on postural control and gait of com-
munity dwelling elderly.
RELATIONSHIP OF NUTRITIONAL STATUS AND
FUNCTIONAL CAPACITY IN ELDERLY PATIENTS
S.Kanwal, W.Qidwai, K.Nanji, Aga Khan University
Hospital Karachi, Karachi, Sindh, Pakistan
Rising elderly population poses a great challenge in terms
of the health care burden due to various social and biological
IAGG 2017 World Congress
387
influence so our older individuals is at risk of malnutrition
and subsequently impairment in there functional activity and
affects quality of life.
This was analytical cross-sectional conducted from
January-July 2015.We evaluated functional and nutri-
tional status by using KATZ scoring and MNA Scale in
elderly>60 years in sample size of n=200.individuals pre-
sented to Family medicine clinics of AgaKhan University
hospital karachi,were recruited via non probability consecu-
tive sampling Data double entered in SPSS 19. To assess the
correlation between nutritional status and functional status
Spearmans rank Correlation Coefficient was applied.
Mean age was (68.3years7.0 SD) male proportion
was(54%)n=109. According to checklist 33.5% (n=67)
were at risk of malnutrition, and 35.5% were function-
ally impaired (n=71) Spearmen correlation between func-
tional and nutritional status was found to be rho=0.65 with
p-value= 0.039 .Both are also significantly associated with
variables like age and educational status p.value=0.000 and
p=0.049 respectively. Hypertension 67% (n=134)and diabe-
tes 50% were found to be most prevalent diseases in elderly,
Polypharmacy was prevalent in 37.5%(n=75)
Our study indicates that there is a significant positive cor-
relation between nutritional and functional status. This needs
to be addressed in a developing country like Pakistan, how-
ever this is a small cross-sectional study in one setting,further
large studies will be required to assess the relationship
PROFESSIONALS IN THE FIELD OF GERONTOLOGY
IN BULGARIA
P.Balkanska-Georgieva, N.Georgiev, E.Ivanov,
S.Mladenova, A.Vodenicharova, A.Yanakieva, Medical
University of Sofia, Faculty of Public Health, Sofia, Bulgaria
Challenges for geriatric care in Bulgaria are significant.
Our country is the second most rapidly aging nation in the
Eastern region of Europe. In this connection, the logical
question is: are the health professionals prepared to meet the
demographic challenges of aging? In search of answers to
these questions was done a large study. The aim of the study
was to explore the specific problems of occupational health
professionals in providing medical and social assistance for
old people and clarify their educational needs in the geron-
tology and geriatric practice Object of Study and Methods:
Respondents are 1875 people in 10 cities across Bulgaria:
940 healthcare professionals and 935 persons over 60years,
consumers of health care, of which 385 people from their
homes for the elderly. The following methods were used:
documentary method; inquiry method; Delphi method; sta-
tistical methods. Research Results: Determined are the main
reasons for the difficulties of health professionals in taking
care for their patients. There were missing or insufficient
knowledge of gerontology and geriatric care in half of the
respondents. Educational needs in medical gerontology are
in the following areas: specific manifestations of disease in
old patients, age changes in mentality and behavior, com-
munication skills for working with elderly, training in health
care for chronically ill and their families, aging prophylaxis.
Based on the survey data, recommendations for adapting the
education of health professionals in the field of gerontology
and geriatric practice were prepared.
388
KEYWORDS: aging, geriatric care, health professionals,
educational needs, medical gerontology
PREPARING ACULTURALLY SENSITIVE
HEALTHCARE WORKFORCE: OUTCOMES AND
BENEFITS OF GERIATRIC COURSES
O.Catolico, A.Boyle, School of Health & Natural
Sciences Department of Nursing, Dominican University of
California, San Rafael, California
The World Health Organization predicts that persons
aged 60years and older will total 2 billion, an increase from
900 million in 2015 (WHO, 2015). In the U.S., there were
44.7 million persons who were 65 and older who accounted
for 14.1% of the total population in 2013. (U.S. Census
Bureau, Population Estimates, 2014). Also notable are demo-
graphic shifts related to migration. Over 1 billion people are
migrants and this includes 244 million persons residing in a
country other than their country of birth (2016, International
Organization for Migration).
Given this information it is imperative that healthcare
professionals are educationally prepared to provide effec-
tive and culturally sensitive care to older adults. Older adults
nonetheless, continue to experience healthcare disparities
including access to care and quality of care. Disparities in
care continue to persist in Asian Pacific Islanders, Alaskan/
Native Americans, African Americans, Hispanics, and LGBT
populations (AHRQ, 2015). Social determinants of health,
limited English proficiency and health literacy, inadequate
healthcare provider knowledge and skills contribute to dis-
parities in minority populations.
California is one of the most diverse states in the nation,
yet few undergraduate programs have dedicated curriculum in
geriatric nursing. Aprivate independent university has required
a foundational course in geriatric nursing for eight years. The
objectives of this study are to: (1) identify the practice patterns
of geriatric nursing competencies among its nursing program
graduates (AACN, 2010), and (2) examine the impact of prac-
tice competencies on care outcomes of the older adult in respec-
tive healthcare settings through facility databases. F;n=258,M;n=192) and Grp4(80 y/o+; F;n=222,M;n=240).
ASSOCIATION BETWEEN FRAILTY AND PAIN:
ATIME BOMB
M.Gurgu1, E.F. Bleotu2, A.Zamfirescu3, H.Gurgu3,
M.Gurgu4, M.Sporis2, 1. Emergency Hospital, Brasov,
Romania,
2. Hospie Casa Sperantei, Brasov, Romania, 3. University
of Medicine an Pharmacy Carol Davila, Bucharest,
Romania, 4. Emergency Pediatric Hospital, Cluj-Napoca,
Romania
Chronic pain is a common, frequently undervalued
symptom in elderly patients. Frailty is a common geriatric
syndrome in elderly, but frequently unquantified in medical
practice. Pain and frailty are independent risk factors for high
dependency in elderly and when associated they increase dis-
ability and lower the quality of life
Objectives: The aim of this paper was to study the asso-
ciation between persistent pain and frailty in two groups:
robust and frail elderly and the impact on functional capacity.
Material and Methods: We conducted an observational
study on 97 elderly patients selected from 678 patients, age
Innovation in Aging, 2017, Vol. 1, No. S1
between 65 and 93year. We excluded oncological patients,
those dependent with advanced stages of somatic and psy-
chiatric diseases. We split the patients in two groups: robust
and frail. We used the Frailty Index to assess frailty, Brief
Pain Inventory to assess pain and IADL and ADL scales to
measure functional capacity.
Results: There was a high incidence of pain in the two
groups (60%), highest being in the frail group (77.7%)
and with a higher analgesic consumption (NSAID and
Acetaminophen being most used). The association of pain
and frailty increases the level of dependency, represented by
ADL and IADL (mean score 4 compared to 6 for robust).
Conclusion: A thorough assessment of elderly patients
that have persistent pain associated with frailty is a chal-
lenge, but with positive effects on quality of life. Frailty rises
the difficulty of pain management which requires a complex
approach: pharmacological and non-pharmacological, moni-
toring the side effects and drug interactions.
A 15-YEAR RETROSPECTIVE STUDY EXAMINING
THE EXERCISE HABITS OF COMMUNITY-DWELLING
OLDER ADULTS
B.Willis, M.Sims, E.Prost, S.Sayers, Physical Therapy,
University of Missouri-Columbia, Columbia, Missouri
Routine exercise habits have been shown to reduce
modifiable health risks associated with aging. Studies
examining the exercise habits of older adults over a 15year
period are limited. The purpose of this study is to better
understand the exercise habits of males (M) and females
(F) in their 50s, 60s, 70s and those 80 years old(y/o).
By examining mean age, sex, and number of lifetime
visits(NLV), clinicians may improve targeted wellness
education, reducing modifiable health risks associated
with aging. The age, sex, and NLV of 1,988 community-
dwelling older adults enrolled in a hospital-based well-
ness center from 9/1/2000 to 1/1/2016 were examined.
Groups included: Grp1(50-59y/o; F;n=372,M;n=125),
Grp2(60-69y/o; F;n=353, M;n=226), Grp3(7079 y/o;
Statistical significance was accepted at p<0.05. Overall
mean age was 55.02.8(F=55.12.8,M=54.92.7) for
Grp1, 64.42.9(F=63.93.0,M=65.12.8) for Grp2,
74.42.9(F=74.52.9,M=74.52.9) for Grp3, and
86.95.2(F=86.85.3,M=86.95.1) for Grp4. Overall mean
NLV was 57.9123(F=52.5108,M=74.0160) for Grp1,
115262(F=115268,M=115253) for Grp2, 198427
(F=173403,M=233455) for Grp3, and 323497(F=301
501,M=343494) for Grp4. Asignificant main effect for
age (f=46;p<0.001) on NLV was observed. Astrong trend
for sex(f=3.5;p=0.06) on NLV was seen. No age by sex
interaction(f=0.68;p=0.57) existed. Significant differences
in NLV at each successive age group over age 60 were pre-
sent. This study demonstrated that age had a significant
impact on NLV. Also, a strong trend(p=0.06) suggests that
men participated in more NLV than women. This reinforces
that clinicians may benefit from considering a clients age
and sex to improve targeted wellness education, increasing
exercise participation and reducing modifiable age related
health risks.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE ASILA PROGRAM: IMPROVED CARE IN
NURSING HOMES FOR FRAIL SENIORS
V.Boscart1, G.Heckman2, K.Huson1, M.Heyer1, J.Hirdes2, P.Zhang1, H.Hayashi1, H.Sato2, T.Yamashita3, 1.
1. School of Health & Life Sciences and Community
Services, Conestoga College, Bright, Ontario, Canada, 2.
University of Waterloo, Waterloo, Ontario, Canada
The Applied Simulated and Integrated Learning Approach
(ASILA) aimed to advance targeted clinical outcomes for sen-
iors through the use of evidence-informed case simulations
of conditions among frail seniors with cognitive and physical
challenges. The ASILA program is based on the use of the
Minimum Data Set as a comprehensive geriatric assessment
(CGA) and quality improvement framework to facilitate care
planning.
A mixed method, repeated-measures design was used to
assess changes in nursing assistants (NA) knowledge and
perceptions of CGAs and resident clinical outcomes.
Quantitative data indicated meaningful improvements in
key knowledge areas. Qualitative data provided a description
of the impact of the ASILA program on staff knowledge and
role perceptions and how that translated to care practices.
The ASILA program successfully enhanced NAs knowl-
edge and perceptions of CGAs, and improved resident out-
comes, while emphasizing quality of life and promoting best
practices within a financial framework of accountability.
MASTER ON GERONTOLOGY: APERSPECTIVE IN
GERONTOLOGY EDUCATION IN MEXICO
E.Arias-Merino, N.M.Mendoza Ruvalcaba, I.Daz-Garca, tion, life management, and social involvement were
M.Flores Villavicencio, Salud Pblica, Universidad de
Guadalajara, Zapopan, Jalisco, Mexico
In order to prepare high-quality human resources in
Gerontology able to face the challenges of our aging soci-
ety, the University of Guadalajara (Mexico) had offered the
Master of Gerontology degree since 1994. Based on this
program, it has been developed a new program evaluated
and accepted in 2016, in the National Quality Graduate
Program of the National Council of Science and Technology
(CONACYT).
For this Master degree, gerontology is understood as a
field of the scientific knowledge inter-multi-transdisciplinary,
dedicated to the study of the process of aging, the old stage
and the older persons as individuals; from bio-psycho-social
perspectives.
From a Public Health approach, and based in solid ethi-
cal values and attitudes, the gerontologist profile includes the
knowledge to: 1) describe understand and explain the life-
span from a bio-psycho-social perspective, 2) differentiate
successful, active and healthy aging from pathological, 3)use
methods and techniques for the generation of knowledge and
intervention in the aging process, 4)understand the admin-
istrative process of institutions in gerontology, 5) analyze
social policy and legislation, 6) analyze the importance of
social perception of the older persons, 7)analyze the impor-
tance of the family and social network, as well as social sup-
port in gerontology interventions.
Is a competence-based program, and in a review, it was
found that its approach applies the gerontology competen-
cies for undergraduate and graduate education published by
AGHE in November 2014.
IAGG 2017 World Congress
389
HIGHER-LEVEL FUNCTIONAL CAPACITY AMONG
THE COMMUNITY-DWELLING ELDERLY IN JAPAN
Department of Nursing, Saitama Prefectural University,
Koshigaya, Saitama Prefecture, Japan, 2. Takesato District
Public Hall, Koshigaya, Saitama Prefecture, Japan, 3. Chuo
Public Hall, Koshigaya, Saitama Prefecture, Japan
Objective: Japan is a rapidly aging society, and thus nurs-
ing approaches that enable the elderly to lead longer and
more independent lives are needed. Therefore, the purpose of
this study was to gain a better understanding of higher-level
functional capacity among community-dwelling elderly.
Methods: A questionnaire survey was conducted at a
Japanese community center for the elderly in October 2015.
The questionnaire was designed to identify the characteris-
tics of the elderly and assess higher-level functional capacity
according to the following four aspects: using a new instru-
ment; collecting information; life management; and
social involvement.
Results: A total of 135 elderly individuals (42 men, 93
women; mean age, 74.6 years; range, 6590 years) com-
pleted the questionnaire. Fifty-nine (43.7%) respondents
were living in a married household, 86 (63.7%) had a
chronic disease, 111 (82.2%) were pursuing a hobby, and
67 (49.6%) frequently participated in activities. The mean
( standard deviation) higher-level functional capacity score
was 10.53.8 points out of a possible total of 16. The mean
scores for using a new instrument, collecting informa-
2.51.3, 3.11.1, 2.81.1, and 2.01.6, respectively.
Conclusions: According to a previous study, the mean
higher-level functional capacity score for a nationally rep-
resentative sample of community-dwelling elderly was
9.74.2; that of this study was higher in comparison, indi-
cating that the elderly individuals in this study had excellent
functional capacity. In the future, nursing approaches that
help rejuvenate the community by enabling the elderly to
lead even longer and more independent lives are expected.
TRAINING AND MOTIVATION OF MEDICAL
PROFESSIONALS FOR WORK WITH OLDER PEOPLE
IN BULGARIA
S.M.Mladenova, E.Ivanov, P.Balkanska,
A.Vodenicharova, A. Yanakieva, Faculty of Public Health,
Medical University - Sofia, Sofia, Bulgaria
Introduction: In the recent decades, in Bulgaria and in
Europe there is a steady trend of increase of the aging popu-
lation and as a result of this raising of the proportion of older
people.
One of the main tasks of our society is to provide appro-
priate conditions and satisfactory levels of care in order to
achieve good quality of life for older people. It is especially
important to take actions to provide a dignified aging of the
elderly.
The training of nurses in Bulgaria in the curricula is
included a course Nursing care for elderly which meets
the increased needs for specialists ready to work with old
people.
The aim of the study is to examine the need for special-
ized training, the readiness of medical specialists to work
390
with older people and to contribute for the motivation of
these professionals to provide quality health care.
Methods applied: Conducted was an anonymous sur-
vey among 62 medical professionals trained in a part time
form of training in the undergraduate program of the
specialty Management of health care. The survey was
conducted during the training internship of the students
of third year who work in health institutions throughout
the country.
The results show that the work with old people is not pre-
ferred by nurses. Working with the elderly is burdening them
mentally and physically and sometimes this hampers the per-
formance of professional activities. In order to motivate the
medical professionals to work with older people they need
more additional stimuli and specific knowledge and training
to make them be able to contribute successfully for the better
quality of life of the elderly.
SESSION 875 (POSTER)
HEALTH CARE
TRAJECTORIES OF MOTOR FUNCTION AND
COGNITION IN RELATION TO HOSPITALIZATION
J.Hallgren1, E.I.Fransson1, D.G.Finkel2, A.K.Dahl-Aslan1, healthcare settings (primary care and community care) with
1. School of Health and Welfare Jonkoping University,
Jnkping, Sweden, 2. School of Social Sciences, Indiana
University Southeast, New Albany, Indiana
Background: Hospitalization among older people is
common and associated with adverse outcomes. However,
knowledge about long-term effects on motor functions and
cognitive abilities in relation to hospitalization is scarce. In
order to explore development of motor functions and cogni-
tion after hospitalization, a longitudinal study among mid-
dle-aged and older adults with up to 25years of follow-up
was conducted.
Methods: Overall, 828 participants from the Swedish
Adoption/Twin Study of Ageing (SATSA) were linked to the
Swedish National Inpatient Register, which contains infor-
mation on participants hospital admissions. Up to 8 assess-
ments of cognitive performance and 7 assessments of motor
functions i.e. fine motor, balance/upper strength, and flex-
ibility, from 1986 to 2010 were available. Latent growth
curve modelling was used to assess the association between
hospitalization and subsequent motor function and cognitive
performance.
Results: Atotal of 735 (89 %) persons had at least one
hospital admission during the follow-up. The mean age at
first hospitalization was 70.2 ( 9.3) years. Persons who were
hospitalized exhibited a lower mean level of cognitive per-
formance in all domains and in motor functions compared
with those who were not hospitalized. Asignificantly steeper
decline was observed in motor function abilities as well as
in processing speed, spatial/fluid, and general cognitive abil-
ity performance of hospitalized participants. These patterns
remained even after comorbidities and dementia prevalence
were controlled for.
Discussion: We are the first to show that hospitalization
is associated with steeper decline in both motor function and
Innovation in Aging, 2017, Vol. 1, No. S1
cognitive abilities across more than two decades of post-hos-
pitalization follow-up.
IMPROVING PATIENT-PROVIDER PARTNERSHIPS
ACROSS THE HEALTHCARE SYSTEM
P.T.Stolee1, J.Elliott1, G.Heckman1, V.Boscart2, S.Group1,
1. University of Waterloo, Waterloo, Ontario, Canada, 2.
Conestoga College, Kitchener, Ontario, Canada
Many older patients and their caregivers wish to be
engaged in decisions around their care, but this is often
not well accommodated in existing practice models. We
synthesized available theories and evidence around engage-
ment of older adults in healthcare decision-making into
our previously developed CHOICE Patient Engagement
Framework (Stolee et al., 2015; Elliott et al., 2016) and
developed strategies to support meaningful partnerships of
older patients and caregivers with their healthcare provid-
ers. In partnership with patients, caregivers and health care
providers, this current project aimed to answer the following
questions: 1)How do the CHOICE principles and strategies
correspond with actual experiences of engagement? 2)What
factors currently facilitate or hinder patient engagement? and
3)What resources, materials and implementation strategies
are needed to support patient engagement in each health
setting? We conducted observations and interviews in two
providers, patients, and families to understand current per-
spectives, practices, and facilitating/hindering factors related
to patient engagement. Observation and interview data were
analyzed using emergent coding as well as directed coding
guided by the CHOICE framework. Using the information
that emerged from the interviews and observations, resources
and materials for patient/caregiver engagement have been co-
created by patients, caregivers and healthcare providers, for
use in multiple care settings.
ATTITUDES TOWARD AGING AND CHANGE IN
PHYSICAL FUNCTION AMONG OLDER ADULTS IN
TAIWAN
C.Sun1, C.Yeh2, H.Cheng1, L.Lu1, R.Shen3, C.Chiu1,
1. Division of Geriatrics and Gerontology, Department
of Internal Medicine, National Cheng Kung University
Hospital, Tainan, Taiwan, 2. Institute of Allied Health
Sciences, National Cheng Kung University, Tainan, Taiwan,
3. Institute of Nursing, National Cheng Kung University,
Tainan, Taiwan
Attitudes are known to exert a powerful influence upon
physical performance in later life, include ADL and IADL
dependency, with variable impact. Aim of this study was to
investigate the impact of attitudes toward ones own aging
on functional outcomes in a national-wide representative
sample of community-dwelling older adults in Taiwan. Data
on participants (N=3778) aged 65 and over who partici-
pated in the 2003 and 2007 Taiwan Longitudinal Study on
Aging (TLSA) were analyzed. Physical disability, including
mobility limitations, IADLs and ADLs were regressed on an
individuals attitude toward aging in 2003, with control of
their physical function and other covariates in 2003. Results
show that positive attitude toward aging was associated with
higher levels of physical function four years later. Specifically,
negative attitude on Will you raise grandchildren in
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
retired-years was associated with higher ADL limitations
during follow-up (OR:1.75, 95% CI 1.262.42, p<0.001).
Negative attitude on Do you agree that government had
provided welfare in accordance with demand was associ-
ated with lower IADL limitations (OR:0.82, 95% CI 0.68
0.99, p<0.05). Besides, negative thought against actively
instruction for intimate relationship maintenance was asso-
ciated with higher limitations in mobility (OR:1.31, 95% CI
1.041.64, p 0.02) and ADLs (OR:1.40, 95% CI 1.011.94,
p <0.05). Findings from this study suggest that having posi-
tive attitudes toward aging may contribute to better physi-
cal outcomes in older adults despite other well known risk.
Helping older adults overcoming negative thought of aging
at societal and individual level may help to achieve successful
aging with positive physical outcomes.
GERIATRIC COLORECTAL SURGERY
CO-MANAGEMENT PROGRAM: IMPACT ON
PATIENT OUTCOMES
S.Cizginer1, E.Prohl1, J.Monteiro2, S.Schechter1,
L.McNicoll1, 1. Brown University, Alpert Medical School,
Providence, Rhode Island, 2. Brown Medical School, Rhode
Island Hospital, Providence, Rhode Island
In elderly surgical patients, multiple comorbidities and
diminished reserve lead to increased post-operative compli-
cations and higher cost. We developed a Geriatric Surgery
Co-management (GSC) program, as an innovative partner-
ship between geriatrics and colorectal surgery, to improve
patient care for elderly colorectal surgery patients in the
post-operative setting. This retrospective study analyzed
colorectal surgery patients aged 70 or older admitted to a
community hospital before GSC program implementation.
Historical control (HC) was compared to patients admit-
ted after implementation of the GSC program. GSC patients
received a post-operative comprehensive geriatric assessment,
identification of risk factors for and prevention of geriatric
syndromes, management of comorbidities and optimization
of pain management. The data was collected via National
Surgical Quality Improvement Program and chart review.
The HC (n=104) and GSC (n=44) groups were comparable
at baseline. The most common type of surgery was colec-
tomy in both groups (59% of all cases). The mean length
of stay (LOS) was 5% shorter (-0.6days) in GSC (p-value=
0.74); more pronounced in older and sicker patients: 15%
shorter (-1.5 days) in patients 80 years old, 22% shorter
(-1.7days) in patients with Charlson comorbidity index 3
(p-values=0.47 and 0.25, respectively). Postoperative cardiac
arrhythmia was markedly diminished from 12/104 (11%)
in HC compared to 0/44 (0%) in GSC (p-value=0.02). The
mean total hospital charge was $9,500 (18%) less per patient
in GSC (p-value=0.1). Our results suggest that a multidisci-
plinary approach to postoperative care for geriatric colorec-
tal surgery could decrease LOS, improve patient outcomes
while decreasing hospital costs.
AWARENESS AND BEHAVIOR ON THE PERIODIC
HEALTH EXAMINATION IN KOREAN ELDERLY
SUBJECTS
J.Shin1, Y.Choi2,3, 1. Department of Family Medicine,
Gangnam Severane Hospital, Yonsei University College
of Medicine, Seoul, Korea (the Republic of), 2. Center for
IAGG 2017 World Congress
391
Health Promotion, Samsung Medical Center, Seoul, Korea
(the Republic of), 3. Sungkyunkwan University School of
Medicine, Seoul, Korea (the Republic of)
To evaluate awareness and behavior on the periodic
health examination (PHE) in Korean elderly person, we
enrolled 899 subjects who visited the health promotion
center of a university or the clinic for any kind of a health
problem in the same hospital from February to May 2016.
Thirty-two questionnaires about awareness, knowledge,
and usefulness of early detection and behavior on PHE
were administered. We compared the responses between
elderly (65 years) and middle-aged (<65 years) group
using Students t-test or 2 -test. The mean ages (standard
deviation) of the two groups were 50.1(10.6) and 68.7(3.5)
years (P<0.001). The elderly subjects perceived the aware-
ness, knowledge and usefulness on PHE, similar with mid-
dle-aged subjects (P>0.05). Also, they wanted to take a PHE
continuously without upper limit of age (52.4%) than mid-
dle-aged group (49.7%, P=0.007), despite a doctors advice
to stop PHE without further benefit. Although the elderly
subjects started PHE later than the middle-aged group
(50 years (66.4%), vs. 4049 years (39.4%), P<0.001),
they has been doing regularly (annual: 54.0% vs. 49.3%,
P=0.006). Conclusively, Korean elderly subjects perceived
the awareness of PHE and showed proactive behaviors.
Therefore, it is needed to understand their awareness and
behavior on PHE to prepare the individualized PHE.
ANALYSES OF HEALTH OUTCOMES FOR OLDER
COPD PATIENTS WITH ICS USE IN TAIWAN
Y.Li, Institute of Health Care Management, National Sun
Yat-Sen University, Kaohsiung, Taiwan
Inhaled corticosteroids (ICS) are commonly prescribed
to patients with chronic obstructive pulmonary disease
(COPD). Studies indicated that ICS use may lead to adverse
effects for COPD patients. Nevertheless, the effects of
increased risk of adverse events are inconclusive. What are
the effects of related treatments for the COPD patients are
critical research questions to be examined. However, limited
study had explored such issues in Taiwan. This study aims to
investigate the health care outcomes for older COPD patients
under medication treatments. This study applied National
Health Insurance database for analyses from year 2009 to
2012. COPD patients were grouped as case group or control
group based on whether they use ICS or not. Meanwhile,
this study conducted propensity score matching method to
reduce potential sample selection bias. Health care outcomes
include probability of having pneumonia, emergency depart-
ment use, and hospital admission. There are 1237 cases and
3711 control observations in the final analyses. The mean
age is 76years old. Multivariate logistic regressions indicated
that case group had significantly higher probability of getting
pneumonia (OR=1.85, 95%CI=1.61, 2.13), higher probabil-
ity of emergency department use (OR=1.57, 95%CI=1.35,
1.82), and higher probability of hospital admission due
to pneumonia (OR=1.73, 95%CI=1.48, 2.01). The study
results from nationally represented dataset provide empiri-
cal evidence that ICS use for older COPD patients in Taiwan
may increase the probabilities of adverse events. Cautions
of treatment influences on care processes for older COPD
patients are in great needs in Taiwan.
392
CHRONIC KIDNEY FAILURE AND CONSERVATIVE
(NON-DIALYSIS) CARE AMONG OLDER ADULTS
H.Tam-Tham, K.King-Shier, C.Thomas, R.Quinn, senile patients comparing to patients from the young group
K.Fruetel, B.Hemmelgarn, Community Health Sciences,
University of Calgary, Calgary, Alberta, Canada
Conservative (non-dialysis) management of adults
with stage 5 chronic kidney disease (CKD, eGFR <15ml/
min/1.73m2) is increasingly being provided in the primary
care setting. We aimed to examine the prevalence of barriers
and facilitators to conservative management of older adults
by primary care physicians. We conducted a cross-sectional
population-based survey of all primary care physicians in
Alberta, Canada. Eligible participants had experience caring
for adults aged 75 years with stage 5 CKD not planning
on initiating dialysis. Questionnaire items were derived from
a qualitative descriptive study, informed by the Behavior
Change Wheel, and tested for face and content validity.
Physicians were contacted via postal mail and/or fax, based
on a modified Dillman method. Four hundred and nine eli-
gible physicians completed the questionnaire (9.6% response
rate). The majority of respondents were male (61.6%), aged
40 to 60 years (62.6%), and practiced in a large/medium
population centre (68.0%). The most common barrier to
providing conservative care in the primary care setting was
the inability to access support to maintain patients in the
home setting (39.1% of respondents). The second most
common barrier was working with non-physician provid-
ers with limited kidney-specific clinical expertise (32.3% of
respondents). Primary care physicians indicated that the two
most common strategies that would enhance their ability to
provide conservative management would be the ability to
use the telephone to contact a nephrologist or clinical staff
(86.9% and 85.6% of respondents respectively). Important
areas were identified to inform clinical programs for sup-
porting primary care physicians provision of kidney con-
servative care.
SYSTEMIC INFLAMMATORY RESPONSE IN SENILE
PATIENTS AFTER SINGLE-INCISION LAPAROSCOPIC
CHOLECYSTECTOMY
A.V.Alekberzade, N.Krylov, J.Badalov, I. M.Sechenov literacy programs especially for the disabled elderly with low
First Moscow State Medical University, Moscow, Russian
Federation
The aim of the study was to compare blood levels of
tumor necrosis factor- (TNF-), interleukin-1 (IL-1), NATIONS: AREVIEW FROM INDIA
1-antitrypsin and C-reactive protein (CRP) during acute
phase of systemic inflammatory response in twenty-eight
patients who suffered from chronic calculous cholecystitis
and underwent single-incision laparoscopic cholecystectomy
(SILC).
Patients were divided into two equal age groups. Youth
group included patients aged up to forty-five years old and
senile group included patients elder than seventy-eight years.
Blood samples were taken from peripheral vein two hours
before the surgery and six, twenty-four and forty-eight hours
after the surgery.
It was found that the acute phase of systemic inflam-
matory response after SILS in senile group is differed from
the youth group, as it had hyperactivity and delayed end-
ing. TNF- and IL-1 increased after surgery if compared to
the initial levels in both young and senile patients. The same
Innovation in Aging, 2017, Vol. 1, No. S1
results were observed for 1-antitrypsin and CRP. The study
revealed the highest rates of pro-inflammatory cytokines in
of control after surgery.
PREDICTING HEALTH LITERACY AMONG DISABLED
ELDERLY IN KOREA: IMPLICATIONS FOR HEALTH
JUSTICE
Y.Kim2, H.Lee1, B.Park3, K.Park 1, 1. School of Social
Work, University of Minnesota, St Paul, Minnesota, 2.
Kyunghee University, Suwon, Korea (the Republic of), 3.
Pusan National University, Pusan, Korea (the Republic of)
Background: Low health literacy is significantly linked to
health disparity, and this link is particularly true for the disa-
bled elderly. Despite 90% of the elderly population in Korea
have chronic disease, there is limited research investigating
health literacy in this population. This study aims to investi-
gate (1) the level of health literacy and (2) factors associated
with it among disabled elderly.
Methods: Aconvenience community dwelling sample of
disabled elderly aged 60 and over (N=212) was recruited
from Busan, Korea. Health literacy was measured by using
16 items from Chew etal.s self-reported measure (2004) and
Andersens behavioral model theoretically guided this study
(Andersen, 1995).
Results: The participants average level of health literacy
was 3.03 from 1 to 5 Likert scale. About 67% of the partici-
pants reported that they had difficulty to understand written
health information, while about 71.2% were not confident
when filling out medical forms. About 34.9% of the partici-
pants reported that they almost always (10.8%) and often
(24.1%) had someone help them to read hospital materials.
The participants education, literacy, income, and health care
cost were positively associated with health literacy.
Implications: Overall, disabled elderly in Korea reported
a lower level of health literacy and this is lower than that
of the elderly without disability (3.13) (Kim et al., 2014).
Since our finding informed that health literacy is significantly
linked to education and literacy, it is important to increase
literacy education combined with community-based health
health literacy.
GERIATRIC HEALTHCARE IN DEVELOPING
C.Felix, 1. Geriatric Medicine, Welcare Hopital, Kochi,
Kerala, India, 2. The George Institute for Global Health,
Hyderabad, India
In the highly populous India, the population above 60
were at 96 million in 2011 or 117 million in 2015, with
a rapidly increasing trend. Alongside the demographic
transition, there is also an epidemiological transition with
increase in non-communicable diseases (NCDs) such as
diabetes, hypertension, stroke and heart disease. Lower
respiratory infections and diarrhoeal diseases decreased
almost 80%, but ischaemic heart disease increased over
20%. For the large number of sick elderly though, geriatric
healthcare, research, infrastructure, programs, policy and
implementation present big gaps. Geriatrics as a medical
specialty too is in its infancy, with only a handful of MD
seats and very few geriatric departments across the nation.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Thus, common age-related medical conditions such as
stroke and dementia are undiagnosed or underdiagnosed.
There is no universal social security such as medicare for
the elderly and very few are insured, that too only for acute
or in-patient care. Elderly healthcare and its access thus
is dismal, especially with disintegration of the traditional
joint family system. For the non-working 60 plus, ration-
ing of healthcare and finances has been the norm. This talk
will address the lacunae in geriatric diagnoses, policy and
implementing healthcare.
SESSION 880 (POSTER)
INNOVATIONS IN RESEARCH METHODS
INVOLVING OLDER ADULTS IN TECHNOLOGY
RESEARCH AND DEVELOPMENT (OA-INVOLVE):
AGE-WELL
Y.Ishigami-Doyle1, I.Panek1, L.Battersby2, K.ODoherty3, research and development. Our scoping review summarizes
P.Kontos4, J.Sixsmith2, S.Kirkland1, 1. Dalhousie
University, Halifax, Nova Scotia, Canada, 2. Simon
Fraser University, Burnaby, British Columbia, Canada, 3.
University of Guelph, Guelph, Ontario, Canada, 4. Toronto
Rehabilitation Institute - University Health Network,
Toronto, Ontario, Canada
Background: Maintaining and improving quality of life,
safety, security, and independence for the growing older
adult (OA) population requires innovative approaches
and transdisciplinary collaboration. The development of
novel technologies that address the needs and preferences
of OAs can benefit from the active engagement of poten-
tial target users across the spectrum of technology research
and development (R&D), from conceptualization, to for-
mulating the research questions, to prototype testing to
commercialization.
Objective: To explore and describe best practices for
active OA involvement in technology R&D.
Methods: OA-INVOLVE is one of over 25 projects within
the AGE-WELL Network, a National Centre of Excellence
focusing on technology and aging. Working closely with an
OA advisory group and partner organizations, OA-INVOLVE
applies a unique participatory action research approach to
document existing OA engagement practices within AGE-
WELL and across the broader research community.
Results: Initial findings indicate that the majority of
OAs are engaged in projects as study participants; few are
involved as advisors or decision makers. We present a frame-
work for OA engagement, including planning, recruitment,
training and engagement strategies for OA participation as
collaborators, consultants, and co-designers at every stage of
technology R&D. We report on facilitators, barriers, lessons
learned, and solutions to enhance meaningful engagement
of OAs. Our multimedia knowledge dissemination strategy
further mobilizes the larger technology R&D community as
well as older adults to form effective partnerships.
Conclusions: This work enables us to establish evidence-
based models for collaborative participatory work with OAs
and describe potential impacts on the research process and
associated outcomes.
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393
LEVELS OF OLDER ADULTS ENGAGEMENT
IN TECHNOLOGY RESEARCH, DESIGN AND
DEVELOPMENT: ASCOPING REVIEW
I.Panek1, E.T.Crumley1, Y.Ishigami-Doyle1, J.Sixsmith2,
P.Kontos3, K.ODoherty4, S.Kirkland1, 1. Community
Health & Epidemiology, Dalhousie University, Halifax,
Nova Scotia, Canada, 2. Simon Fraser University,
Vancouver, British Columbia, Canada, 3. University Health
Networks, Toronto, Ontario, Canada, 4. University of
Guelph, Guelph, Ontario, Canada
Background: Engaging older adults (OAs) in technology
research, design and development is considered to be key in
creating products that better fit their needs and preferences.
However, engaging OAs, especially persons with mobility,
physical or cognitive limitations, often requires employing
individualized approaches and flexible ways of participating.
Guidelines to support researchers and developers in creat-
ing meaningful working relationships with OAs are limited.
In order to formulate guidelines facilitating effective OA
engagement, we explored practices of conducting technology
methods used for involving OAs and highlights different lev-
els of their engagement.
Methods: We searched six databases and independently
assessed articles for inclusion. Atotal of 54 articles met the
inclusion criteria.
Results: The majority of studies involved OAs as par-
ticipants in technology or prototype testing; fewer reported
engagement in an advisory role or in true partnerships with
shared decision-making. Making the research rewarding by
catering to the interests and capabilities of the participants
and providing adequate information about the technology
and research process were essential to improved retention.
Aconstant refinement of the activities and information mate-
rials, addressing the levels of the individuals understanding
was also critical. Furthermore, ensuring inclusive and non-
exploitative relationships may involve re-consenting OAs at
each step of the study or utilising process consent.
Conclusion: Involving OAs in research on a continuum,
from conceptualization and technology development to user
testing and knowledge translation, albeit time and human
resource intensive, leads to social, research and technology
development benefits.
DETECTING ASSOCIATIONS BETWEEN
CHARACTERISTICS OF WALKING AND AGE USING
RAW ACCELEROMETRY DATA
J.Harezlak1, W.Fadel1, J.Urbanek2, N.W.Glynn3, 1.
Biostatistics, Indiana University Fairbanks School of Public
Health, Indianapolis, Indiana, 2. Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland, 3. University
of Pittsburgh Graduate School of Public Health, Pittsburgh,
Pennsylvania
Various subjective and objective methods have been pro-
posed to measure physical activity. Subjective methods, such
as ecological momentary assessment and surveys constitute
relatively inexpensive ways of measuring ones physical
activity; however, they are riddled with measurement error
and bias due to self-report. Wearable accelerometers offer a
non-invasive and an objective measure of study participants
physical activity and are widely used in observational studies.
394
Accelerometers record high frequency data and produce an
unlabeled time series at the sub-second level. Since walking is
often the only form of physical activity for older adults, it is
important to properly identify its quantity (number of min-
utes per day) and quality (e.g. stability). Most methods use
activity summaries which ignore nuances of walking data.
Using in-the-lab data from the Developmental Epidemiologic
Cohort Study (DECOS, N=49), we propose a statistical meth-
odology to model age (scalar response variable) as a function
of subject-specific walking acceleration power spectral den-
sity (PSD) estimated from the cadence-normalized domain
utilizing functional linear models. Cadence-normalized PSDs
provide representation of dynamic gait parameters that are
robust to between- and within-subject variability caused by
the cadence heterogeneity. We incorporate prior knowledge
of walking mechanics as an additional information source
in the statistical models proposed. We applied our methods
to associate the characteristics of in-the-lab usual-paced
400-meter-walk DECOS data with age. We showed that
older age is associated with a number of high harmonics
indicating less stable and disrupted walking patterns. Our
novel approach will be further applied to predict fall risks
and mobility disability.
METHODOLOGY AND RECRUITMENT FOR
DEVELOPMENT OF APAIN MEASURE FOR PERSONS
WITH DEMENTIA (PIMD)
M.M.Hilgeman1,2,3, P.Nash1, P.Block2,1, A.N.Collins1,
M.L.McDarby4,5,6, M.Ersek5,6, T.PIMD Investigator
Team7,8,9, 1. Tuscaloosa VA Medical Center, Tuscaloosa,
Alabama, 2. The University of Alabama, Tuscaloosa,
Alabama, 3. University of Alabama at Birmingham (UAB),
Birmingham, Alabama, 4. Washington University in St.
Louis, St. Louis, Missouri, 5. University of Pennsylvania
School of Nursing, Philadelphia, Pennsylvania, 6. Corporal
Michael J.Crescenz VA Medical Center, Philadelphia,
Pennsylvania, 7. Northwestern University, Evanston,
Illinois, 8. University of Iowa, Iowa City, Iowa, 9. The
Mountain-Whisper-Light Statistics, Seattle, Washington
This paper describes the recruitment strategy and sam-
pling plan for a study to develop a multidimensional pain
intensity measure for individuals with moderate to severe
dementia. Almost 590 nursing home residents from 16 facili-
ties across four states screened eligible (Brief Interview for
Mental Status, BIMS < 10) and consent was obtained for
N = 208. Participants were 45.8% women, 31% Black/
African American with a mean age of 83.9 (range=50107)
and BIMS = 3.42 (SD = 3.14, range = 09). Sampling to R.J.Martin1, R.Ziman3, W.Ashford4, A.Wetherell5,
observe a range of pain levels necessary for scale develop-
ment was difficult. Pain was generally well-controlled in
the recruited sample. Amendments to study methods during
data collection were made to increase the number of par-
ticipants with high pain intensity (e.g., expanded/targeted
recruitment; observations at movement; increased frequency
of observations). Expert clinicians estimated current pain
intensity on a scale from 010; indicating a mean of 3.17
(SD=6.36), mode=0, median=1, and range=09. Current cation. Rushed presentations frequently truncate messages.
pain intensity of 3 or greater was observed in 16% (n=33)
of the final sample. Four facilities with higher rates of cur-
rent pain (range=2225% of participants) were examined
for commonalities. Though sample sizes in this four-facility
Innovation in Aging, 2017, Vol. 1, No. S1
sub-group are small, thematic observations about researcher
access to residents in distress are described (e.g., higher
Centers for Medicare/Medicaid Services quality ratings;
outsider vs. insider perceptions of the research team).
Strategic approaches are necessary to ensure that recruited
study samples reflect clinical populations in long term care
settings.
THE USEFULNESS OF LOWER-LIMB MUSCLE
ULTRASONOGRAPHY AS ADIAGNOSTIC METHOD
OF SARCOPENIA
K.Sugimoto, M.Isaka, T.Fujimoto, H.Akasaka,
K.Yamamoto, H.Rakugi, Osaka University Graduate
School of Medicine, Suita, Osaka, Japan
The problem in the diagnosis of sarcopenia is that cal-
culated values of muscle mass are dependent on measuring
instruments and enough space and time is needed to measure
walking speed accurately, and that standard way of meas-
uring muscle mass cannot detect decline of fast-twitch fib-
ers, which is accentuated in age-related sarcopenia. Thus,
the method making it possible to diagnose sarcopenia more
accurately and conveniently should be required. The goal of
this study is to examine the usefulness of lower-limb muscle
ultrasonography in the diagnosis of sarcopenia.
The subjects of this study were outpatients or inpatients
in our department of Osaka University Hospital who were
over 65years old. Muscle mass, muscle strengths and physi-
cal functions including walking speed and balancing ability
were measured, and the relationships between these indexes
and muscle thickness or echo intensity of lower-limb muscles
(TA; anterior tibialis, GM; gastrocnemius, SOL; soleus) using
ultrasonography were examined.
102 subjects were recruited in this study and the aver-
age of age was 75.66.1. There were positive correlations
between muscle thicknesses of TA, GM and SOL and knee
extensor muscle strength, grip strength and walking speed.
Muscle echo intensities of TA and GM were negatively cor-
related with knee extensor muscle strength and grip strength,
however muscle echo intensity of SOL was not correlated
with muscle strengths or physical functions.
The measurements of muscle thickness and echo intensity
of lower-limb muscles using ultrasonography were useful as
a convenient diagnostic method of sarcopenia.
AAA-2016 CONFERENCE IDENTIFIES RAPALOG
MILESTONE; NOMINATES EXEMPLARY
HEALTHSPAN RESEARCH PROTOCOLS
G.M.Martin2, 1. Blueberry Health Study / MMT Corp,
Sherman, Connecticut, 2. University of Washington, Seattle,
Washington, 3. Genentech, South San Francisco, California,
4. Stanford / Veterans Affairs Aging Research Ctr, Palo Alto,
California, 5. Department of Defence, United Kingdom,
United Kingdom
Background: Research conferences generally cluster sci-
entists by discipline and limit cross-disciplinary communi-
Travel costs prevent most scientists from ever meeting one
another. And delays prior to publication and [sometimes]
year-long web-posting embargoes impede the progress we all
desire. In some research areas preclinical and clinical trials
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
have replication problems so severe that the US-National
Institutes of Health funded a replication program which then
failed to replicate 15 of 16 key studies [see PMIDs: 18838
063,22078760,22134153,22177997]. Because the plenary
discussion of the first large-scale healthspan/longevity trial,
the TAME trial (Targeting/Taming Aging with MEtformin),
was cut short by time constraints, a communication group
formed to continue the healthspan-trial-design discussion
after the American Aging Association conference (AAA-
2016), thereby improving/speeding communication between
conferees and with IAGG-2017 and other healthspan-related
conferences.
Methods: A brief 6-question survey (Healthspanstudy.
com/Survey) invited trial-design recommendations, exem-
plary protocols, comments on memorable conference
moments and research milestones.
Results: TAME and rapalog milestones were supported
by convincing (>3-to-1) majorities; blueberry-milestone by
1-to-1; exemplary trial protocols included the CALERIE
Protocol [www.calerie.duke.edu/files/phase2_protocol.pdf
specifically citing research samples now available], the US/
NIH Toolbox[NIHToolbox.org], European AGARD STRES
battery[www.ncbi.nlm.nih.gov/pubmed/9182033]; high-pre-
cision Memtrax.com-memory and Blueberry Study hearing
websites.
Main Conclusion: These results represent a rapalog-
research milestone [L]ife expectancy [increased] by more
than 50%[Kaeberlein]; [R]apamycin can rejuvenate
cardiac function, the cardiac proteome, metabolome and
energetics[Rabinovitch group]; RAD001 enhanced human
immune-function and reduced impaired T-lymphocyte accu-
mulation with age [Mannick]; Rapamycin reverses meta-
bolic deficits in Lamin A/C-deficient mice[Liao & Kennedy];
and reduces A accumulation and restores AD-like-memory
deficits [Hussong & Galvan].
SESSION 885 (POSTER)
LGBT AGING AND GENDER
HOME CARE EXPERIENCES OF OLDER LESBIANS:
ANATIONAL QUALITATIVE STUDY
S.S.Butler, University of Maine, Orono, Maine
Research has found that lesbian, gay, bisexual and
transgender (LGBT) older adults fear what they might
experience in accessing long term services and supports
(LTSS) and that these fears are often grounded in reported
incidents of discrimination. This paper reports on a
national study isolating the experiences of older lesbians
who have used LTSS (thus women receiving care predomi-
nantly from womenoften older themselves), to deter-
mine if such experiences might be less fraught. Telephone
interviews, comprised of open-ended questions, were com-
pleted with 20 lesbian women, 65 years of age and older
(m = 71.9), who had received home care in the previous
ten years. Additionally, six informal caregiving partners
and five of the study participants home care workers were
interviewed. Themes emerging from constant comparative
qualitative data analysis underscore diverse experiences.
IAGG 2017 World Congress
395
Most study participants did not discuss their sexuality with
their workers (n=12), with some considering the informa-
tion irrelevant to the relationship and others feeling a need
to protect themselves from discrimination; a few disclosed
their sexuality up front (n = 4). A minority experienced
homophobic behavior from a home care aide (n =6), while
most described their care as non-homophobic (n = 13).
While many study participants (n=16) had had home care
workers with whom they were dissatisfied, ultimately, all
but two had also experienced very good care. Study impli-
cations outline how the experiences of older lesbians may
be unique within the overall LGBT category. Understanding
such distinctions is critical in providing culturally compe-
tent care.
SOCIAL REPRESENTATIONS OF LGBT AGING: STUDY
AMONG LAW, PEDAGOGY, AND PSYCHOLOGY
BRAZILIAN STUDENTS
L.F.Araujo, F.Negreiros, K.Pessoa Teixeira Carlos,
Psychology, Universidade Federal Do Piau, Parnaiba, Piaui,
Brazil
This study aimed to evaluate and compare the social rep-
resentations of brazilians university students (Law, Education
and Psychology) on LGBT aging of a private higher educa-
tion institution in the city of Teresina-PI, Brazil. It also sought
to identify the participated and elaborate knowledge of the
students about homosexuality in old age and check and com-
pare the social representations about homosexuality. It took
part 300 university students (100 of each course), of both
genders, with a mean age of 28years old. It used Free Words
Association Test (TALP) Socio-demographic questionnaire
and semi-structured interviews, conducted collectively within
the educational institution. Data were analyzed with the sup-
port of Iramutec software (Camargo & Justo, 2013)through
the Analytic Hierarchy Descending, which allows an analysis
of lexical roots, considering the word as unit also offers its
contextualization in the corpus. The data obtained emerged
representations into two antagonistic poles: on the other
hand, the right that every individual has to make their inde-
pendent sexual choices apart of the stage of life they are in,
and other, the prejudice suffered by homosexuals, worsening
when they are elderly. It was verified that there were social
representations of old age LGBT in a negative connotation,
and commonly associated with shame, loneliness, suffering
and oppression. It emphasizes the need for further study of
gender and generation, psychosocial interventions that focus
on improving the quality of life of LGBT elderly, and pub-
lic policies that protect the elderly and especially the LGBT
public.
METHODOLOGICAL ASPECTS OF GENDER ON
CAREGIVING BURDEN: EVIDENCE FROM 2015U.S.
CAREGIVING DATA
H.Kim1,2, S.Hong1, B.Woo1, M.Lee3, S.Kwon1, 1. College
of Nursing, Yonsei University, Seoul, Korea (the Republic
of), 2. Mo-Im Kim Nursing Research Institute, Seoul,
Korea (the Republic of), 3. School of Nursing University of
Virginia, Charlottesville, Virginia
Although extensive research has investigated gender
to predict caregiving burden, methodological challenges
396
resulting from univariate comparison between men and
women need to be overcome. This study adopted a dyadic
approach to differentiate gender status and discrepancy to
explain the caregiving burden.
Using 2015 National Alliance for Caregiving data
(N=1391), we compared caregiving burden models using:
(1) a traditional approach that includes separate gender vari-
ables of caregivers and care-recipients; and (2) an alternative
approach that includes a variable of gender discrepancy, in
which caregivers and care-recipients differ. Covariates include
caregivers age and years spent caregiving. Descriptive, uni-
variate, and a series of multivariate linear regression analyses
were completed for general caregivers and sub-groups.
Based on adjusted R-squared change, Akaike, and Bayesian
information criteria, both models could be considered for
general caregivers and non-Hispanic African American car-
egivers of older care-recipients(aged>65). The alternative
model of gender discrepancy was more appropriate than the
traditional model for non-Hispanic Caucasian caregivers of
care-recipients with cognitive or emotional problems. Both
models aggravated the model fit in non-Hispanic Asian car-
egivers with younger care-recipients (aged<65) with behavio-
ral problems. Gender discrepancy had a predictive value for
the caregiving burden with a regression coefficient ranging
from .278 to .388 (p < .001), but separate gender variables
did not.
Overall, the model of gender discrepancy is more suggest-
ible to predict the caregiving burden. However, we suggest
researchers to consider both the traditional and the alterna-
tive model for specific types of caregivers. Primary data col-
lection and in-depth interview are required to confirm our
findings.
RELEVANCE OF INTERSECTIONAL APPROACH
TO UNDERSTAND AGING AMONG ELDERLY
IMMIGRANT WOMEN
M.Charpentier, 1. Social Work, UQAM-University of
Quebec in Montreal, Montreal, Quebec, Canada, 2.
Research Chair on Aging and Citizen Diversity, Montral,
Quebec, Canada
This poster will present some of the results of a qualitative
research aimed to analyze the experiences of aging among
older immigrant women in Montreal, Quebec (Canada).
The sample included 83 women aged 65years and older
with diverse variables such as: age, ethno-cultural back-
ground (Arab, African, Haitian, Japanese, Romanian, etc.);
timing of migration (during youth, adulthood or retirement)
and immigration status. Each focus group consisted of 36
women sharing the same ethno-cultural background and
speaking the same language, but having varied characteris-
tics in terms of marital status, education, income and migra-
tion patterns.
Results show that immigration brings changes to women.
These women demonstrate resiliency and great capacity for
adaptation. For them, aging is not conceptualised and lived
in terms of losses, far from it; they speak about it more in
terms of gains in regards to identity and liberty. Migration
has allowed them to age in a safer environment but also for
the majority to feel freer as a woman, free to be themselves,
to dress as they wish, to go out alone. Migration has opened
opportunities for personal development and self-affirmation.
Innovation in Aging, 2017, Vol. 1, No. S1
Aging is also accompanied by significant challenges for
women arising from a triple discrimination; ageism, sexism
and racism whose socio-economic conditions are particularly
present in women of an advanced age especially when they
migrated at an older age. The findings presented demonstrate
the relevance of the intersectional approach in understand-
ing the complexity and social conditionings of womens life
courses.
A TIME SERIES ANALYSIS OF THE CORRELATION
BETWEEN WIDOWHOOD AND THE ECONOMIC
STATUS OF ELDERLY WOMEN
H.Oh, Seoul National University, Seoul, Korea (the
Republic of)
Millar(1996) has mentioned that there are gender dimen-
sion of poverty so that it leads the economic dependence
of the wife on her husband. Older women without a spouse
are more likely than men to face threats to their economic
security. This study used data from Korea Welfare Panels
(KOWEPs). KOWEPs is the largest panel study in Korea
that allows long-term samples from 2006 to the present. In
this study, descriptive analysis have been performed for 297
elderly women who were married from the ten waves (2006
2015) of the KOWEPs. Hierarchical Linear Model (HLM)
and Hierarchical Generalized Linear Model (HGLM) were
conducted for the adjusted household income and the pov-
erty status. Women over 60 year-old and married in 2006
were included. The dependent variable is income, consump-
tion, poverty status. The independent variable is marital
state (married=0, spouse loss=1), age, education, living area,
health condition, employment statement, child co-residence,
employment status. The changes in the marital status do
not have significant effects on household income changes of
elderly women nor increase the risks of living in poverty for
elderly women in Korea. These results, which are contrary to
those of existed foreign studies reporting negative impacts of
widowhood on the economic status of elderly women, would
be due to strong dependence on private transfers from their
children and comparatively greater impact on co-residence
with children on the economic status of elderly women. In
the future, theres need of enhancing and redesigning pub-
lic income security policy focusing on women in Korean
context.
MENTAL HEALTH RESILIENCE IN OLDER CHINESE
WOMEN
H.Chen2, A.T.Hagedorn1, X.Peng2, 1. Gerontology,
University of Southern California, Monterey Park,
California, 2. Fudan University, Shanghai, China
Nearly all older women across China are dependent
on family support due to limited income to support for
their retirement years. Declines in family size and migra-
tion strains that family dependence. Older women offer
a unique perspective as they generally played a key role
in their families lifelong and generally depend on social
support from their family and close friends in older age
to cope with any limitations they face as a result of age-
related changes in their health and functional ability. We
examine the research question which factors predict men-
tal health resilience in older women using the Third wave
of the 2010 Female Social Status Survey conducted by the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Womens Federation (n=3,527). Regression models explor-
ing predisposing, supportive and health need variables
were tested using SPSS version 22 exploring an 8 ques-
tion mental health scale. Results showed that living with a
spouse was not a significant predictor of mental health for
women, while it was for men (b=-1.2, p<.01), income was
significant only for women (b=-.71, p<.01), ownership of
property only for men (b=-.96, p<.05), whereas womens
mental health is more strongly predicted by current exercise
(b=-.89, p<.01) and participation in leisure activities (b=-
.69, p<.001). Policy making and implementation should
do more than assess gender differences, but also mitigate
the negative impacts on both genders with the help of the
policy lever. Even under the current situation, it should play
some role in protecting older women to compensate for the
impacts of cumulative disadvantage on their later life.
SESSION 890 (POSTER)
ORAL HEALTH
ASSOCIATION BETWEEN SATISFACTION WITH
ORAL HEALTH AND DEMOGRAPHIC CONDITIONS
IN MEXICAN ELDERLY
I.Daz, E.Arias-Merino, R.Pelayo-Ramrez, D.Hernndez- ing difficulties. To improve chewing ability, strategical oral
Santos, University of Guadalajara, Guadalajara, Jalisco,
Mexico
Objective: To determine association between satisfaction
with oral health and demographic conditions in Mexican
elderly. Methods: A randomized cross-sectional study was
conducted with data from the Survey of Health, Welfare
and Aging. Project coordinated by the Pan-American Health
Organization. This study included 1547 participants, men
and women cognitively healthy 60years and over living in
the metropolitan area of Guadalajara City. Data were col-
lected by examiners trained and calibrated at participants
homes and included an interviewer-administered structured
questionnaire with items on socioeconomic variables, etc.
To measure satisfaction with oral health, the Geriatric Oral
Health Assessment Index [GOHAI] validated and trans-
lated in Spanish language was applied. This questionnaire
is a Likert scale of 12 items, is scored: Always, often, some-
times; rarely and never. The total score ranges from 12 to
60 points. Ascore below 57 is considered as an indicator
of dissatisfaction with oral health. The GOHAI values Oral
health-related quality of life in the context of older peo-
ple. Descriptive statistics and Chi square test was applied to
analyze data for sex, age and GOHAI. Two age groups of
6074 and 75102years were created. Results: 983 women
(63.6%) and 564 men (36.4%). (Mean age 72.58.4years).
The sample had an average value of GOHAI (53.327.3)
which means a moderate satisfaction with oral health. No
significant differences were observed in relation to sex
and GOHAI p> 0.05, but if for age, showing less satisfac-
tion with their oral health the group of 6074 years old;
p = 0.0001 with 95% confidence. Conclusions: The par-
ticipants perceive a moderate dissatisfaction of their oral
health. The youngest group (6074years old) had less oral
health satisfaction.
IAGG 2017 World Congress
397
PREDICTORS OF CHEWING DIFFICULTIES AMONG
COMMUNITY-DWELLING OLDER ADULTS IN KOREA
S.Moon, G.Hong, Nursing, Hanyang university,
Hwaseong-si, Kyeong-gi do, Korea (the Republic of)
Chewing difficulties in older people associated with not
only poor health status but also risk of mortality. The pur-
pose of this study was to identify the prevalence and the
predictors of chewing difficulties among community-dwell-
ing older adults. This study used the sixth Korea National
Health and Nutrition Examination Survey (KNHANES) con-
ducted in 2014. Of the total 7,550 participants in the sixth
KNHANES, data from 1,340 older adults aged over 65years
olds were used for analysis. Chewing difficulties was assessed
by the self-report for having chewing problems. Mean age
of the participants was 72.705.60 and a total of 62.7% of
the older adults reported having chewing difficulties. 78.4%
and 31.9% were reported having perceived poor oral health
and having oral pain, respectively. In logistic regression, edu-
cation level (OR=1.51, 95% CI= 1.022.24), perceived oral
health (OR=3.18, 95% CI=2.124.76) and oral pain (OR
=2.03, 95% CI=1.472.81) were the significant predictors
of chewing difficulties among community-dwelling older
people. In conclusion, the prevalence in chewing difficulties
was fairly high in Korean older adults, and education level,
perceived oral health, oral pain were associated with chew-
health program is needed in this population.
RELATIONSHIP BETWEEN SARCOPENIA AND
CHEWING ABILITY IN JAPANESE COMMUNITY-
DWELLING ELDERLY
H.Hirano2, Y.Watanabe1, M.Murakami1, A.Edahiro1,
K.Motokawa1, M.Shirobe1, J.Yasuda1, 1. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan, 2.
Tokyo Metropolitan Geriatric Hospital and Institute of
Gerontology, Itabashiku, Tokyo, Japan
Purpose: In old age, one of the most important factors to
maintain chewing ability is the number of remaining teeth.
Although in recent years elderly people increasingly tend
to have greater remaining teeth, chewing ability decreases
with age. Therefore, this study investigated the relation-
ship between sarcopenia and chewing ability in addition
to determining chewing ability related factors. Methods:
A total of 1097 participants (445 men and 652 women,
aged 74.86.1years) who attended the comprehensive sur-
vey for early detection and treatment of geriatric syndrome
were selected in this study. We defined sarcopenia accord-
ing to EWGSOP, and adopted the cut-off value according
to AWGS. The logistic regression analysis was performed to
determine the association of the occlusal force with each fac-
tor for sarcopenia. Results: Of the participants, 13.6 % were
classified as sarcopenia. As a result of the logistic regression
analysis, the decrease in the occlusal force was associated
with the number of remaining teeth (OR: 0.86, Cl=0.85
0.88), the presence of sarcopenia (OR: 2.04, Cl=1.263.32),
and the presence of medication (OR: 1.48, Cl=1.092.02).
Conclusion: This study suggests that sarcopenia is related to
chewing ability, even after controlling for known chewing
ability related factors. As a background of this result, there
might be a possibility that sarcopenia influences masticatory
muscles. The present results suggested that sarcopenia, and
398
not only number of teeth, is an important factor in main-
taining chewing ability among community-dwelling elderly
people.
THE RELATIONSHIP BETWEEN ALZHEIMERS
DISEASE AND ORAL HEALTH: ASCOPING REVIEW
G.Mathur2, K.Mehndiratta2, T.Yasmina1, N.Bhela3, in approximately 20% of Japanese elderly residents.
R.M.Mirza1, 1. University of Toronto, Toronto, Ontario,
Canada, 2. Poznan University of Medical Sciences, Poznan,
Poland, 3. York University, Toronto, Ontario, Canada
A growing number of elderly will be diagnosed with
Alzheimers disease (AD), and although AD is recognized as
a debilitating illness with no cure, limited attention has been
paid to the implications of poor oral health for those with
cognitive impairments such as AD. Oral health care is often
not appropriately assessed by carers for those with AD and
as such those with AD are at greater risk for oral diseases.
A scoping review was conducted to synthesize the avail-
able literature on AD and oral health. With the assistance
of a professional librarian, an exhaustive database search
using keyword strings yielded 6000+ articles. Abstracts were
manually curated and 110 studies which fulfilled inclusion
criteria were fully analyzed. Studies of AD and oral health
identified outcome and quality-of-life differences between
community dwelling patients versus those in long-term care
(N=34), implications of tooth-loss (n=13), influence of medi-
cations (n=11), assessment strategies (n=22), and mortality
risk (n=30). Findings indicate that those in institutional set-
tings have poor oral health; that the severity of AD may lead
to deterioration of oral health and that the reverse associa-
tion may also exist; that individuals with the fewest teeth had
the highest risk of AD; and that women with AD had better
oral health then men. The findings from this scoping review
highlight that poor oral health for AD sufferers may have far-
reaching implications and that greater research and practice
focus on assessment in institutional settings will be needed
in this area.
POOR ORAL CONDITIONS ARE RELATED TO THE
DECLINE OF ORAL DIADOCHOKINETIC RATE
AMONG JAPANESE ELDERLY
S.Hara1, H.Miura2, K.Yamasaki1, 1. Kyushu Univ. of resulted in improvement of the clinical symptoms of candidi-
Health and Welfare, Nobeoka, Miyazaki, Japan, 2. National
Institute of Public Health, Wako, Saitama, Japan
Purpose: There are few studies that have reported the
prospective change of Oral diadochokinetic (ODK) rate. We
studied the association between the 1-year change of ODK
and dental status among the elderly living in rural Japan.
Subjects and Methods: Atotal of 268 Japanese residents
aged >65years (mean age=74.5) participated in this study. SALIVATION DISORDERS IN ELDERLY PATIENTS
ODK was measured by having subjects repeat the phonetic
sounds /pa/, /ta/, /ka/, and /pataka/ for 5 s each. The tooth
and periodontal status as well as intraoral cleaning habits
were assessed. We analyzed the change in ODK rate over
1 year and compared tooth and periodontal status and
intraoral cleaning habits between subjects that had declining
ODK and those that had maintained their ODK rates.
Results: The number of subjects that showed decreased
ODK by 5 points in score was 58 (21.6%) in /pa/, 49
(18.3%) in /ta/, and 46 (17.2%) in /ka/. In total, 64 sub-
jects (23.9%) had decreased ODK by 2 points of /pataka/
Innovation in Aging, 2017, Vol. 1, No. S1
over 1 year. Subjects in the declining /pataka/ group had a
significantly higher number of untreated teeth than those in
the maintained /pataka/ group (p < 0.05). The decline of /pa/
was significantly associated with the presence of periodontal
diseases and low awareness in oral cleaning habits (p < 0.05).
Conclusion: Decreasing ODK for 1 year was found
Furthermore, the results suggest that poor oral conditions
and cleaning habits have been closely related to the decline
of ODK.
EFFICACY OF PROPOLIS ON DENTURE
STOMATITIS IN OLDER ADULTS: AMULTICENTRIC
RANDOMIZED TRIAL
G.Pina1,4, E.N.Lia4, A.A.Berreta3, A.P.Nascimento3,
E.C.Torres3, A.M.Buszinski3, E.B.Coelho2, V.d.Martins4,
1. UniEvanglica University Center, Anapolis, Brazil, 2.
University of Sao Paulo, Ribeirao Preto, Brazil, 3. Apis Flora
Indl. Coml. Ltda., Ribeirao Preto, Brazil, 4. University of
Brasilia, Brasilia, Brazil
Our hypothesis tested the efficacy and safety of standard
formulation of Brazilian propolis extract gel compared to
miconazole oral gel for the treatment of denture stomatitis
due Candida spp infection in older adults. Atotal of 40 older
patients were randomly allocated in a non-inferiority clinical
trial (NCT02818803) into two groups. The control group
(MIC) received 20mg/g miconazole oral gel and the study
group (PROP) received mucoadhesive formulation contain-
ing standardized extract of 2% propolis (EPP-AF) during
14 days. Patients were examined by a dentist on days 1, 7
and 14. The Newtons score was used to assess the denture
stomatitis. The colony forming unity count (CFU/mL) was
quantified and compared before and after the treatment (days
1 and 14). Age, gender, duration of complete dentures use,
baseline Newtons score, and baseline CFU/mL did not dif-
fer between groups. Both treatments reduced the Newtons
score (P<0.0001). Miconazole, but not propolis, reduced
the CFU (6.2x103 vs. 10 CFU/mL, D1 vs. D14; P<0.001).
The candidiasis cure rate, defined as both absence of oral
lesions and a negative culture for Candida, was only 30% for
miconazole and 20% for EPP-AF group. Both treatments
asis, showing a clinical cure rate of 0.60 for miconazole and
0.50 for propolis. No serious adverse events were observed
in neither group. The EPP-AF appears to be non-inferior
to miconazole considering the clinical cure rate and could be
recommended as an alternative treatment for oral candidiasis
in older patients. Finantial support: FINEP(Brazil)/CNPq
N.Denewet, Geriatric Department, CHU Charleroi,
Brussels, Belgium
Saliva possesses many important functions including anti-
microbial activity, pH balance, lubrication, remineralization
and mechanical cleansing of the oral mucosa. Xerostomia
results from reduced or absent saliva flow. Its prevalence
increases with age and is approximately 30% in patients
over 65years. Numerous medications include xerostomia as
side effect. Dry mouth has multiple oral health consequences
and affects quality of life. Oral candidiasis is one of the most
common oral infections seen in association with xerostomia.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: We recorded systematic anamnesis about swal-
lowing difficulties, taste modification, dry mouth sensation,
and results of oral dysphagia and mouth clinical examination.
Results: Forty-one patients were admitted consecutively
in an acute geriatric unit. Median age was 86 (range: 7699),
and 80% of the patients were female. The median num-
ber of drugs lines was 8 (range 117). Thirty-one patients
(76%) complained of xerostomia, 19 (46%) for more than
3months, 27 (66%) need liquids to swallow dry foods, 16
(39%) feel swallowing difficulties, while 11 (37%) had a real
dysphagia screened by a speech therapist. Oropharyngeal
candidiasis was found in 14 patients (34%). Patients with
MNA-confirmed risk of malnutrition complained more of
xerostomia. Only red depapillation had significant statistical
association with candidiasis. Antibiotics, opioids and diuret-
ics showed an increased trend to xerostomia.
Conclusion: Xerostomia and oropharyngeal candidiasis
can be frequently symptomatic in the elderly, who are par-
ticularly frail and challenged by polypharmacy and multi-
ple comorbid conditions. Physicians should be aware of oral
health and drug related salivation disorder.
IDENTIFYING ORAL FUNCTION AS AN INDEXING
PARAMETER FOR DETECTION OF MILD COGNITIVE
IMPAIRMENT
Y.Watanabe1, H.Arai2, H.Hirano1, Y.Ohara3,
A.Edahiro1, H.Shimada2, T.Kikutani4, T.Suzuki2, 1. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan, 2.
National Center for Geriatrics and Gerontology, Obu,
Japan, 3. Department of Oral Health Education, Graduate
School of Medical and Dental Science, Tokyo Medical and
Dental University, Tokyo, Japan, 4. Division of Clinical
Oral Rehabilitation, Graduate School of Life Dentistry,
Nippon Dental University, Tokyo, Japan
Objectives: We examined the association between MCI
and oral cavity conditions (e.g., oral hygiene and compro-
mised oral function). In addition, we developed a screening
index to identify MCI, focusing on oral assessment.
Methods: Atotal of 5,104 elderly people living in a com-
munity in Japan were classified into 930 people with MCI
and 2,669 without MCI, and analyzed for relevant factors.
Results: Both the men and women with MCI showed sig-
nificantly lower levels of the following: the number of the
functional teeth; number of the remaining teeth; oral diado-
chokinesis (ODK) /Pa/Ka/; palpation of masseter muscle tone
(p < 0.01). As a result of discriminant analysis between two
groups of MCI, MCI and non-MCI groups a significant asso-
ciation was observed in age, sex, educational background,
grip strength, Geriatric Depression Scale, Mini-Mental State
Examination, history of cardiac disease, albumin level, and
ODK /pa/ as assessment of the oral function. Although the
proper diagnosis rate of our screening index for MCI was
not as high at 0.63, it was in the acceptable range as a screen-
ing index because it is possible to increase sensitivity.
Conclusion: The results of our study showed a possibility
that lip movement might have been impaired in patients with
MCI. Impairment of movement of the lips may occur before
oral hygiene worsens or chewing ability is impaired. This
index may support early detection of MCI, and be one of the
keys to prevent dementia. Also it may provide information
which is useful to establish effective prevention strategy.
IAGG 2017 World Congress
399
ADMINISTRATIVE PERSPECTIVES ON
INTERPROFESSIONAL ORAL HEALTH EDUCATION
IN LONG-TERM CARE SETTINGS
J.Crittenden1, L.W.Kaye1, L.Nelligan2, C.Mackenzie2,
D.OConnell2, 1. UMaine Center on Aging, Bangor, Maine,
2. Lunder-Dineen Health Education Alliance of Maine,
Bangor, Maine
The WHO has recognized the importance of older adult
oral health as a global health issue of concern. Responding to
the global call-to-action to improve older adult oral health,
Lunder-Dineen Health Education Alliance of Maine and an
advisory team have established MOTIVATE: Maines Oral
Team-Based Initiative: Vital Access To Education project;
an interprofessional, evidence-based, and sustainable educa-
tional model to enhance oral health care in long term care
(LTC). MOTIVATE training curriculum was formulated
based on a needs assessment study administered at six LTC
pilot sites. Administrative staff (N=51) were surveyed to
assess oral health practices, training priorities, and their rela-
tionship to organizational mission. Respondents indicated
oral health training fits with their organizational mission as
it relates to: 1)providing high quality care (98%); 2)advanc-
ing resident and family satisfaction (94%); and 3)embody-
ing resident and family-centered care (90%). Barriers to the
provision of preventive oral care included resident behavior
(85%), lack of staff training (70%), and lack of access to an
oral health provider (62%). Varying levels of knowledge of
interprofessional care roles were reported with 26% disa-
greeing that every healthcare team member has a clear role
in oral care provision. Staff do not generally receive oral
health training at the start of their employment (57%) or
follow-up trainings (68%) leaving room for additional oral
health training in LTC settings. Recommendations include
framing oral health in terms of its fit with organizational
mission, the need to increase understanding of oral health
interprofessional roles, and increase opportunities for LTC
staff training.
EFFECT OF ORAL HEALTH CARE ON
HYPERSENSITIVITY SYNDROME AMONG THE
ELDERLY IN LONG-TERM CARE
M.Shirobe1, R.Nakayama2, Y.Ohara2, K.Endo2,
Y.Watanabe1, H.Hirano1, C.Hakuta2, 1. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan, 2.
Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University, Tokyo, Japan
Background: There are some elderly people with hypersen-
sitivity syndrome (HS) showing symptoms, such as thrashing
ones arms and legs, and frowning up ones faces. In addition,
HS is difficult for care-givers to implement oral health care for
elderly people. The purpose of this study was to examine the
effect of hypersensitive removal care on HS, that is one of the
professional oral health care. Methods: From 80 residents of
nursing home in Tokyo, we selected 14 residents (1 men and 13
women; mean age: 90.64.5 y) who had HS. The participants
were randomly divided into two groups: intervention (n=7)
and control groups (n=7). The intervention group was with
usual care by the facility staff and hypersensitive removal care
by dental hygienists twice a week for 3months. The control
group was with only usual care by the facility staff. We counted
places of HS on the face and in the mouth before and after the
400
intervention (0 - 9). Results: There were no differences in the
participant characteristics between two groups at baseline. In
the intervention group, the HS numbers significantly improved
after the intervention (1.72.1) as compared to the baseline
(3.61.5). In the control group, there was no significant change
in the HS numbers. Conclusions: The present study suggested
that hypersensitive removal care was effective for elderly peo-
ple in long-term care. Therefore, this technique can contribute
to not only easing their discomfort but also reducing the bur-
den of care-givers.
SATISFACTION WITH DIETARY LIFE AFFECTS
SUBJECTIVE WELL-BEING IN VERY ELDERLY PEOPLE
T.Iinuma1, Y.Fukui1, Y.Shioda1, J.Lee1, M.Fukumoto1, to socioeconomic inequalities.
N.Gionhaku1, Y.Arai2, M.Takayama2, 1. Nihon University
School of Dentistry, Tokyo, Japan, 2. Keio University School
of Medicine, Tokyo, Japan
Age-related deterioration in physical condition and oral
health in very elderly people are important problems that
decrease healthy life expectancy. We investigated the effects
of satisfaction with dietary life (SDL) in everyday life on sub-
jective well-being in very old individuals. We evaluated 426
elderly individuals aged 85 years or older. All participants
completed a questionnaire and oral, physical, and mental
health examinations. The comprehensive oral health assess-
ment consisted of a face-to-face interview, including a ques-
tionnaire about SDL and subjective well-being.
The relationship between the results of the questionnaire
about SDL and subjective well-being were confirmed using a
multiple logistic regression analysis. In the multivariate model
adjusted for age, gender, drinking status, BMI, cognitive func-
tion, disability, physical performance, and comorbidity, par-
ticipants who answered enjoyable with regard to SDL had
a significantly lower risk for getting the lowest scores on the
PGC and WHO-5 (OR = 0.589, 95% CI = 0.3480.996;
OR=0.452, 95% CI=0.2630.775, respectively). After fur- biota, aging, and health, we conducted microbiota analyses
ther adjustment for number of teeth present, the association
was generally maintained. SDL was significantly associated
with subjective well-being, even after adjusting for potential
confounders, such as age, drinking habits, cognitive function,
physical fitness, presence of disease, and loss of teeth. Based on
these results, dental professionals must contribute to the lives
of very elderly individuals in order to maintain oral function.
SOCIOECONOMIC DIFFERENCES IN RECENT USE
OF DENTAL HEALTH SERVICES AMONG ELDERLY
INDIVIDUALS
F.Bof de Andrade1, F.Barroso 2, 1. Oswaldo Cruz
Foundation - FIOCRUZ, Belo Horizonte, MG, Brazil, 2.
Dental School, PUC Minas, Belo Horizonte, MG, Brazil
Objective: Assess the prevalence of recent use of dental
services and its association with sociodemographic factors
among community-dwelling elderly individuals from Brazil.
Methods: This was a cross-sectional study with data from
the last Oral Health Survey conducted in the State of Minas
Gerais, Brazil. The sample was representative of people aged
6574years living in Minas Gerais. The dependent variable
was recent use of dental services (last dental visit 2years).
Independent variables included: sociodemographic factors
(age, gender, education, household income, skin color); clini-
cal measures of oral health (number of teeth, need for dental
Innovation in Aging, 2017, Vol. 1, No. S1
treatment, prosthetic use, need for prostheses). The independ-
ent association between the use of the dental services and
sociodemographic variables was assessed by multiple logistic
regression. Results: The prevalence of recent dental appoint-
ment was 36.7%. According to the adjusted analysis recent
use of dental services was independently associated with
schooling. There was a positive gradient showing increasing
chances of recent use with increasing number of schooling
years. Higher chance of recent use was also observed among
elderly individuals in need for dental treatment, whereas
individuals in need for dental prosthesis had lower chance of
recent dental appointment. Conclusion: Recent use of dental
services among these elderly individuals is low and is related
THE MOUTH MATTERS: CHARACTERIZATION OF
ORAL MICROBIOTA IN NURSING HOME RESIDENTS
T.Ogawa1, M.Honda2, K.Ikebe1, M.Kibi1, S.Kawabata2,
Y.Maeda1, 1. Department of Prosthodontics,
Gerodontology and Oral Rehabilitation, Osaka University
Graduate School of Dentistry, Suita Osaka, Japan, 2.
Department of Oral and Molecular Microbiology, Osaka
University Graduate School of Dentistry, Suita Osaka,
Japan
Oral health in aging is recognized as an increasingly
important area of research endeavor. Over 700 bacte-
rial species have been detected in the mouth. However, the
relationship between oral commensal bacterial community
(microbiota), aging, and health still remain unclear. Amicro-
biota is the ecological community of commensal, symbiotic
and pathogenic microorganisms that literally share our body
space that controls the human body in health and disease.
The link between intestinal microbiota and health is well
studied using the new technology of microbiome analysis.
To elucidate potential associations between oral micro-
using salivary samples from 16 independently living older
adults (aged 83 to 93years old), 15 nursing home residents
(aged 68 to 101years old), and 17 young, healthy controls
(aged 25 to 53years old). Genomic DNA was extracted from
each salivary sample for bacterial identification.
We found that microbial composition among three
groups was significantly different at the phylum, which has
potential implications for human health and aging. The
change of bacterial composition itself is not important,
however, the reduced microbiota diversity is possibly the
result of increased frailty, that indicated by numerous previ-
ous reports. For example, loss of gut microbiota diversity is
known to associate with aging or frailty.
Besides, saliva may be preferable for assessment of micro-
biota in older individuals due to its ease of sampling. It
was previously reported that both gut and oral microbiota
showed universal dynamics, potentially indicating similar
mechanisms for imbalance of bacterial composition.
ORAL HEALTH INTEGRATION IN LONG-TERM
CARE SETTINGS: LESSONS FROM AVIRGINIA PILOT
PROGRAM
L.D.Slashcheva, Geriatric & Special Needs Dentistry,
Dental Public Health, University of Iowa College of
Dentistry, Iowa City, Iowa
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Meeting oral health needs of older adults in Long-Term
Care (LTC) settings means addressing unique challenges
and disparities for this population. The Virginia Dental
Association (VDA) LTC Access to Care Work Group facili-
tated a one-year pilot program integrating oral healthcare
professionals into two public LTC facilities to demon-
strate cost-effectiveness and benefits of ensuring preven-
tive and referral oral health services into the LTC setting.
A Registered Dental Hygienist and a Dental Assistant
staffed the pilot program, providing training to direct sup-
port staff on oral disease/hygiene and recording oral health
status, treatment indicated and rendered, and oral health-
associated hospitalizations throughout the pilot program
in order to raise the value placed on oral health in LTC
settings, improve oral health of LTC residents, and dem-
onstrate reduced morbidity and cost of oral health-related
ailments/hospitalizations. To qualitatively assess the pilot
program and inform the broader discussion on best prac-
tices for integrating oral health programs into LTC set-
tings, VDA LTC Access to Care Work Group members
and pilot program staff were interviewed. Key challenges
and opportunities for integrating oral health services into
LTC settings exist both on the direct care provision and
administrative level. The novel Community Dental Health
Coordinator (CDHC) may be a suitable catalyst to address
recommendations emerging from pilot program. Continued
collaboration between oral healthcare and LTC profession-
als as exhibited in this pilot program will strengthen and
improve the LTC infrastructure in valuing and improving
oral health for older adults.
SESSION 895 (POSTER)
PHYSICAL ACTIVITY AND EXERCISE II
FOUR-YEAR TRAJECTORIES OF PHYSICAL HEALTH
IN CANADIAN SENIORS
S.Figueiredo1,2, J.A.Morais3,4, N.E.Mayo5,1,4, 1. School
of Physical and Occupational Therapy, McGill University,
Montreal, Quebec, Canada, 2. Center for Outcomes
Research and Evaluation, Research Institute, McGill
University Health Centre, Montreal, Quebec, Canada, 3.
Faculty of Medicine, McGill University, Montreal, Quebec,
Canada, 4. Department of Geriatrics, McGill University
Health Center, Montreal, Quebec, Canada, 5. Division
of Clinical Epidemiology, McGill University, Montreal,
Quebec, Canada
Seniors are living longer and many experience what is
called Healthy Aging, an aging process without significant
impairment. However, the vast majority of older adults
will have some degree of limitations. In order to develop
successful healthcare strategiesits necessary to understand
the dynamics of aging. The global aim of this study was to
describe trajectories of physical health over a 4-year period
among a Canadian senior population and to identify factors
associated with deteriorating health.
Between 2004 and 2009, the Quebec Longitudinal Study
on Nutrition and Successful Aging (NuAge) recruited 1793
seniors. Participants were assessed annually, for up to 4years,
including socio-demographic characteristics, comorbidities,
IAGG 2017 World Congress
401
medication, physical function, cognition, health behaviors,
social environment, and health status. Physical health was
assessed using the SF-36 Physical Component Summary
(PCS). Group-based trajectory modelling (GBTM) was used
to create group individuals with similar physical health tra-
jectories. Logistic regression was used to identify predictors
of physical health deterioration among those with excellent
or very good physical health.
From the sample of 1793 seniors (853 men, 940 women;
mean age 744years), 6 unique trajectories of physical health
were identified. Three groups started at values well below
Canadian norms but this poor physical health remained sta-
ble over time. Three groups (n=869) had values above the
norm and 1 showed persistent excellent health (PCS inter-
cept=55); 2 groups started with very good physical health
(PCS intercept = 52) but 1 showed a drastic deterioration.
Among those with starting out with excellent or very good
health, three factors predicted membership in the deteriorat-
ing group: (i) heavier body weight (OR = 1.31 per 30kg.
difference; 95%CI 1.121.78);(ii) more depressive symptoms
(OR per symptom=1.08; 95%CI 1.031.15); whereas (iii)
higher physical activity (PA) protected against deterioration
(OR=0.69 per 30% more PA; 95%CI: 0.480.97). In con-
clusion, inactive, seniors with excess weight and depressive
symptoms do not age well. These should be targets of preven-
tive health strategies.
ASSOCIATION OF MULTISITE CHRONIC
MUSCULOSKELETAL PAIN WITH PHYSICAL
ACTIVITY IN ELDERLY
S.Murata1, R.Sawa2, T.Isa1, Y.Tsuboi1, K.Torizawa1,
A.Fukuta1, S.Misu1,3, R.Ono1, 1. Department of
Community Health Sciences, Kobe University, Graduate
School of Health Sciences, Kobe, Hyogo, Japan, 2.
Department of Physical Therapy, School of Health Sciences
at Narita, International University of Health and Welfare,
Narita, Chiba, Japan, 3. Kobe City Hospital Organization,
Kobe City Medical Center, West Hospital, Kobe, Hyogo,
Japan
To our knowledge, no study focus on number and sever-
ity of pain about the association between pain and physi-
cal activity. The purpose of this study is to investigate the
association of the number of chronic musculoskeletal pain
and pain severity with objectively measured physical activity
in community-dwelling older adults. In this cross-sectional
study, 231 community-dwelling older adults in Japan (mean
age: 74.9 years, women: 71.0%) were recruited. Exclusion
criteria included a score of <18 in the mini-mental state
examination (MMSE), broken or lost accelerometer, not
meeting criteria to wear accelerometer and not having com-
pleted all clinical examinations. Participants were asked to
wear uniaxial accelerometer (Kenz Lifecorder EX; Suzuken
Co, Ltd, Nagoya, Japan) for one week in order to assess
steps, light intensity (1.52.9 METs) and moderate intensity
(3.05.9 METs) of physical activity. The number of chronic
musculoskeletal pain was assessed by counting the number
of chronic musculoskeletal pain locations, and was catego-
rized into three groups (no pain, one site and multisite). Pain
severity was assessed using subscale of Brief Pain Inventory
and was categorized into tertile. Linear regression mod-
els showed that significant association of multisite chronic
402
musculoskeletal pain with low steps and low moderate
intensity of physical activity even after adjustment with age,
gender, education, obesity, smoking status, alcohol consump-
tion, MMSE, depressive symptoms and analgesic medication
use [steps: beta = -1209.53, p < 0.05; moderate intensity:
beta=-8.72, p<0.05 (reference: no pain)]. Multisite chronic
musculoskeletal pain may effect on physical activity.
STEP COUNT ACCURACY AND RELIABILITY FROM
ACTIVITY MONITORS WORN BY MOBILITY-INTACT
OLDER ADULTS
S.A.Maganja1, M.G.Donaldson2, D.C.Mackey1,2, 1. Simon
Fraser University, Burnaby, British Columbia, Canada,
2. University of British Columbia, Vancouver, British
Columbia, Canada
Accurate and reliable measurement of physical activity is
necessary to assess adherence to and effects of physical activ-
ity interventions within a growing population of physically
inactive older adults. The STRIDES Study was designed to
determine accuracy (criterion=tally counter) and reliability
(test-retest) of step counting in mobility-intact older adults
from six wearable activity monitors (Fitbit Charge, Fitbit
One, Garmin Vivofit2, Jawbone UP2, Misfit Shine, and New-
Lifestyles 1000 pedometer). Participants (n=10, 6980years)
completed a continuous 400-meter walk (average speed
1.3m/s), a non-continuous 400-meter walk (1.1m/s) designed
to mimic daily walking patterns incorporating small distur-
bances, and two 100-step reliability walks. For the continu-
ous walk, five monitors had small mean errors less than +/-5%
(One -0.3%,95%CI=-0.4to-0.2%; Vivofit2 -0.6%,CI=-
1.4to0.2%; UP2 -3.2%,CI=-5.7to-0.6%; Shine 0.5%,CI=-
6.3to7.4%; New-Lifestyles -0.7%,CI=-1.1to-0.3%) while
error for the Charge was larger (-7.7%;CI=-17.1to1.6%).
Step counts from the One, Vivofit2 and New-Lifestyles were
strongly correlated with criterion (r0.95). For the non-
continuous walk, the One, Vivofit2, and Shine had small
errors less than +/-5% (-4.4%,CI=-5.4to-3.5%; -4.2%,CI=-
8.1to-0.2%; -1.4%,CI=-5.6to2.8%), while errors for the
Charge, UP2 and New-Lifestyles were larger (-8.1%,CI=-
15.5to-0.6%; -6.3%,CI=-10.6to-2.1%; -6.2%,CI=-
11.4to-0.9%). Only step counts from the One were strongly
correlated with criterion (r=0.95). The Charge, One, Vivofit2,
and New-Lifestyles were reliable with no significant differ-
ences in step counts between trials, while the Shine and UP2
were unreliable (mean differences between trials of 25.6 and
14.6%, p<0.05). In summary, we found that most activity
monitors were reliable and accurate for step counting in
older adults during continuous walking, while accuracy of
some monitors was compromised during non-continuous
walking.
REACH FOR AN ACTIVE LIFESTYLE: PROGRAM
FEASIBILITY AND PARTICIPANT PERCEPTIONS
N.Cherneski2, L.Burnett2, L.Fleig4, K.Milne5,
L.Giangregorio6, L.Clemson7, M.C.Ashe1,2,3, 1. Family
Practice, The University of British Columbia, Vancouver,
British Columbia, Canada, 2. Centre for Hip Health and
Mobility, Vancouver, British Columbia, Canada, 3. The
University of Adelaide, Adelaide, South Australia, Australia,
4. Freie Universitt Berlin, Berlin, Germany, 5. Cardea
Health Consulting, Vancouver, British Columbia, Canada,
Innovation in Aging, 2017, Vol. 1, No. S1
6. University of Waterloo, Waterloo, Ontario, Canada, 7.
University of Sydney, Sydney, New South Wales, Australia
Return to Everyday Activities in the Community and
Home (REACH) is an active living model targeting adults
around retirement age. The gradual progression of the
REACH program and its evidence-based foundation support
the main principles of the model: sit less, move more and be
strong. Our overall aim is to scale up the program; in this
feasibility study we included women 55years+ who attended
a 6-week community-based group program (2-hours/ses-
sion) to test key implementation factors and selected health
outcomes. Participants provided feedback after each session,
and additional information via semi-structured interviews
at baseline, 3 and 6 weeks. They also completed question-
naires on habit formation, and exercise identity and confi-
dence. We report all values as median (IQR). There were 10
women who completed the program, aged 64.1 (8.3) y, BMI
24.8 (4.7) and 9714 (4111) baseline steps/day. Participants
attended 5(1)/6 sessions; they rated sessions as 5.94 (0.59)/7
and presentation/group facilitation as 6.19 (0.51)/7. For
habit formation (pre-post: 7 point scale) they had an increase
of 0.75 (2.35) point for breaking up prolonged sitting, 0.97
(1.26) point for physical activity and 1.03 (1.54) point for
balance and strength activities. At final assessment, partici-
pants reported a very high level of confidence in their ability
to use what they learned in daily life routines.
GAIT ADAPTATIONS AND DORSIFLEXION
STRENGTH OF OLDER CARIBBEAN AMERICANS
AFTER AN EXERCISE PROGRAM
E.R.Vieira1, R.M.Tappen2, M.M.Severi1, G.Engstrom2,
S.Gropper2, 1. Physical Therapy and Neuroscience, Florida
International University, Miami, Florida, 2. Florida Atlantic
University, Boca Raton, Florida
Older Caribbeans are migrating to the US in increasing
numbers. They have difficulty integrating and often become
isolated and deconditioned. The objective of this pilot study
was to evaluate the feasibility and effects of an exercise pro-
gram on walking during street crossing situations and on
the dorsiflexion strength of older Caribbean Americans. Ten
older Caribbean Americans completed a 30 to 40 minutes
long group exercise program twice a week for 6months with
assessments at baseline, 3 and 6months including measures
of walking velocity, cadence, step length, base support, swing
and stance time, single and double support time, knee flex-
ion, and dorsiflexion strength. Participants walked 3 times
at preferred speed (reference to normalize the street crossing
simulations), and at simulated street crossing with regular
time and with reduced time. There were no significant dif-
ferences between street crossing conditions at baseline, but
there were significant differences between conditions at 3
and 6months for velocity (P < 0.005) and peak knee flexion
(P < 0.013), and at 6months for cadence (P = 0.009), step
length (P = 0.012), swing time (P = 0.045), single (P = 0.036)
and double support time (P = 0.013). Dorsiflexion strength
at 6 months was significantly higher than during baseline
(p<0.001) and 3months (P = 0.004). The program was feasi-
ble, acceptable, and showed some positive effects on walking
and knee flexion during street crossing situations, and on the
dorsiflexion strength.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 403

BALANCE AND MOBILITY PRE-AND POST- Results. Sedentary behavior increased with age and was
TREATMENT WITH VIRTUAL REALITY OF OLDER higher among men than women. The most sedentary quar-
LIVING AT NURSING HOMES tiles for each age group (youngest-oldest) spent an average
M.Scheicher, L.Faber, L.Moreira, Department of of 659709 minutes and 620694 minutes per day sedentary
Physiotherapy and Occupational Therapy, Marlia, So for men and women, respectively. The least sedentary quar-
Paulo, Brazil tiles for each age group (youngest to oldest) spent an average
Falls are common among older people needing health care of 376419 minutes and 326396 minutes per day sedentary
and are a serious public health problem in this population. for men and women, respectively.
Studies indicate that about 5066% of people over 65years Conclusions. Approximately 22.5 hours of sedentary
who live in the nursing homes fall annually. Often, institu- time per day differentiated the most and least sedentary quar-
tionalized older have fewer opportunities to participate in tiles from the middle quartiles in each age/gender group. This
activities and tasks of daily living, having a higher deleteri- reference can help identify individual risk relative to peers.
ous effects in the physiological losses from aging, compro-
mising gait and balance. Postural balance training involving CHANGES IN COGNITIVE FUNCTION AFTER
new technologies can promote challenging situations for the EXERCISE INTERVENTION AMONG COMMUNITY
older, increasing patient motivation and adherence to the DWELLING OLDER ADULTS
program. The aim of this study was to evaluate the effects M.Chang Gudjonsson1,2, A.Ramel3, O.Geirsdottir3,
of virtual reality training on the static balance and mobility I.Thorsdottir3, P.V.Jonsson1,3, 1. The Icelandic
of older living at nursing homes. Five institutionalized older Gerontological Research Center, Landspitali University
participated in the study and were submitted to 12 weeks Hospital, Reykjavik, Iceland, 2. Reykjavik University,
of virtual reality training (Nintendo Wii Balance Board). Reykjavik, Iceland, 3. University of Iceland, Reykjavik,
The static balance was assessed using a force platform (eyes Iceland
open and closed base). Were used the total path length (cm), Background: Low cognitive function is a risk factor for
the mean velocity (cm/s) and the 95% of the ellipse area to mobility disability and low physical activity. The purpose of
measure the subjects stability. The mobility was assessed by the study was to investigate the changes of cognitive function
TUG test. The results showed a decrease of TUG values pre after 12 weeks of resistance training among healthy com-
and post-treatment (17.34.3 and 14.74.7, p=0.19). The munity dwelling older adults in Iceland. Methods: Subjects
static balance showed decrease pre and post-treatment in (N=236, 73.75.7 years, 58.2% female) participated in a
total path length (61.318.7 and 59.816.3, p=0.86) and 12-week resistance exercise program (3 times/week; 3 sets,
mean velocity (2.080.62 and 1.990.54, p=0.75), but 68 repetitions at 7580% of the 1-repetition maximum),
not in the 95% of the ellipse area (5.52.96 and 5.71.7, designed to increase strength and muscle mass of major mus-
p=0.87). The results showed that the treatment with virtual cle groups. Body composition, physical activity status, cardi-
reality can increase the balance and mobility of institutional- ovascular risk factors, 6 minute walk for distance (6MWD),
ized older patients. and Mini Mental State Examination (MMSE) were meas-
ured at baseline and endpoint. Results: The mean MMSE at
baseline was 27.52.1, and the MMSE score significantly
THE DISTRIBUTION OF SEDENTARY BEHAVIOR increased (change of score, 0.53) after the exercise interven-
AMONG OLDER U.S. ADULTS BY AGE AND GENDER: tion. However, at the individual level, half of the study sub-
IDENTIFYING RISK jects improved their cognitive function while the other half
M.Huisingh-Scheetz1, E.Chang1, M.Kocherginsky2, had the same or lower levels of cognitive function after the
P.Schumm1, S.Birch1, W.Dale1, L.J.Waite1, 1. University intervention. According to linear models, post intervention
of Chicago Medicine, Chicago, Illinois, 2. Northwestern MMSE score was significantly associated with baseline grip
University, Chicago, Illinois strength.
Background. Sedentary behavior is a risk factor for and Conclusion: After 12-week resistance training, improve-
marker of poor health, independent of activity participation. ment in cognitive function was significantly associated with
Older adults spend the majority of time sedentary making baseline grip strength.
this behavior a critical target for successful aging. The pur-
pose of this study is to provide older adult normative data DETERMINANTS OF FUNCTIONAL MOBILITY IN
for sedentary behavior by age and gender, identifying the OLDER ADULTS
least and most sedentary patterns for each group as a refer- S.Gore, J.Blackwood, Physical Therapy, University of
ence to gauge risk. Michigan - Flint, Bad Axe, Michigan
Methods. We used hip accelerometry data from the Background and Purpose: Physiological changes with age-
nationally representative National Health and Nutrition ing are associated with muscle strength and physical activity
Examination Survey (NHANES) sample from 20032006 (PA) declines in older adults. The purpose of this study was
to examine the distribution of average daily minutes of sed- to assess if changes in muscle strength and time spent in PA
entary behavior among older U.S.adults. Sedentary behav- could predict gait speed (GS) in older adults.
ior was defined as fewer than 100 counts per minute. The Methods: The study population was identified from the
average number of minutes spent sedentary per day were NHANES 1999 - 2000 data set. All adults over the age of
calculated for the most sedentary quartile, the least seden- 64years were included in the study. GS was assessed using
tary quartile, and the middle quartiles for each age category a 20-foot timed walk. Quadriceps muscle strength was
(6569, 7074, 7579, 8085) by gender. assessed using the Kim Kom dynamometer and recorded as

IAGG 2017 World Congress

404
the peak force in newtons (N). Time spent in PA was assessed
by a questionnaire.
Results: Data from 198 older adults were included in
the study. Muscle strength was significantly associated with
timed walk (r = -0.217, p <0.05). Using the enter method,
our regression model with muscle strength, PA, BMI, age and
gender as predictors explained 18.1% of the variance in GS
(F(5,191) = 8.451, R2 =.181, p < 0.001).
Discussion: Muscle strength, age and BMI were found to
be significant predictors of GS in older adults. The walk time
decreased by 0.13 seconds for every 1 N unit increases in
strength. On the other hand, the walk time increased by 0.01
and 0.145 seconds respectively for every 1 unit increase in
age and BMI.
Conclusion: Based on the standardized coefficients,
strength appears to have the biggest impact on GS. Gender
and physical activity duration did not significantly predict
gait speed performance in older adults
RELATIONSHIP BETWEEN THE 8-FOOT UP-AND-GO
AND POWER IN OLDER ADULTS
L.Boyd, M.Powers, M.Curtis, A.Kiser, M.Smith,
S.Wickham, C.Patrick, T.Bodman, Kinesiology and
Health Studies, University of Central Oklahoma, Edmond,
Oklahoma
As people age, muscular power tends to decline to a greater
extent than muscular strength. This may have a detrimen-
tal impact on balance and functionality. However, the rela-
tionship between vertical power and dynamic balance and
agility are not completely understood. The purpose of this
study was to determine whether power production during
a chair stand is related to 8 Foot Up-and-Go (UPGO) time.
METHODS: Participants included residents of an independ-
ent living retirement community (N=31, M=816.81years).
The UPGO required participants to stand and walk around
a cone 8 feet away and return to a seated position as quickly
as possible. Muscular power was assessed using a Tendo
Power Analyzer during a maximum velocity chair stand
conducted five times. A one minute rest period was given
between each trial. RESULTS: After removal of an outlier,
no relationship existed between the UPGO and average (r=-
.04, p=.85) and peak (r=-.11, p=.57) power. CONCLUSION:
The lack of a relationship between power production and
the UPGO may indicate other factors are more influential in
dynamic balance and agility performance. Differing move-
ment angles of the tests may have also played a role in the
results. Future research should evaluate the influence other
factors, such as muscular strength or reaction time, might
have on UPGO performance, as well as account for angular
differences.
THE FEASIBILITY AND EFFICACY OF AN
EXERGAMING PROGRAM IN UNDERSERVED URBAN
COMMUNITIES
Y.Chao, R.Musanti, Rutgers, the State University of New
Jersey, New Brunswick, New Jersey
Purpose: Low levels of regular leisure-time physical
activity were noted among African Americans. The study
tested the feasibility and efficacy of an exergaming pro-
gram in this underserved communities. Methods: The study
was a single-group with pre-and-post test design. Twelve
Innovation in Aging, 2017, Vol. 1, No. S1
older African-American (64.176.74 years old) engaged
in a Wii Fit U exergaming program once or twice a week
for 24 sessions over 14 weeks. Community health workers
(CHWs) implemented the program through coaching and
supporting mechanism to motivate participants to exer-
cise in the two public housing health centers. Outcomes
included functional mobility (muscular strength, flexibility,
dynamic balance), depressive symptoms, and quality of life.
Descriptive statistics and Wilcoxon signed-rank test were
used. Semi-structural individual interviews were also con-
ducted. Results: After the program, participants showed
statistically significant improvements in lower-body flexibil-
ity (p = .012), and physical domain of health-related qual-
ity of life (p=.005). Participants had comparable outcomes
of upper-body strength and flexibility, lower-body strength,
dynamic balance, depressive symptoms, and mental domain
of health-related quality of life before and after the program.
Four themes were identified related to the benefits of the
CHW-led exergaming program: (1) improving health; (2)
feeling enjoyment; (3) getting connected; and (4) knowing
you. Conclusion: CHWs played a significant role in influenc-
ing and improving health outcomes in the underprivileged
communities. The CHW-delivered exergaming program
provided an easy-to-implement and potentially effective
intervention that could be used in the community-directed
center to improve health and well-being in the underserved
population.
CHINESE IMMIGRANTS VIEWS ON EXERCISE AND
USING TECHNOLOGY TO ENHANCE PHYSICAL
ACTIVITY
C.Katigbak1, S.Zuo1, P.Chan2, 1. Connell School of
Nursing, Boston College, Chestnut Hill, Massachusetts,
2. Chinese Consolidated Benevolent Association of New
England, Boston, Massachusetts
Older Asian Americans have lower rates of physical activ-
ity (PA) compared to their White counterparts and other
minority groups. Little is known about PA among older
Asian American immigrants and few studies disaggregate this
data to highlight the variations in PA profile among Asian
ethnic groups. To address this knowledge gap, we employed
a community based participatory research approach to con-
duct focus groups aimed at understanding older Chinese
immigrants culturally bound attitudes, behaviors, and
beliefs about PA. Asecondary aim sought to elicit perspec-
tives on the acceptability of, and barriers and facilitators
to engaging with PA-promoting technology such as wear-
able physical activity trackers and exergaming devices (e.g.
Nintendo Wii , and Microsoft Kinect ) technologies
not typically available to at-risk vulnerable groups such as
immigrant elders.
A bilingual (Cantonese/English) facilitator led focus
groups using an interview guide based on constructs from
Ajzens (1991), Theory of Planned Behavior. Data were trans-
lated, transcribed, and analyzed following methods for quali-
tative thematic analysis.
We will present the main findings from 6 focus group
interviews with community-dwelling elders in Boston,
Chinatown; sharing salient themes relating to culturally
bound normative attitudes and beliefs on PA, and perceived
barriers and facilitators to engaging in leisure time physical
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
activity. Furthermore, we will present participants perspec-
tives on using PA-promoting technology, and offer their
views on how these tools may be integrated into the larger
context of their daily lives. This study has broad applicability
to gerontological professionals seeking to develop interven-
tions that improve PA for minority older adults.
HAND GRIP STRENGTH, PHYSICAL FUNCTION, AND
MORTALITY AMONG MEXICAN AMERICANS 75
YEARS AND OLDER
D.Sampson3, J.Graham1, A.Kumar2, K.S.Markides1,
K.J.Ottenbacher1, S.Al Snih1, 1. University of Texas
Medical Branch at Galveston, Galveston, Texas, 2. Center
for Gerontology and Healthcare Research, Providence,
Massachusetts, 3. Genesis in Myrtle Beach, SC, Charleston,
South Carolina
The objective of this study was to investigate the asso-
ciations between handgrip strength and both physical
function and mortality in older Mexican Americans. Data
are from a ten-year prospective cohort study of 1,368
Mexican-Americans aged 75 and older from the Hispanic
Established Population for the Epidemiologic Study of the
Elderly. Measures included socio-demographic variables,
hand grip strength, the Short Physical Performance Battery
(SPPB), medical conditions, cognitive function, depression,
body mass index, and mortality. Baseline hand grip strength
means for women and men were 17.6 Kg (4.8) and 27.9 Kg
(7.2), respectively. Means for the SPPB were 6.7 (2.9) for
women and 7.5 (2.9) for men. At follow-up, 584 participants
were confirmed dead. Using general linear mixed models, we
found that women in the second and third lowest handgrip
strength quartiles had greater SPPB declines over time (b=
-0.13; standard error=0.06, p=0.02 and b= -0.14, standard
error=0.05, p=0.01, respectively) compared to participants
in the highest quartile. This association remained statistically
significant after controlling for all covariates. No significant
association was found between hand grip strength quartiles
and changes in SPPB scores in men. In women and men in the
lowest hand grip strength quartile, the hazard ratio of death
controlling for all covariates was 1.66 (95% CI=1.172.37)
and 2.09 (95% CI = 1.423.07), respectively, compared
with those in the highest hand strength quartile. Hand grip
strength is a strong predictor of long-term decline in physi-
cal function and mortality in older Mexican Americans, after
controlling for other relevant risk factors.
FATIGABILITY AS AMEASURE OF PHYSICAL
RESILIENCE IN OLDER ADULTS
S.L.Murphy1,2, S.L.Schepens3, A.L.Kratz1, 1. Physical
Medicine and Rehabilitation, University of Michigan, Ann
Arbor, Michigan, 2. Ann Arbor VA Health Care System,
GRECC, Ann Arbor, Michigan, 3. University of Southern
California, Los Angeles, California
A better understanding of physical resilience, abil-
ity to recover or optimize function when confronted with
stressors such as age-related losses or disease, is needed to
develop effective successful aging strategies. Few measures
of physical resilience exist; one method is to use measur-
able aging phenotypes, such as fatigability. Fatigability can
IAGG 2017 World Congress
405
be captured by assessing older adults capacity to perform
strenuous physical tasks. The purpose of our study was to
examine fatigability as an indicator of physical resilience in
older adults by exploring its associations with recently pro-
posed contributors to physical resilience (Whitson, 2016).
This was a secondary data analysis of 163 older adults with
clinically-relevant fatigue and lower extremity osteoarthri-
tis. Participants completed questionnaires, 7-days of at-home
physical activity monitoring, and functional assessments,
including a test of fatigability measured via change in self-
reported fatigue pre- to post-Six-Minute Walk Test (SMWT)
divided by distance walked. Abinary logistic regression was
performed to identify relevant psychosocial and physiologi-
cal contributors to high versus low fatigability (determined
by median split). Low fatigability was associated with fewer
chronic conditions, faster scores on the timed up and go test,
and lower BMI compared to high fatigability. Fatigability
was not associated with peak V02, depression, pain, or
percent immobile time during home monitoring. While lab-
based fatigability assessments may reflect some aspects of
physical resilience, such as physical functioning, obesity, and
comorbidities. Other facets of physical resilience, such as
physiologic reserve, mood, symptom burden, and sedentari-
ness, may not be captured by lab-based fatigability tests.
EFFECTS OF TRAMPOLINE TRAINING ON
COGNITIVE FUNCTIONS IN OLDER ADULTS:
APRELIMINARY STUDY.
G.Zurek1,2, A.Zurek3, T.Halski2, 1. Wroclaw Sports
University, Wroclaw, Poland, 2. Public Medical School,
Opole, Poland, 3. University of Wroclaw, Wroclaw, Poland
Intellectual ability gains a lot of importance in the era of
aging of societies and in the face of the impact of variable
diseases violating its level. This is confirmed by the results
of research, indicating that along with the aging the impor-
tance of physical health decreases, while the role of mental
health remains unchanged. Other research show the strate-
gic role of the balance for the independent life of seniors.
The purpose of the presented research was evaluation of the
efficiency of regular physical exercises, performed on a mini
trampoline, for selected cognitive functions among variously
aged seniors.
32 people (aged 60,5 - 81,7) took part in the research.
According to WHO classification they were divided into two
subgroups: younger (below 70yo) and older (over 70yo).
Participants took part for ten weeks in a trampoline
balancing program. Classes were always held in the morn-
ing, twice a week. Seniors were examined twice: before and
after the cycle of classes. The CTT-test (Color-Trails-Test
composed of CTT-1 and CTT-2) was used to access the
efficiency of the processes of attention and executive func-
tions. Analysis of variance revealed differences between the
results obtained before and after the study. As a result of the
applied intervention the duration of completing the tasks sig-
nificantly reduces in CTT-2 in the older group (Duncan-test).
The CTT-1 confirmed there are no differences in the duration
of completing tasks in the first and second group. The mini
trampoline program showed a significant effect in intelligent
functioning in the older group.
406
SESSION 900 (POSTER)
PREVENTION, HEALTH RISK, AND HEALTH CARE
USING OLDER ADULTS GOALS OF CARE TO DRIVE
PERFORMANCE MEASUREMENT
M.Henry, E.Giovannetti, E.Anderson, P.Lighter, elders may have easy access to traditional healers in their
S.H.Scholle, J.B.French, NCQA, Washington, District of
Columbia
Care for older adults with complex needs should be
aligned with their goals, values, and preferences. To cre-
ate alignment, providers must elicit and document goals.
Efforts are underway to make goal-directed care a reality.
This qualitative descriptive study was conducted to build a
taxonomy of older adults goals to be used for goals-based
performance measurement. Community-dwelling older
adults with one or more functional limitations participated
in focus groups or semi-structured interviews at six sites
in three regions. Researchers coded transcripts in a tem-
plate modeled on a pre-existing taxonomy with the follow-
ing domains: Accessing Services and Supports; Choice and
Control; Advanced Illness; Medical Care; Physical Quality
of Life; Social, Emotional and Cognitive Quality of Life; and
Caregiver Support. New goals were added as needed. [JBF1]
Among the 65 goal codes across domains, a plurality of goals
articulated by participants were clustered in the Medical
Care domain. While many of these goals were outcomes
(e.g. lose weight, manage pain), the goals most often articu-
lated were care processes, including receive needed care,
coordinated care, and providers who work with/listen to/ mary care clinicians to make antihyperglycemic medication
hear me. Goals were influenced by past and current health
care experiences and were context-specific. More research is
needed to address the complexity and heterogeneity of older
adults care goals for care planning, goal-based care and
performance measurement. These results will support future
research efforts to align care goals with care provided and
to identify outcome measures (e.g. patient-reported outcome
measures) that are important to and driven by older adults.
[JBF1]Redundant w/ next sentence
ALCOHOL USE AND OUTPATIENT SERVICE
UTILIZATION AMONG OLDER ADULTS IN CHINA
Y.Zhang1, A.C.Mui1, H.Chen2, N.Jiang1, Y.Li3, 1. School hypoglycemia in these populations. Compared to family
of Social Work, Columbia University, New York, New York,
2. Washington University in St. Louis, St. Louis, Missouri,
3. Tsinghua University, Beijing, China
This secondary research is based on the WAVE I(2010)
of the WHO Study on Global AGEing and Adult Health
(SAGE). This study used the China sample to examine the
role of alcohol use and other factors in predicting outpatient
service utilization among older alcohol drinkers (self-identi-
fied) in China [n=2,497; age 55 and older; 82% male; mean
age=65.23; SD=7.88)]. Outpatient services included consul-
tation to doctors, Chinese traditional healers, and pharmacy
use in the last 12months Alcohol consumption was measured
from no days per week to 5 or more days per week in the C.Chen1,2, S.Sidharta2, W.Koh3, J.Yuan4, S.Ma5,
last 12months. Results showed that 60.1% of the sample had
received at least one outpatient service in the last 12months
(mean= 6.14; SD=9.7). Based on the Andersen and Newman
Behavioral Model of Health Services Utilization, factors of
Innovation in Aging, 2017, Vol. 1, No. S1
predisposing, enabling and need were used in the logistic
regression. Other things being equal, alcohol consumption
is a disabling factor to outpatient service use. Results sug-
gest heavy drinkers were less likely to use outpatient services.
Among the predisposing factors, rural residency was asso-
ciated with outpatient service use. In China context, rural
villages. Other significant enabling factors predicting ser-
vice use were elders who had more financial resources, had
a higher level of social participation, and reported a better
quality of life. As expected, poor health was a need factor for
outpatient service utilization. Implications of the findings for
health care professionals will be discussed.
THE EFFECT OF AGE AND CLINICAL COMPLEXITY
ON PRIMARY CARE CLINICIANS GLYCEMIC
MANAGEMENT DECISIONS
E.McCreedy, R.L.Kane, University of Minnesota,
Minneapolis, Minnesota
To reduce the risk of severe iatrogenic hypoglycemia,
existing guidelines recommend less stringent glycated hemo-
globin (HbA1c) targets for medically complex type 2 diabet-
ics with limited life expectancy. The current study considers
the effects of patient age, cognitive impairment, and history
of myocardial infarction on primary care clinicians deci-
sions to intensify antihyperglycemic medication therapy at
two HbA1c levels within the acceptable range for more com-
plex patients: 7.5% and 8.5%.
We employed a vignette study design that asked pri-
decisions for hypothetical patients with diabetes. For each
vignette, clinicians recommended continuing with first-line
treatment, Metformin, or intensifying the current medication
by adding one of five second-line treatments. We adminis-
tered vignettes to 376 primary care clinicians in 11 states.
At a HbA1c of 8.5%, 74% of clinicians intensified treat-
ment for an 80-year old woman with longstanding diabetes,
cognitive impairment, and heart disease; 36% of clinicians
intensified treatment for the same patient with a HbA1c of
7.5%. Further, 29% of clinicians who viewed the 80-year-
old patient with cognitive impairment intensified with insu-
lin or a sulfonylurea, agents known to increase the risk of
practice physicians, internal medicine physicians and nurse
practitioners had a higher predicted probability of treatment
intensification.
Our findings conservatively suggest clinicians may inap-
propriately recommend an additional medication for com-
plex older patients over a third of the time. Family practice
physicians lower enthusiasm for intensifying treatment for
medically complex patients suggests they may be more famil-
iar with existing guidelines.
FORECASTING HOSPITAL UTILIZATION AND COST
OF FUTURE ELDERLY IN SINGAPORE.
D.Heng5, K.Tan5, J.Yoong1,2, 1. University of Southern
California, Los Angeles, California, 2. National
University of Singapore, Singapore, Singapore 3. Duke
NUS, Singapore, Singapore, 4. University of Pittsburgh,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Pittsburgh, Pennsylvania, 5. Ministry of Health, Singapore,
Singapore
Singapore is one of the fastest-aging populations in the
world. Predictions show that the percentage of citizens aged 65
and above will increase from 12.4% in 2014 to 24.0% in 2030.
In addition, obesity and the burden of chronic diseases are both
increasing as lifestyles change. Future health expenditures are
determined by multiple factors: age, sex, health status, obesity
and smoking. Resource allocation and cost-containment pose
growing challenges to policy makers. The goal of this paper
is to model future healthcare expenditures based on current
trends and evaluate the impact of alternative interventions that
aim to reduce smoking prevalence and obesity.
To project the health and functional status of future
cohorts of the elderly and to understand their cost impli-
cations, we have developed a version of the Future Elderly
Model (FEM) adapted to the context of Singapore. FEM-
Singapore is a dynamic Markov micro-simulation model
that allows individual health states to evolve over time and
accounts for trends in background drivers such as aging, obe-
sity, diseases and disability. Our main source of population
data is the Singapore Chinese Health Study (SCHS), a cohort
study of over 63,000 respondents followed in three waves
from 19932010. The SCHS is linked with a detailed cost
database from the Ministry of Health, Singapore that cap-
tures all hospitalization episodes for the same period. Our
simulation model projects inpatient healthcare costs into
2050.
UN AGENDA 2030: ADULT VACCINATIONS AS
APUBLIC HEALTH INTEREST FOR HEALTHY
AGEING
C.Stuen1, J.Barratt1, K.Bluestone3, E.Dhar2, 1. United establishing impact and calculating SROI. We report here the
Nations, International Federation on Ageing, New York,
New York, 2. AARP International Office, New York, New
York, 3. Age International, London, England, United
Kingdom
The United Nations adopted a 15 year Sustainable
Development Agenda for 20162030 (Agenda 2030). The
prior agenda, known as the Millennium Development Goals,
made no reference to older persons, however a Stakeholder
Group on Ageing advocated so that Agenda 2030 has an
overarching principle of leaving no one behind. There
are 17 Goals and 169 Targets and accompanying indicators
that contain specific and implied references to older persons.
Specific attention will be given to Goal 3 of Agenda 2030-
to ensure healthy lives and promote wellbeing for all at
all ages. The implementation of one of its targets such as
Achieve universal health coverage...access to safe, effective,
quality, and affordable, essential medicines and vaccines for
all provides a global opportunity to develop and seek ways
to promote healthy ageing including adult vaccinations.
Research has shown that adult immunizations can drive
healthy ageing initiatives however obstacles still remain to
successful implementation. This poster presents the oppor-
tunities and strategies to convince policymakers to adopt a
lifecourse approach to healthy ageing including adult immu-
nizations. The Stakeholder Group on Ageing members from
across the globe will identify programmes to influence poli-
cies on ways to promote healthy ageing and reablement in
this poster.
IAGG 2017 World Congress
407
SOCIAL VALUE OF PREVENTING ELDERLY
DEPRESSION WITH COLLABORATIVE STEPPED
CARE AND PRODUCTIVE AGEING
T.Lum, A.C.Cheung, J.Tang, P.W.Wong, V.Lou, W.Chan,
S.Ng, G.Wong, The University of Hong Kong, Hong Kong,
Hong Kong
Approximately 10% of older adults living in the com-
munity has clinically significant depression in Hong Kong.
The associated societal costs (e.g., years of life lost, direct
healthcare and long-term care costs, disease complications)
are huge. Previous analysis of Medicare and Medicaid claims
data has suggested an additional direct healthcare costs
for late-life depression ranging from US$5,771 to up to
US$17,607 per person per year depending on care setting.
Indicated prevention (targeting older persons with high
risk factors) and selective prevention (targeting those with
high risk factors and mild symptoms) can reduce suffering
and societal costs. Funded by the Hong Kong Jockey Club
Charities Trust, this study aims to test a best practice model
for effective outreach, engagement, and prevention of late-
life depression in 3,840 community-dwelling older adults.
The 3-year project has three components: (1) collaborative
stepped care between elderly and mental health services; (2)
productive ageing for active outreach and engagement; and
(3) community empowerment for mental health literacy.
The overall social value of the model will be assessed
using social return on investment (SROI) method, a type
of cost-benefit analysis, to provide evidence for further ser-
vice rollout. Following standard SROI study method, focus
groups and interviews will be conducted to identify areas of
changes and map outcomes/financial proxies with stakehold-
ers, and quantitative data will be collected for evidencing,
service model, preliminary findings from focus groups and
interviews, and the forecast SROI of the model.
U.S. RESOURCES FOR DELIVERING CHRONIC
DISEASE-SELF-MANAGEMENT EDUCATION: THE
NATIONAL RESOURCE CENTER
C.Plass1, M.Altpeter2, K.Kulinski3, 1. National Chronic
Disease Self-Management Resource Center, National
Council on Aging, Arlington, Virginia, 2. University
of North Carolina, Chapel Hill, North Carolina, 3.
Administration for Community Living/AoA, Washington,
District of Columbia
Effective interventions, such as chronic disease self-
management education (CDSME) programs, are neces-
sary to address the growing epidemic of chronic diseases in
the US and abroad. Funded by the US Administration for
Community Living (ACL), the National Council on Aging
(NCOA) serves as the National Resource Center to support
the expansion and sustainability of evidence-based CDSME
programs countrywide. This poster is designed for profes-
sionals interested in exploring CDSME program delivery
resources that are accessible at the Center. It will showcase
the ways NCOA provides training and technical assistance
to a nationwide network of state and community-based
organizations that offer CDSME programs. It will describe
and explain how to access the range of webinars that cover
a variety of topics on CDSME programming, including out-
reach to underserved populations, health care integration,
408
strategies for sustainability, and more. The poster will also
feature the Centers national clearinghouse of resources
and best practices for CDSME programs. This includes the
Best Practices Toolkit, a compilation of over 150 resources,
grounded in real world contexts from partners across the
country implementing CDSME programs. It will also fea-
ture the Centers multi-level online Community Integrated
Health Care Toolkit, designed to help community-based
organizations build partnerships with health care systems
and receive payment for the CDSME programs that they
offer. The clearinghouse resources are organized for ease of
access and can help professionals strategize their efforts in
building leadership and partnerships, enhancing capacity,
creating centralized and coordinated processes, designing
business plans, and conducting quality assurance and evalu-
ation activities.
EXPANDING THE SCOPE OF PATIENT-CENTERED
PRACTICE TO INCLUDE NON-MEDICAL RESOURCES
J.Ilardo, D.Contreras, College of Human Medicine,
Michigan State University, East Lansing, Michigan
Using resource mobilization aspects of social movement
theory, we conceptualize the melding of patient self-manage-
ment education led by community organizations, such as area
agencies on aging and senior centers, into medical manage-
ment of chronic conditions as an element of a social move-
ment. According to the partial theory defined in the seminal
work by McCarthy and Zald, resource mobilization exam-
ines the variety of resources that must be mobilized, the link-
ages of social movements to other groups, and dependence
of movements upon external supports for success and the
tactics used by authorities to control or incorporate move-
ments. In our frame, we identify community-based patient
education and coaching as resources that can be mobilized to
enhance patient outcomes and quality of life. We will describe
the methods we used to create an interdisciplinary team that
includes physicians, social workers, nurses, health educators,
program designers, dieticians, outpatient practice adminis-
trators, and reimbursement specialists to design innovative
models that incorporate patient engagement, activation, self-
management education, and coaching. We will present two
models that emerged from this process.
ADHERENCE TO GLYCEMIC CONTROL GUIDELINES
AND 8-YEAR MORTALITY RISK AMONG U.S.
ADULTS WITH DIABETES
E.Handing1, H.Meng2, W.Monaco2, M.Ji2, M.Li2, the formal support system to meeting critical social support
P.Foulis2, S.Buslovich3, 1. Wake Forest School of Medicine,
Winston-Salem, North Carolina, 2. University of South
Florida, Tampa, Florida, 3. University of Buffalo, Buffalo,
New York
The objective of this study was to examine whether life
expectancy adjusted adherence to glycemic control guidelines
is associated with 8-year mortality risk among U.S. older
adults with diabetes. We used data from the Health and
Retirement Study to identify a cohort of adults who had gly-
cated hemoglobin A1c (HbA1c) tested in 2006. The study
sample consisted of 1,300 adults aged 50 and older with dia-
betes. Glycemic control was defined as: (1) having an HbA1c
of under 7% (the old guideline); or (2) having an HbA1c
of under 7.5%, 8.0%, or 8.5% based on an individuals life
Innovation in Aging, 2017, Vol. 1, No. S1
expectancy (the new guideline). The primary outcome meas-
ure is time until death or censoring as of 2014. Independent
variables included socio-demographics, diabetes treatment
regimen, health status, comorbidities, and lifestyle variables.
We used Cox Proportional Hazards model to estimate the
effect of guideline adherence on survival, controlling for
covariates. The mean age of the sample was 69.2years and
59.5% were female. We found that individuals who met the
new guideline had similar survival as compared to those
who met the old guideline (HR=1.02, 95% CI=0.771.36,
p=0.881), whereas those who met neither guideline had a
38% increase in risk of death (HR=1.38, 95%CI=1.051.81,
p=0.020). The findings suggest that diabetes patients who
are reclassified as achieving glycemic control under the new
guidelines are not at greater mortality risk. Further research
is warranted on how to balance the needs for glycemic con-
trol and the management of other comorbidities that contrib-
ute to mortality for diabetes patients.
FILLING THE GAP: SOCIAL SUPPORT FOR OLDER
ADULTS LIVING WITH HIV/AIDS
V.A.Charles1,2, J.Gradillas1, K.H.Marr1, 1. Youth Learning
Institute, Clemson University, Pickens, South Carolina, 2.
University of South Carolina, Columbia, South Carolina
Social support is a critical resource for older adults liv-
ing with HIV/AIDS to help meet both emotional and func-
tional needs. Social isolation and loneliness have been linked
to decreased quality of life and poorer health, especially for
populations marginalized by social stigma. Recent litera-
ture has identified a gap in knowledge about training and
service provision to reduce HIV-related stigma and loneli-
ness (Beaulaurier etal., 2009; Roger, Mignone, & Kirkland,
2013). This descriptive study aims to provide information
on sources of social support in middle and older adulthood
generating knowledge for tailoring training and service
provision.
The study sample (n=181) consisted of people in SC
on an HCBS HIV/AIDS Medicaid waiver. Most were men
(68%) with a mean age of 56years. When asked to identify
people providing social support, family members and case
managers were selected as providing the most social support
(64%). One in 5 reported no support from family or friends.
Asubgroup of participants (n=39) had home health workers,
whom they identified as providing more social support than
any other group (67%).
These findings underscore the importance of the role of
needs. Given the world wide growing HIV/AIDS aging popu-
lation and the reality that resources are limited everywhere, it
is imperative to meet the need now. Home health workers are
already providing these supports. Therefore organizations,
large and small, can structure training around culturally and
ethically appropriate methods of social engagement to build
working relationships with older adults.
IMPACT OF ORAL CARE BY DENTAL
PROFESSIONALS AMONG ELDERLY PATIENTS IN
AREHABILITATION FACILITY
S.Ono1, M.Ishimaru1, Y.Ono2, H.Matsui1, H.Yasunaga1,
1. The University of Tokyo, Tokyo, Japan, 2. National
Defense Medical College, Saitama, Japan
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Evidence has suggested that oral health may be linked
with general health, and oral care potentially decrease pneu-
monia in frail elderly. However, it remains uncertain whether
oral care by dental professionals is superior to that by non-
professionals in terms of improvement in general health in
elderly patients. In 2009, Japanese long-term care insurance
system introduced additional reimbursement for oral care by
dental professionals in geriatric rehabilitation facilities. This
system innovation prompted us to conduct a quasi-experi-
mental study using a nationwide database of long-term care
to analyze the impact of oral care by dental professionals
on the outcomes (incidence of critical illness, hospitalization,
or mortality; discharge to home; and costs) among elderly
patients in geriatric rehabilitation facilities. We identified in
294,541 patients in 1168 facilities that provided oral care by
dental professionals, and 329,678 patients in 1523 facilities
that did not provide oral care by dental professionals from
2008 to 2012. In difference-in-difference analyses, no signifi-
cant difference was shown in the incidence of critical illness,
hospitalization, mortality, or costs between patients with
and without oral care by dental professionals. Significant
increases in the proportions of discharge to home were
observed in patients with oral care by dental professionals,
being 0.16% (95% confidence interval, 0.02% to 0.30%)
at 1year, 0.26% (0.05% to 0.48%) at 2years and 0.37%
(0.10% to 0.65%) at 3years. The results suggest that oral
care by dental professionals may improve general condition
of elderly patients in geriatric rehabilitation facilities and
promote their discharge to home.
HOW ELDERLY MIGRANTS ACCESS HEALTHCARE?
AQUALITATIVE ANALYSIS
W.Wang1, Y.Wang1, Z.Li2, Z.Wang3, F.Yan1, 1. Fudan for additional information and resources, and even inter-
University, Shanghai, Shanghai, China, 2. Health Bureau
of Jing-An District, Shanghai, China, 3. Gong He Xin
Community Health Center of Jing-An District, Shanghai,
China
The number of elderly migrants (60) in China reached
10.6 million in 2014. There have quite a few studies on social
adaptation of these old people, but limited focus on their
utilization of healthcare. This study aims to understand the
health services utilization of elderly migrants and identify its
impact factors.
In-depth individual interviews were employed. 4 admin-
istrators from the district-level government departments,
2 health workers from a community health center and 30
elderly migrants from 3 communities in Shanghai were inter-
viewed in 2015.
The results showed that majority of elderly migrants
didnt see doctor when they got sick, except in an emergency
or serious illness. They might buy drugs from pharmacies
nearby or take the reserved drugs from hometown, and some
of them would go back to their hometown to see doctor, espe-
cially for hospitalization. The factors including familiarity of
living environment, family members accompanying, benefit
package of health insurance and income played more impor-
tant role in the pattern of accessing health care for the elderly
migrants, compared to the local elders. Especially, almost all
of the interviewees mentioned the problem of cross-region
benefit of health insurance. When the elderly migrants see
the doctor in Shanghai, they need go back to hometown to
IAGG 2017 World Congress
409
get the reimbursement, the reimbursement procedure is com-
plicated and the rate is much lower, and most outpatient ser-
vices are not covered.
It requires particular attention on improving cross-region
settlement system of health insurance, and strengthening the
role of social organization and family supports.
EVIDENCETOPROGRAMS.COM: TOOL KIT FOR
IDENTIFYING, SELECTING, AND IMPLEMENTING
EVIDENCE-BASED PROGRAMS
A.B.Stevens1, M.G.Ory2, R.McGhee3, 1. Center for
Applied Health Research, Baylor Scott & White Health,
Temple, Texas, 2. School of Public Health, Texas A&M
Health Science Center, College Station, Texas, 3. Central
Texas Council of Governments, Belton, Texas
Community organizations are an excellent delivery chan-
nel for evidence-based programs (EBPs), and organizations
providing EBPs frequently receive preference in accessing
program funding. However, it is often challenging for them
to access and implement EBPs that match their clients needs.
In response, we developed a web-based interactive toolkit,
EvidenceToPrograms.com, to serve as a user-friendly guide
to select, implement, and evaluate EBPs.
Divided into two sections, (1) selecting a suitable EBP and
(2) implementing EBPs with fidelity, the Toolkit provides a
comprehensive overview of EBPs that can benefit community
organizations, healthcare professionals, and students alike.
The Toolkit also guides the user through a series of steps
to facilitate an organizations understanding of their ability
to deliver evidence-based programming with model fidelity.
Some of the Toolkits unique features include rich content
with supporting diagrams and tables, links to external sites
active Readiness Questions that help foster organizational
readiness to implement an EBP. The Toolkit also offers strat-
egies that can help organizations increase the sustainability
of their implemented program. Other features of the Toolkit
include expert videos and an FAQ section where users can
submit their questions regarding EBPs.
Whether new or experienced with EBPs, all organizations
will find useful materials within the Toolkit.
MERELY ARHETORIC PROMISE? OLDER USERS
CHOICE AND CONTROL IN SWEDISH HOME CARE
SERVICES
A.Dunr, P.Bjalkebring, B.Johansson, University of
Gothenburg, Gothenburg, Sweden
Swedish eldercare is a publicly funded, municipal respon-
sibility and older people are encouraged to remain in their
own homes for as long as possible, supported by home care
services. The policy goals have traditionally emphasized uni-
versalism [same services were directed toward and used by
all socio-economic groups]. But in recent years, a policy shift
towards individualized eldercare, with an emphasis on con-
sumer-choice, has taken place. The policy intention is to give
older people more choice and control and more customized
services, regardless of what service or form of support they
receive, and however it is provided. The aim of the paper is
to analyze older peoples views and experiences of available
choice and control in the home care services. Empirical data
consist of a survey (n=2676) and qualitative interviews (n=
410
25) with older people in three Swedish municipalities with
different social care models that we label a consumer-choice
model, a service-choice model and a traditional model. The
theoretical frame for the analysis comprise Trontos concepts
care logic vs market logic and Hirchmans concepts voice,
exit and loyalty. Preliminary results show that the respond-
ents had trouble acting as consumers according to market
logics. Instead, they emphasized the importance of a mutu-
ally respectful caring relationship and wanted to have voice.
A DEMONSTRATION STUDY ON THE ELDERLYS
DEMANDS FOR NURSING CARE SERVICES IN
BEIJING, CHINA
Q.Yuan, H.Ruan, G.Chen, Peking University, Beijing,
China
Based on the data from the fourth survey of the living
condition of Chinese elderly in 2015, this paper studied the
factors of the elderlys demands for nursing care services
from the perspective of gender.Binary Logistic model was
used in this paper to analyze the effect of each variable on
the elderlys demands for nursing care services.The results
showed that the economic status and health status were the
most important factors that affect the elderlys demands for
nursing care services. That means those who are in better eco-
nomic condition are in a higher demand for nursing care ser-
vices and the healthier the elderly people are,the lower their
demand is.Besides,a Good social participation can reduce the
elderlys demands for nursing care services.In addition,male
elderly have a higher demand for nursing care services than
female elderly,and their demand is quite different in the type
of aging service projects.So integrating the perspective of
gender into the construction of aging service system and the
improvement of aging service projects is urgently needed in
Beijing,China.
NEW COLLABORATIVE PRACTICES IN PRIMARY
CARE: PROVIDING COMPREHENSIVE SERVICES TO
PATIENTS AT RISK
R.Mahrer Imhof1,2, L.Imhof1, 1. Institute of Nursing,
Zurich University of Applied Sciences, Winterthur, ZH,
Switzerland, 2. University of Southern Denmark, Odense,
Denmark
One of the major challenges is to provide effective, effi-
cient and better care to older people in primary care. ARCT
study that tested a prospective care intervention provided
by Advanced Practice Nurses to home dwelling people over
the age of 80years (n=461) in an urban area of Switzerland
showed significant effects on reducing acute events (NNT
4.3; p=.001), falls (NNT 7.1; p=.003), and hospitalization
(NNT 10.0; p=.03). Following this positive trial, a new
model of care highlighting collaborative practices amongst
health care professionals in primary care has been proposed.
Subsequently, a program for home dwelling frail patients
has been developed by a group of health care professionals
in primary care and researchers using participatory action
research methodology. The program focuses on patients-
directed goal setting, involvement of family members, in-
home care provision and coordination of services amongst
health care providers especially advanced practice nurses and
family physicians in an urban area. Despite many challenges
Innovation in Aging, 2017, Vol. 1, No. S1
such as different professional languages and cultures, resist-
ance of health care professionals toward new models of care
and lack of reimbursement systems that allow embracing
new collaborative practices, the program has been imple-
mented and testing is under way. Primary results of the
acceptance and satisfaction of patients and families, as well
as collaborative practices amongst health care professionals
will be presented.
COMPARING AGE PATTERNS OF CARDIOVASCULAR
DISEASE AND ITS RISK FACTORS IN THE USA AND
RURAL GHANA
M.Hafkamp1, J.Koopman2, R.Westendorp3, J.Slaets1,
D.Van Bodegom1, 1. Research, Leyden Academy on Vitality
and Ageing, Leiden, Netherlands, 2. Leiden University
Medical Center, Leiden, Netherlands, 3. University of
Copenhagen, Copenhagen, Denmark
Despite increasing efforts of prevention, western popula-
tions face a persistently high prevalence of age-related dis-
eases, most notably cardiovascular diseases and diabetes.
Since these diseases are largely driven by a modern affluent
lifestyle, they are scarce in developing populations without
such a lifestyle.
Here, we compare population distributions of cardiovas-
cular disease and risk factors amongst older people in the
United States (NHANES) with our own field data from older
people in a rural area in northern Ghana. We compared the
mean levels and distributions of body mass index (BMI), glu-
cose and cholesterol.
We observed that the mean levels of these risk factors
were markedly lower in Ghana than in the United States.
Interestingly, however, the entire distributions of these risk
factors were shifted while retaining a similar dispersion
around the mean. When studying the prevalence of cardio-
vascular disease, we observed a shift of disease onset towards
later ages.
The observed shift of the distributions of lifestyle-related
risk factors of cardiovascular diseases suggests that the high
prevalence of these diseases in developed nations is due to
factors that increase cardiovascular disease risk in all indi-
viduals, rather than a subset of individuals. In the termi-
nology popularized by the epidemiologist Geoffrey Rose,
developed nations have sick populations, and they still have
much to gain from combatting the determinants of disease
that act on entire populations. Though lifestyle change may
be brought about through an individual-based approach,
interventions aimed at disrupting population-level determi-
nants of unhealthy lifestyle will likely be more successful in
reducing disease prevalence.
USING EDUCATIONAL INTERVENTIONS TO AFFECT
PROVIDER PRACTICES IN IMMUNIZATIONS
D.Hawks, ACOG, Washington, District of Columbia
Infectious diseases and vaccine-preventable diseases pose
great health burdens to the older population. The older
population suffers a significantly higher ppoportion of dis-
ease burden than other populations in vaccine-prevent-
able diseases such as influenza, pneumonia and shingles.
Obstetrician-gynecologists provide a high proportion of pri-
mary care to women. The American College of Obstetricians
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
and Gynecologists developed several educational resources
and toolkits for providers and patients to increase the uptake
of immunizations by adult women. A national survey was
conducted prior to and following the educational interven-
tion to assess the impact on providers knowledge, attitudes
and practices regarding education, recommendation, and
implementation of immunizations into their standard prac-
tice with their adult female patients. Arandomized pre- and
post-intervention survey was sent to 1500 ob-gyns in 2012
and 2105. In the postintervention survey significantly more
ob-gyns reported that they had received the educational
toolkit (84.5% vs 67.0%, p<.001) and that they offered or
planned to offer influenza and other vaccines to their adult
patients (76.8% vs 59.3%, p<.001). Astatistically significant
difference was found in providers following these educa-
tional interventions documenting the efficacy on increasing
immunization uptake in adult health care.
HEALTH INEQUALITY AND ITS DECOMPOSITION
AMONG THE OLDER ADULTS IN XIAMEN, CHINA
Y.Fang1,2, K.Elder3, S.Hao1,2, Z.Qian4, Z.Zhou1,2, 1. State
Key Laboratory of Molecular Vaccinology and Molecular
Diagnostics, Xiamen, China, 2. Key Laboratory of Health
Technology Assessment of Fujian Province University,
Xiamen, China, 3. Department of Health Management &
Policy, Saint Louis University College for Public Health
& Social Justice, Saint Louis, Missouri, 4. Department of
Epidemiology, Saint Louis University College for Public
Health & Social Justice, Saint Louis, Missouri
Purpose of the Study: To examine socioeconomic status
(SES) inequality in comprehensive health (CH) among the
Chinese elderly and to evaluate the contributions of the key
factors to the inequalities.
Design and Methods: Data were utilized from a survey of
14,292 Chinese adults aged 60years and older in Xiamen,
China. The health included six domains, and each had five
three-point or five-point items. First, domain score was cal-
culated as the sum of each item score within the domain and
then was normalized into the scale of 0 to 100. Second, CH
and SES scores were derived by factor analyses. Third, con-
centration indices (CIs) were used to quantify the CH ine-
quality. Finally, linear decomposition analysis was performed
to estimate the contributions of key factors to CH inequali-
ties across five SES groups.
Results: The means of the CH scores for SES from I to
V were 61.10, 64.36, 68.43, 74.30 and 79.04, respectively.
The CIs for overall CH was 0.053 (95%CI: 0.050, 0.055).
76.54% of the CH inequality was contributed by economic
condition and education, other notable contributors were
childrens economic status (16.92%) and Medical Insurance
for Urban Residents (-10.01%). Living in an urban area
(9.77%), having Medical Insurance for Urban Employees
(7.03%) and exercising (7.99%) also had significant contri-
butions to the CH inequality.
Implications: Inequality in health among the elderly in
Xiamen of China was largely determined by economic con-
ditions, educational level, medical insurance, residence, and
exercise. Comprehensive social policies should be considered
to address CH inequalities for older adults.
IAGG 2017 World Congress
411
FILLING THE GAP IN ORAL HEALTH FOR OLDER
ADULTS: ACOMMUNITY GUIDE TO PROGRAM
IMPLEMENTATION
C.A.Gruman1, M.Worstell2, P.Sprowls3, 1. The
Lewin Group, Rehoboth Beach, Delaware, 2. Office of
Womens Health, Washington, District of Columbia, 3.
Administration for Community Living, Washington, District
of Columbia
The realization that oral health is strongly connected to
overall health is growing. Beyond the health of teeth and
gums, a visit to a dental professional can detect signs of poor
nutrition, disease, infection, immune disorders, and some
cancers, leading health experts to regard the mouth as a
mirror of health and disease.
The Administration for Community Living and the Office
on Womens Health funded The Lewin Group to develop
and disseminate the Community Guide to Adult Oral Health
Program Implementation - a web-driven, online database of
promising oral health programs for older adults, and a how-
to-guide for communities interested in starting such oral
health programs.
The team identified and researched over 200 community-
based oral health programs through a systematic review.
Performance criteria were developed with the help of a
Subject Matter Expert Working Group, and five reviewers
used the criteria to independently evaluate these programs.
These programs serve a broad cross-section of the older
adult population and they range from mobile dentistry to
hygienist administered prevention programs. The commu-
nity-based oral health programs will be catalogued in a
searchable online database organized by key program fea-
tures such as location, services, and funding sources. The
website will also include a Community Guide to Adult
Oral Health Program Implementation providing resources
addressing the following components of program develop-
ment: conducting a needs assessment, developing a mission
and goals, establishing partnerships, designing a program,
financing the program, implementing the program, evalua-
tion, and program sustainability.
REGISTERED NURSES DELEGATES THE
ADMINISTRATION OF MEDICINE TO UNLICENSED
PERSONNEL IN NURSING HOMES
M.Westerbotn1,2, .Gransjn Craftman1, 1. Sophiahemmet
University, Stockholm, Sweden, 2. Department of Clinical
Science and Education, Sdersjukhuset, Karolinska
Institutet, Stockholm, Sweden
Aims and objective: The administration of medicine is fre-
quently delegated by registerd nurses to unlicenced assisting
personnel when caring for older people in residential care.
Our aim was to describe registered nurses experience in the
context of delegating the administration of medication to
unlicensed personnel in residential care homes.
Background: The residents in residential care homes have
a need for extensive care and nursing and large amounts of
medicines are common practice. Registered nurses workload
and difficulties in fulfilling their duties, such as administra-
tion of medicines, have led to frequent delegation of this task
between the registered nurses and unlicensed assisting per-
sonnel. It is of course a great responsibility to ensure that the
412
care of the elderly remains safe while maintaining quality in
the prevailing situation.
Design: Aqualitative inductive descriptive study.
Methods: Data were collected using audio-recorded
semi-structured interviews with a purposive sample of 18
registered nurses and interpreted using manifest content
analysis. The study was approved by the Ethical Research
Committee.
Results: The study showed that registered nurses dele-
gate the administration of medicine to unlicensed person-
nel with a wide-ranging variety of experiences in the care
of the elderly and knowledge of medicine, administration
and side-effects. Good communication and follow-up of the
delegated administration of medicines to unlicensed person-
nel were considered to be two important factors in patient
safety.
Conclusions: Delegating the administration of medicine
as a registerd nurse to unlicensed assisting personnel in resi-
dential care homes entails a challenging responsibility.
SESSION 905 (POSTER)
TECHNOLOGY
PARKINSONS DISEASE CAN LIMIT THE EFFECTS
OF MOTOR-COGNITIVE TRAINING IN VIRTUAL
REALITY ENVIRONMENT
J.R.Bacha, T.B.Freitas, K.G.Silva, G.Gomes, L.Viveiro,
C.Torriani-Pasin, J.Greve, J.Pompeu, Department of
Physical Therapy, Speech Therapy and Occupational
Therapy, School of Medicine, University of Sao Paulo, So
Paulo, So Paulo, Brazil
Objective: To evaluate if patients with Parkinson s dis-
ease and elderly people can improve on their postural control
(PC) and cognition after virtual reality training.
Methods: Sample size was composed by ten subjects, 5
idiopathic PD (PDG) [68.26.01 years; Hoehn & Yahr
scale = 1:2 subject; 1.5:2 subject and 3:1 subject], and 5
elders subjects (ESG) [68.26.3years]. Fourteen sessions of
Kinect Adventures games were carried out [1 hour, 2x/week
for 7 weeks, during on period of dopaminergic replacement].
PC and cognition were assessed by Mini-Balance Evaluation
Systems Test (MBT) and Montreal Cognitive Assessment
(MoCA). Assessments were performed before, after and
1 month after the end of training (follow-up). Descriptive
analysis was performed (mean, standard deviation and
confidence interval of 95%). Results: Regarding PC, MBT
scores in PDG were at baseline: 26.03.6 [21.52 30.47];
after training: 26.23.42 [21.95 30.44] and follow-up:
27.62.6 [24.36 30.83]. MBT scores in ESG were at base-
line: 27.42.7 [24.04 30.75], after training: 29.22.77 ing the benefits of an exercise routine. We partnered with
[25.75 32.64] and follow-up: 28.41.81 [26.14 30.65]. a smart-phone application manufacturer to test the feasibil-
MoCA scores in PDG were 24.01.87 [21.67 26.32]
at baseline 23.63.2 [19.61 27.58] after training and
23.62.7 [20.24 26.95] at follow up. MoCA scores in
ESG were 21.03.08 [17.17 24.82] at baseline, 27.22.16 access to personalized videos taken during PT sessions that
[24.50 29.89] after training and 26.22.48 [23.10 29.29] show the OA or physical therapist performing exercises.
at follow up. Conclusion: Scores of groups in both scales at
baseline indicated that patients were next to ceiling of scales.
Nevertheless, CG showed improvement on PC and cognition
Innovation in Aging, 2017, Vol. 1, No. S1
after training. However, future studies with larger sample are
needed in order to generalize the results.
EFFECT OF KINECT GAMES ON COGNITION AND
QUALITY OF LIFE OF ELDERLY: RANDOMIZED
CLINICAL TRIAL
J.R.Bacha, K.G.Silva, T.B.Freitas, G.Gomes, E.M.Varise,
L.Viveiro, C.Torriani-Pasin, J.Pompeu, Department
of Physical Therapy, Speech Therapy and Occupational
Therapy, School of Medicine, University of Sao Paulo, So
Paulo, So Paulo, Brazil
Objective: To analyze the effect of Kinect Adventures
games on cognition and quality of life of community dwell-
ing elderly people. Method: This is randomized clinical trial.
36 elderlies were selected with mean age 69.68 (5.60) were
randomized into control group (CG) and experimental group
(GE), 18 in each group. The subjects underwent 14 training
sessions of one hour, twice a week. The sessions of the CG were
composed by warming up, balance training, aerobic exer-
cises, muscular strengthening and cool-down. EG played four
Kinect Adventures games. Participants were assessed before,
after and 30 days after the training (follow up). Cognition
was assessed by the Montreal Cognitive Assessment (MoCA)
and the quality of life by the World Health Organization
Quality of Life-Older Adults (WHOQOL-OLD). The Study
was registered in the Brazilian Registry of Clinical Trials
(RBR-4z4f48). Statistical analysis was performed using
ANOVA of repeated measures and the post hoc test of Tukey,
adopting alfa of 0.05. Results: CG showed improvement on
MoCA after training (the mean difference between before
and after training was 3.5; 95% Confidence Interval 1.11 to
5.99; P<0.01). GE showed improvement on MoCA on follou
up (the mean difference between before and follow up was
3.66; 95% Confidence Interval 1.18 to 6.14; P<0.01). There
was no difference between the groups. Regarding Quality
of Life, both groups showed no improvements. Conclusion:
Both training improved cognition and did not interfere on
quality of life of community dwelling elderly people. This
result is attributed to the short intervention time and small
sample.
SMART-PHONE APPLICATION EVALUATION FOR
OLDER ADULTS PRESCRIBED PHYSICAL THERAPY
FOR FALL PREVENTION
L.Kneale1, S.Chaudhuri1, D.Rosenberg2, G.Demiris1,
E.A.Phelan3,1, 1. University of Washington, Seattle,
Washington, 2. Group Health Research Institute, Seattle,
Washington, 3. Harborview Medical Center, Seattle,
Washington
Strength and balance exercise reduces fall risk in older
adults (OAs), but low adherence is a key barrier to realiz-
ity and effectiveness of Wellpepper, an application designed
to improve adherence to physical therapy-based (PT) exer-
cise, with OAs at high fall risk. Wellpepper provides users
Wellpepper also generates reminders, allows communication
between the OA and physical therapist, and facilitates track-
ing exercise completion, pain and/or other difficulty with the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
exercises. Study participants are community-dwelling OAs
aged 65+ who are undergoing PT for fall risk reduction, their
physical therapists, and their caregivers. Data collection con-
sists of interviews to assess user perceptions and a survey to
assess physical activity level, fear of falling, and confidence
to perform at-home exercise. Data collection is ongoing.
Findings to date (N=4 physical therapists, 2 OAs) suggest
that physical therapists are eager to use these tools in their
practice and believe that the tools will help the OA adhere
to their home exercise program. OAs are willing and able to
use smart-phone applications as part of their exercise routine
following instruction in use of the application. Effectiveness
data indicate that the OA participants have a strong commit-
ment to their at-home routines and low fear of falling at the
close of the intervention period. Data from the entire study
sample will be presented at the meeting.
CHALLENGES AND BENEFITS OF TECHNOLOGY-
ENABLED REHABILITATION TO PROMOTE
PHYSICAL FUNCTIONING
L.Letts, J.A.Richardson, D.Chan, H.Siu, S.Sinclair, activating the TV screen. The screen provides a voice/touch
S.Sanford, L.Thabane, School of Rehabilitation Science,
McMaster University, Hamilton, Ontario, Canada
Rehabilitation has potential to exploit information
technology (IT) to address changes in physical functioning
associated with chronic diseases and aging. This presenta-
tion will explore technology-specific aspects of a cohort
study designed to determine feasibility of using an electronic
patient health record to prevent physical functional decline
in persons 44years. Participants in the study (97 persons
with chronic diseases/conditions (CD) and 50 persons with-
out chronic conditions (NCD); mean age 64years) interacted
with occupational and physical therapists primarily through
on-line assessments within a patient health record, and sub-
sequently used secure messaging to receive and communicate
about suggested rehabilitation strategies. Although most par-
ticipants described themselves as being familiar users of IT
(86% of CD group; 92% of NCD), some participants were
either non-users or beginners. Seven in-depth interviews were
conducted to explore participants experiences and satisfac-
tion with the technology and intervention at the studys com-
pletion. Initial content analyses suggest many participants
experienced technological challenges; people who reported
high levels of computer literacy professed greater engage-
ment with the process. Benefits of technology included flex-
ibility with on-line communications, and ongoing awareness
of targets in relation to physical function from self-monitor-
ing. However, participants requested more direct integration
between their providers and the technology, including oppor-
tunities to discuss findings, and to better understand the
purpose of advice received electronically. Findings suggest a
range of experiences in using IT-enabled rehabilitation; such
rehabilitation strategies can be developed to promote physi-
cal function, but may need to be implemented in a blended
model with in-person interactions.
LUDO: AN INTERVENTION SYSTEM TO DETER
PERSONS WITH MILD DEMENTIA FROM
INACTIVITY AND RESTLESSNESS
S.Khan1, N.Neubauer2, J.Jeremic3, T.Jose1, V.F.Cervantes2, loneliness. Loneliness did not change over time. Because this
M.Lussier4, 1. Department of Occupational Science and
IAGG 2017 World Congress
413
Occupational Therapy, Toronto Rehab Institute, Toronto,
Ontario, Canada, 2. University of Alberta, Edmonton,
Alberta, Canada, 3. Simon Fraser University, Vancouver,
British Columbia, Canada, 4. Universite Du Quebec
Montreal, Montreal, Quebec, Canada
The prevalence of dementia is on the rise worldwide.
As symptoms of dementia progress, many will experience
increased bouts of physical inactivity and restlessness, which
will inevitably impair their ability to remain independent
in their homes. Existing interventions have incorporated
home-based monitoring and/or stimulating activities, how-
ever standalone they remain insufficient. In this work, we
present LuDo, which integrates home-based monitoring
and stimulating activities in a single working system. LuDo
is equipped with two components: (i) Awearable device, and
(ii) An interactive stimulating suite. Using advanced machine
learning algorithms, LuDo senses an extended period of
inactivity or restlessness in persons with dementia (PWD),
which triggers the computer to play a familiar sound. Users
respond by approaching the periphery of the Kinect camera,
interface for PWD to interact with LuDo. Options include
interactive activities and music. LuDo is capable of learning
the habits of PWD over time which will recommend content
based on user preference, and provides alerts to the carer
if the PWD does/ doesnt respond or engage with the audi-
tory cue. LuDo operates automatically, without user or carer
intervention, works passively, activates only when necessary
and can be deactivated at any time. An Initial prototype of
LuDo is tested on healthy adults and was found to be able
to reroute them from their inactive state and engage them in
mentally stimulating activities. In future, we plan to conduct
similar experiments with PWD and test their level of interac-
tion with LuDo.
IPAD TRAINING INCREASES FRIENDS AND REDUCES
LONELINESS IN OLDER ADULTS
J.T.Giger1, S.Smallfield3, J.Austin2, 1. University of
Kentucky College of Social Work, Lexington, Kentucky, 2.
Oregon Health and Science University, Portland, Oregon, 3.
Washington Univerisity in St. Louis, St. Louis, Missouri
Information and communication technologies such as the
iPad are important instruments for reducing loneliness and
improving social connectedness. The present study exam-
ined change in loneliness following an iPad training pro-
gram. Asample of 46 women and 9 men, aged 63 to 95, was
drawn from community-dwelling older adults. Loneliness
and key variables were assessed at baseline, 6months, and
12months. A6-month iPad training was delivered following
baseline measurement. We hypothesized that iPad training
would reduce loneliness, and that increases in the reported
number of close friends would be negatively associated with
loneliness. We performed a tobit-mixed-effects model includ-
ing age, socioeconomic status, meal habits, baseline number
of friends, change in number of friends from baseline, and
time. Data revealed both baseline number of friends and
increases in the number of friends were negatively associated
with loneliness. Eating meals alone was associated with more
loneliness and increased age was associated with decreased
contradicted our initial hypothesis, we performed a follow-up
414
analysis to test whether change in number of friends was
accounting for the effect of time. We removed this variable
from the model and re-ran the analysis. In this model, lone-
liness was significantly lower in the follow-up period than
either baseline or end of the intervention. Findings suggest
that iPads can be used as a suitable intervention for loneli-
ness in older adults by helping improve relationships with
family and friends. Implications of the findings are discussed
for practitioners, researchers, and policy-makers.
MOBILE TECHNOLOGY IN MEDICATION
MANAGEMENT FOR OLDER ADULTS: FEASIBLE AND
EFFECTIVE
M.Tse, School of Nursing, The Hong Kong Polytechnic
University, Hong Kong
This study aims to encourage community older adults to
use technology for medication management. Ten commu-
nity-dwelling older adults joined our study. Each participant
attended a one-on-one teaching session which lasted for
around 40 to 60 minutes. Each session included (1) teaching
on the use of smartphone apps and QR code; (2) return dem-
onstration; (3) immediate evaluation. Adisc consisting of edu-
cational video and leaflet were given after the teaching session.
Medication incidents such as delayed dose (70%) and
missing dose (40%) were common. In spite of these prob-
lems, nearly all of the participants (90%) did not adopt any
methods to remind them taking the medications. After the
intervention, participants used the reminder apps (80%) and
QR code (70%) for medication management. An increased
medication adherence was demonstrated by self-reported
survey. This pilot study shows that mobile technology has
potential to increase the compliance and knowledge of medi-
cation among older population.
RELIABILITY OF ASENSOR TO DETECT FLUID
SWALLOWS IN COMMUNITY-DWELLING OLDER
ADULTS
J.C.Mentes1, H.Kalantarian2, M.Sarrafzadeh2, 1. Nursing,
UCLA, Los Angeles, California, 2. UCLA Computer
Science, Los Angeles, California
Dehydration continues to be a costly, underappreciated
precipitating or co-morbid condition leading to excess hospi-
talizations for older adults. There is no gold standard meas-
ure of hydration status, however many methods to assess this
have been used, such as biologic specimens from blood, urine
and saliva as well as clinical signs and symptoms. In this study
we pilot tested a piezoelectric sensor (WearSens) worn as a
necklace, as a novel method to detect swallows of various flu-
ids in real time. The purpose of this project was to determine
the ability of the device to reliably distinguish fluid swal-
lows. We recruited 14 participants, mean age 68.7years, 10
females, 4 males. Participants drank pre-determined amounts
of fluid in 4 randomized situations (cold, hot, room tempera-
ture and with a straw) while wearing the Wearsens device.
Percent agreement (n=13, one was not included because the
sensor was loose) was 67%, with agreement highest for cold
fluids (75%), with room temperature at 70%, fluids by straw
at 61.5% and hot fluids at 50%. Cold (r=.632,p=.02) and
room temperature (r= .711, p= .004) actual and predicted
values were significantly correlated. Hot values had the most
errors in prediction. When these outliers were removed the
Innovation in Aging, 2017, Vol. 1, No. S1
correlation was significant (r=.788, p= .007). We concluded
that the lower reliabilities were related to a less than optimal
fit of the sensor. An improved design is being used in current
study, which is focusing on distinguishing between solid and
fluid swallows under normal living conditions.
VALIDATION OF ASCREENING TOOL FOR ED
TO IDENTIFY OLDER AUSTRALIANS IN NEED OF
SPECIALIST ASSESSMENT
M.Martin-Khan1, Y.C.Hornby-Turner1, A.P.Costa2,
L.C.Gray1, 1. Centre for Research in Geriatric Medicine,
The University of Queensland, Brisbane, Queensland,
Australia, 2. McMaster University, Hamilton, Ontario,
Canada
EDs are inefficient at diagnosing and treating elderly
people with geriatric complexity. To meet the needs of older
adults in ED, high risk screening for those most in need of
targeted assessments, risk reduction interventions, as well as
those who would benefit from community based care/ser-
vices is warranted. The aim of this study is to validate the
interRAI ED Screener to categorize high risk older adults at
triage.
364 patients (50% female) aged 70+ years, presenting to
ED were assessed with the interRAI ED screener. The inter-
RAI ED screener scores were compared with hospital identi-
fied frail elderly persons whose needs are sufficiently complex
to warrant further assessment, as well as those most in need
of specialist support services after leaving ED. Secondly, we
tested for an association between the interRAI ED screener
score and hospital admission (N=364), ED representations
(N=102), referrals for specialist services (N=364), and pro-
longed length of hospital stay (N=262).
Implementing the interRAI ED screener instrument into
EDs may help identify those in need of further comprehen-
sive geriatric assessment. An implementation case study will
be described as one site has adopted the screener as part of
standard clinical practice.
FEASIBILITY OF VIRTUAL REALITY EXPERIENCE OF
NATURE AS ANURSING INTERVENTION
T.Song, S.Moon, B.Park, Y.Hwang, E.Song, H.Kim,
G.Hong, Hanyang University, Seoul, Korea (the Republic
of)
Older adults in nursing homes have a limited visual
experience due to their moving abilities. This study aimed
to investigate the feasibility and effects of Virtual Reality
Experience of Nature (VREN) using head mounted device
(HMD) in older adults residing in nursing homes in Korea.
Aone-group pre-posttest design was used to assess the posi-
tive (PEE) and negative emotional expression (NEE) using
the Observable Display of Affect Scale. One time VREN
intervention was done for 2 minute. Two trained research
assistants rated the PEE (facial, verbal, and posture) and
NEE (facial, verbal, and posture) at pre, during, and post
intervention for 2 minute. Data were analyzed with the
repeated ANOVA to examine the changes of PEE and NEE.
Means age and level of education of total 61 participants
were 82.368.34 and 6.615.14, respectively. Majorities
were female (70.5%), diagnosed with dementia (65.6%),
and partially dependent on mobility (63.9%). Atotal score
of PEE (F=31.68, p<.001) was significant, but total NEE
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
(F=1.06, p=.354) was not significant among pre, during, and
post intervention. Verbal (F=43.36, p<.001) and posture
PEE (F=12.01, p<.001) were significantly high during the
intervention. Facial NEE (F=6.34, p=.003) was significantly
high at pre-test, but verbal NEE (F=6.77, p=.002) was sig-
nificant during the intervention. There were no significant
differences in emotions during the intervention period by
cognitive impairment and mobility. The results demonstrate
that the VREN promotes PEE during and post the interven-
tion for a short period of time. Replication study of VREN
should be investigated using the randomized clinical trials
with a larger sample.
THE CAREGIVER PERSPECTIVE ON USING THE
MOBILE SYSTEM FOR ELDERLY MONITORING
(SMAI)
L.B.da Motta, A.Sztanjberg, A.Brites, C.Caldas, Rio de toms became so severe that affect their work or daily activi-
Janeiro State University, Rio de Janeiro, Rio de Janeiro,
Brazil
The Mobile System for Elderly Monitoring (SMAI) uses
Android mobile applications as the infrastructure to monitor
elderly patients with chronic degenerative disease and func-
tional loss. The system development involves the Computer
Science Laboratory (CSL) and the Geriatric Service (NAI)
from the Rio de Janeiro State University (UERJ). Applications
are designed based on strict requirements proposed by the
heath team, which assists over 300 elder patient and their
caregivers. SMAI is being assessed in a randomized clinical
trial with 60 patients (30 intervention and 30 control group),
focusing the caregiver perspective on using the system. Pre-
configured smartphones were delivered with minimal train-
ing, and the system was used for six months. The evaluation
was based on the amount and frequency of sent information
and through an interview with the caregivers. AFocus Group
Interview (FGI) was then conducted with a sub-set of seven
caregivers, which shared their opinions on using the SMAI
to transmit information regarding the patient and to interact
with the NAI professionals. Applying the thematic-categori-
cal content analysis method, four categories were designed:
caregiver overall experience; communication; management
and administration of medicines to the patient; and the per-
ceived impact/burden using the system. One of the caregiver
reported: I feel more confident taking care of my mother.
Whenever I need, I get help.The data collected will be Montral, Montreal, Quebec, Canada, 5. Faculty of Nursing
mined correlating system use, caregiver stress and system
resoluteness to confirm the expected outcomes: quality of life
improvement for the caregivers and an effective tool for the
health team.
SESSION LB910 (POSTER)
LATE BREAKER POSTER SESSION 2
SOCIAL SUPPORT AS FACILITATORS OF DENTAL
CARE UTILIZATION AMONG LOW-INCOME OLDER
CHINESE IMMIGRANTS
S.Ge1, X.Dong3, B.Wu2, 1. School of Nursing, Duke Peers delivered the program to groups of 12 participants in 6
University, Durham, North Carolina, 2. NYU Rory
Meyers College of Nursing, New York, New York, 3. Rush
University Medical Center, Chicago, Illinois
IAGG 2017 World Congress
415
Background: Few studies have been conducted that exam-
ined dental care utilization among low-income older Chinese
immigrants in the United States (US). The purposes of this
study are to (1) understand dental care utilization behaviors;
and (2) understand the perceived sources and types of social
support as facilitators of accessing dental care among low-
income community-dwelling older Chines immigrants in the
US.
Method: Data was collected in the Greater Chicago area
from July 1st to July 28th, 2016. Eighteen participants with
income below the state-level poverty threshold completed an
in-depth interview. Content analyses were conducted.
Results: The results show that all the participants inter-
viewed had some oral health problems (e.g., toothache,
bleeding, dentures, missing teeth, and edentulism). However,
treatment to any dental issues were delayed until the symp-
ties. Most older immigrants preferred going back to China
to see a dentist rather than seeking care locally given their
perceived high cost of dental care in the US.
Children were the major source of informational and
instrumental (financial) support, while spouses were the
major source of emotional support for the participants.
Meanwhile, participants were skeptical to seek any support
from friends due to that they did not perceive friends as
being able to help. Childrens financial support was the most
efficient facilitator towards seeking any dental care in the US.
Conclusion: Low-income older Chinese immigrants have
unmet dental care needs. Childrens financial support played
he most significant role in promoting dental care utilization
among low-income community-dwelling older Chines immi-
grants in the US.
AN IMPLEMENTATION EVALUATION OF APEER-
LED HEALTH PROMOTION PROGRAM FOR SENIORS
WITH FEAR OF FALLING
A.Lorthios-Guilledroit1,2,3, J.Filiatrault4,2, L.Richard5,3, 1.
School of Public Health, Universit de Montral, Montreal,
Quebec, Canada, 2. Research Center, Institut Universitaire
de Griatrie de Montral, Montreal, Quebec, Canada, 3.
Institut de Recherche en Sant Publique de lUniversit
de Montral (IRSPUM), Montreal, Quebec, Canada, 4.
School of Rehabilitation, Faculty of Medicine, Universit de
Sciences, Universit de Montral, Montreal, Quebec,
Canada
The use of seniors as peer educators is gaining in popularity
for promoting seniors health. However, the conditions under
which peer-led health promotion programs (HPP) can be
optimally implemented are not well understood. Based on an
extensive literature review, we developed a theoretical frame-
work to identify factors related to programs, participants,
peer educators and the organizational/environmental context,
which could impact implementation outcomes of peer-led
HPP. Our study aimed to test this framework using imple-
mentation data collected in a pragmatic effectiveness study
of a peer-led HPP targeting seniors who are afraid of falling.
retirement homes. Program fidelity (peers adherence to pro-
gram principles and guidelines) and participants responsive-
ness to the program were monitored using peers logbooks,
416
observation grids, attendance sheets and satisfaction question-
naires completed at program termination. Implementation
factors were documented through individual interviews con-
ducted among a subgroup of program participants (n=24),
peer leaders (n=6) and program managers in each retirement
home (n=6). Participants response to the program was excel-
lent, as reflected by their high satisfaction level with the pro-
gram and a 91% attendance rate. Peers closely followed the
program principles and guidelines. Coherent with our frame-
work, individual-related factors (e.g. participants health con-
dition, peers experience) and program-related factors (e.g.
quality of materials) emerged as important implementation
factors during preliminary qualitative data analysis. Results
from this study can help program practitioners and managers
design effective strategies to achieve successful implementa-
tion of peer-led HPP for seniors.
OLDER ADULTS AND READINESS TO CEASE
DRIVING
D.Kandasamy1,2, D.B.Carr3, T.M.Meuser4, A.Harmon3,
M.Betz2, 1. University of Michigan-Flint, Flint, Michigan,
2. University of Colorado-Denver, Denver, Colorado, 3.
Washington University in St. Louis, St. Louis, Missouri, 4.
University of Missouri-Saint Louis, St. Louis, Missouri
Examining older driver readiness for driving cessation
may facilitate successful mobility transitions that decrease
adverse outcomes like depression and social isolation. The
purpose of this study was to examine associations between
older driver characteristics and driving cessation readiness
using the Assessment of Readiness for Mobility Transition
(ARMT), a measure that evaluates attitudinal and emotional
readiness for prospective mobility loss or change. The study
recruited community-dwelling, English-speaking adults aged
65years from three internal medicine clinics affiliated with
a tertiary-care academic center; all were active drivers lack-
ing significant cognitive impairment. Participants completed
the ARMT short-form questionnaire: ARMT scores 29
points suggest unreadiness for driving cessation while scores
<29 suggest readiness. Descriptive statistics were generated
for each ARMT group, with chi-squared tests utilized to con-
sider associations. Among 301 participants, 89% were white,
5% were Hispanic and 29% lived alone; 53% were male
and median age was 72 (range: 6593). Median ARMT score
was 25 (SD=5.60); 25% had scores 29. Only 13% had dis-
cussions about mobility transition. Older adults unready to
relinquish driving were Hispanic (10% vs 3%, P=0.02) and
not college graduates (43% vs 29%, P=0.04). ARMT score
was not significantly associated with other demographic
characteristics. Results confirm positive associations between
driving cessation unreadiness and Hispanic ethnicity and
education level. They also indicate that while most partici-
pants were ready to cease driving, few had discussed mobility
transitions with anyone. Introducing the ARMT measure to
clinical and private settings may assist in beginning the dia-
logue for eventual driving cessation in older adults.
PREDICTORS OF FEAR OF FALLING AMONG
COMMUNITY-DWELLING OLDER ADULTS IN KOREA
E.Song, G.Hong, Hanyang University, Seoul, Korea (the
Republic of)
Fear of falling is a common and syndrome with poten-
tially serious health problems in older adults. Fear of falling
Innovation in Aging, 2017, Vol. 1, No. S1
can lead to the avoidance of activities, loss of independence,
depression, and decreased quality of life; however, predictors
of fear of falling among community-dwelling older adults are
not well-explored. The purpose of this study was to explore
the predictors of fear of falling in community-dwelling older
adults based on Health Belief Model. Data collection was
done from August 2016 to September 2016. Atotal of 143
older adults over 65years old were recruited from Seoul and
Kyung-gi areas, Korea. Data analysis included descriptive
statistics, independent t-test, one-way ANOVA, and hierar-
chical multiple linear regression. The mean age of the partici-
pants was 75.96.2years. Atotal of 88.8% of participants
reported a fear of falling. Fear of falling by characteristics
of participants were significantly associated with living with
spouse, number of chronic diseases, perceived chronic pain
in last 6months, falling experience in last 1year, exercise, and
self-efficacy for exercise. Exercise was the strongest predictor
for fear of falling (=-.31, p<.001). Perceived chronic pain in
last 6months (=.20, p=.026), falling experience in last 1year
(=.15, p=.056), and living arrangement (=-.15, p=.056)
were also significant predictors. These variables explained
25.8% of the variance in fear of falling (F=5.11, p<.001).
The prevention and management on fear of falling should
be developed considering the factors of exercise, perceived
chronic pain, falling experience, and living arrangement in
this population.
WALKING FOR OUR HEALTH: MARRIED PARTNERS
COLLABORATION AND PHYSICAL ACTIVITY
M.Marshall1, M.M.Franks1, E.Richards1,
M.McDonough2, S.Christ1, 1. Human Development &
Family Studies, Purdue University, West Lafayette, Indiana,
2. University of Calgary, Calgary, Alberta, Canada
Despite the known benefits of regular physical activity
(PA), less than 5% of older adults meet PA recommenda-
tions, and maintaining PA is even more challenging. Several
couple-focused interventions have been tested to promote
PA, and findings have been mixed. The purpose of this study
was to examine whether collaborative strategies to promote
PA may be facilitated when partners are working toward
similar PA goals.
The Walking for Our Health intervention study included
older adult couples (n=32), and partners were randomized
together into two goal-setting conditions. In the collabora-
tive goal-setting condition, partners set a combined goal and
tracked cumulative steps taken by both members of the cou-
ple. Partners in the concurrent individual goal-setting condi-
tion set goals and tracked their steps independently. Partners
use of collaborative strategies to increase PA (e.g., worked
together) was assessed pre and post intervention. Moderate
to vigorous PA was measured objectively using accelerom-
eters pre and post intervention. During the 8-week interven-
tion, participants tracked daily steps using pedometers, and
participated in weekly goal-setting phone consultations.
Following the goal-setting intervention, partners reports
of collaborating with one another to be more active increased
(p < 0.001) in both intervention conditions. Additionally,
weekly minutes of moderate to vigorous physical activity
increased (p < 0.001), and BMI decreased (p < 0.01), on
average. There was no difference in changes across interven-
tion conditions. Future research should examine whether
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Innovation in Aging, 2017, Vol. 1, No. S1
collaborative strategies are effective in facilitating health
behavior change and maintenance in the context of married
partners.
VARIOUS INTENSITIES OF PHYSICAL ACTIVITY IN
CHINESE OLDER ADULTS WITH CHRONIC KIDNEY
DISEASE
E.Chen1, V.Lou1, E.J.Nicklett2, Y.He3, 1. Department of cognitive health of individuals living in poverty. Therefore,
Social Work and Social Administration, The University of
Hong Kong, Hong Kong, China, 2. School of Social Work,
University of Michigan, Ann Arbor, Michigan, 3. School
of Public Health, Shanghai Jiaotong University, Shanghai,
China
The increasing prevalence of chronic kidney disease (CKD)
become a health problem in China and worldwide. Physical
activity can improve physical functioning and slow the
decline in kidney function. However, less is known on corre-
lates of physical activity among early stages of CKD. The cur-
rent study used the data from China Health and Retirement
Longitudinal Study to examine physical activity with differ-
ent intensities and its correlates among Chinese middle-aged
to older adults with chronic kidney disease. Based on eGFR
less than 60mL/min per 1.73 m2, 1089 adults older than
40years old and completed the measure of physical activity
were identified. Overall, 28.7% of adults with CKD partici-
pated in vigorous-intensity activities, and 50.1% and 78.7%
participated in moderate- and light-intensity activities in a
week, respectively. Multivariate logistic regression analysis
indicated that older age (>80 years old), being female, liv-
ing in city, receiving higher education (high school or more),
being single/widowed/divorced, no employment, perceiv-
ing higher financial burden, having functional limitation in
at least one aspect, having diabetes and heart disease con-
tributed to lower participation in vigorous-intensity activi-
ties. Living in city, no employment, and having functional
limitation in at least one aspect significantly predicted the
lower engagement in moderate-intensity activities. However,
socio-demographics and comorbidity exerted little effect on
engagement in light-intensity activities. Since effect of physi-
cal activities on health can vary with the intensity of activi-
ties, it is recommended to consider the correlates of physical
activity with different intensity in promoting the engagement
in physical activity among older adults with CKD.
IMPACT OF EDUCATION AND INCOME ON
COGNITIVE FUNCTIONING IN LOW- AND MIDDLE-
INCOME COUNTRIES
F.S.Then1,2, S.G.Riedel-Heller2, T.Luck2, S.Chatterji3, 1. AND INCLUSION GROUPS
USC Edward R Roybal Institute on Aging, Los Angeles,
California, 2. University of Leipzig, Leipzig, Germany, 3.
World Health Organization (WHO), Geneva, Switzerland
Previous studies have shown that higher education, in
sense of a cognitive reserve, promotes a good cognitive health.
Poverty, on the other hand, represents a threat to health. We
therefore investigated whether a cognitive reserve (higher
education) would still enhance cognitive functioning under
the constraints of poverty (low income). Our analyses were
based on a sample of 45,000 individuals from low- and mid-
dle-income countries who participated in the World Health
Organizations multi-country Study on global AGEing and
adult health (WHO SAGE). Multivariate regression analyses
IAGG 2017 World Congress
417
and structural equation modelling (adjusted for childhood
socioeconomic conditions, health state, age, gender, and
country) revealed that higher education as well as higher
income was significantly associated with a better cognitive
functioning with similar effects in middle-aged and old-
aged individuals. Our results suggest that a cognitive reserve
of only six years of education could substantially enhance the
expanding efforts to achieve universal education are essential
for offsetting adverse effects of poverty and early life dis-
advantages and for promoting a good cognitive functioning
over the entire life-span.
DOES DIAGNOSIS TYPE MATTER? GAPS IN END OF
LIFE PLANNING
M.Hendricksen, N.V.Shellito, C.Lee, University of
Massachusetts Boston, Boston, Massachusetts
End of life planning can be a useful tool to help people
cope with a complex period of the life course. Individuals
who plan in advance for their end of life care are less likely to
experience pain and depression. As more of the United States
population enters old age, research continues to explore if
an association between disease burden and end of life care
decisions exists. The objective is to investigate the impact
of disease diagnosis on end of life planning. This study
uses data from the Health and Retirement Study to exam-
ine participants who died between 2012 and 2014, merged
with core data from 2010. 2,065 participants are included
and variables analyzed include individual disease diagnoses
and completion of written end of life instructions. Findings
show that participants who have been diagnosed with can-
cer (OR=1.59, p<.001) and heart problems (OR=1.25,
p<.05) are more likely to have end of life care instructions
than those who have never been diagnosed. Additionally,
demographic factors show that increases in age (OR=1.04,
p<.001), education (OR=2.60, p<.001), and household net
worth (OR=1.86, p<.001) all have greater odds of complet-
ing end of life plans. These findings suggest that depending
on diagnosis type, patients may not receive exposure to end
of life planning opportunities. Fatal diagnoses, such as lung
disease and stroke, did not show significant associations with
end of life planning. These results demonstrate a potential
gap in patient care and provide possible opportunities for
improvement in physician and patient communication.
INVESTIGATION OF PERSONALITY USING
DIFFERENT TIME MATRICES, CONTROL VARIABLES,
T.Yoneda1, E.Graham2, A.Berg3, B.Johansson3, M.Katz5,
N.L.Pedersen4, A.M.Piccinin1, 1. University of Victoria,
Victoria, British Columbia, Canada, 2. University
of Northwestern, Evanston, Illinois, 3. University of
Gothenburg, Gothenburg, Sweden, 4. Karolinska Institutet,
Solna, Sweden, 5. Einstein Aging Study, Bronx, New York
Two studies suggest that personality change may be an
early indicator of dementia (Balsis etal, 2005; Smith-Gamble
etal, 2001); however, these studies did not assess personal-
ity trait change. Although Yoneda etal (2015) prospectively
examined personality traits, the nature of the analyses did
not allow comparison between trajectories in normal and
abnormal aging. The current study includes comparison
418
of trajectories of extraversion and neuroticism personality
traits in individuals who did and did not receive a dementia
diagnosis.
This study used data from the OCTO-Twin Study,
Longitudinal Aging Study Amsterdam, Swedish Adoption
Twin Study of Aging, and Einstein Aging Study. For each
dataset, a series of latent growth curve models were run
examining each personality trait, first including a subsample
of individuals eventually diagnosed with dementia and time-
to-dementia metric, and second including the entire dataset,
dementia diagnosis as a variable, and time-in-study metric.
Controlling for sex, age, education, depressive symptoms,
and the interaction between age and education, the first
series of analyses revealed a consistent pattern of personality
change preceding dementia diagnosis across datasets, spe-
cifically linear increases in neuroticism and stability in extra-
version. The second series of analyses revealed a less stable
pattern of results: dementia diagnosis was only a significant
predictor of neuroticism trajectories in some datasets. These
findings will be discussed.
Identification of early indicators of dementia, specifically
how personality changes differ for healthy individuals com-
pared to individuals eventually diagnosed with dementia,
may aid in early care strategies and facilitate development of
screening assessments.
PERSONALITY TRAITS PREDICT DIETARY HABITS
IN MIDDLE-TO-OLDER ADULTS
S.Weston1,2, G.Edmonds3, S.Hampson3, P.Hill1, 1. and working memory performance in one of the studies,
Psychology, Washington University in St. Louis, Evanston,
Illinois, 2. Northwestern University, Evanston, Illinois, 3.
Oregon Research Institute, Eugene, Oregon
Personality traits predict dietary habits in middle-to-older
adults.
Personality traits are consistently associated with health
behaviors, but little research has examined the role of traits
on eating habits among middle-to-older adults. Importantly,
food choices are constrained by financial resources or avail-
ability of healthy options, suggesting the need to test differ-
ential associations across SES. We examined the associations
between traits and dietary habits, whether healthy eating pre-
dicted health at age 60, and if SES moderated these relation-
ships. We used a sample of 665 middle-to-older adults from
the Hawaii Personality and Health Cohort. Participants com-
pleted personality and eating questionnaires at age 44 and
reported health at age 60. Dietary items were consolidated
using factor analysis, which resulted in two factors: healthy
and unhealthy foods. Eating healthy foods was associated
with higher levels of agreeableness (r=.11), conscientious-
ness (.14), emotional stability (.14) and openness (.19) and
predicted better self-rated health (.21) and lower BMI (-.19).
Eating unhealthy foods was associated with lower levels of
agreeableness (r=-.11), conscientiousness (-.12), emotional
stability (-.09) and openness (-.14) and predicted lower self-
rated health (-.13). Unhealthy food consumption did not pre-
dict BMI. Surprisingly, these results were not moderated by
SES. Overall, we conclude that personality traits have a con-
sistent relationship with dietary habits across levels of SES,
and thus the use of traits to predict and understand eating
choices can be applied consistently across patients, regardless
of financial resources. Moreover, these associations between
Innovation in Aging, 2017, Vol. 1, No. S1
traits and eating choices may consequences for older-adult
health.
STRESS, PHYSICAL ACTIVITY, AND AGING:
COORDINATED ANALYSES OF TWO LONGITUDINAL
DATA SETS
R.Vendittelli, Psychology, University of Victoria, Saanich,
British Columbia, Canada
Although modest declines in cognition are considered
normative, it is becoming increasingly evident that severe
decline and dementia are not inevitable outcomes caused
by age. Person-specific variables such as physical activity
(PA) and stress are two modifiable lifestyle factors that have
been demonstrated to be associated with poorer cognitive
outcomes. To date, there are no studies examining both the
between-person (BP; or person-mean levels) and within per-
son (WP; or occasion specific fluctuation relative to ones
expected trajectory) effects of PA and stress on cognitive abil-
ities. Data from two longitudinal data sets were analyzed in
a coordinated manner. Specifically, utilizing comparable vari-
ables, data were fit to the same models with processing speed,
memory and MMSE as separate outcome variables. Higher
average PA was associated with less decline in processing
speed, working memory and MMSE scores in one of the two
data sets. Interestingly, the WP effects of PA were associated
with better cognitive outcomes in all models except memory
performance in one of the studies. Unexpectedly, the WP
effects of stress were associated with higher processing speed
while the BP effects were non-significant across both studies
and outcome variables. Findings indicate that higher aver-
age PA, as well as individual specific fluctuations in activity
can positively influence cognition. Moreover, proximal stress
seems to enhance cognition. These findings corroborate lit-
erature implicating activity in cognitive functioning, and
are nuanced in demonstrating that more proximal indica-
tors of activity level and stress are associated with cognitive
performance.
THE IMPORTANCE OF SUFFICIENT CHALLENGES
TO POSITIVE EMOTIONS AMONG OLDER ADULTS
D.Tse, J.Nakamura, M.Csikszentmihalyi, Quality of
Life Research Center, Claremont Graduate University,
Claremont, California
Flow theory postulates that people enjoy the optimal
experience when challenge level of an activity matches
their skill level. However, little research has extended
the theory to examine the effect of challenge-skill bal-
ance on older adults emotional experiences. This recently
completed study investigated whether older adults expe-
rienced more frequent high arousal positive(HAP) and
low arousal positive(LAP) emotions in challenge-skill
balanced activities. 104 younger(Mage=25.8, SD=2.76)
and 93 older adults(Mage=65.0, SD=4.78) identified
underchallenging(challenge-lower-than-skill), challenge-skill
balanced, and overchallenging(challenge-higher-than-skill)
activities that they had chosen to do in the past, and reported
their typical emotions in each activity. Results were ana-
lyzed by repeated measures ANOVA and paired compari-
son t-tests. Consistent with flow theory, both younger and
older adults reported more frequent HAP and LAP emotions
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in challenge-skill balanced activities than in underchal-
lenging or overchallenging activities, F(2,392)=133.42,
p<.001, partial eta-squared=.405 for HAP emotions; and
F(2,392)=139.92, p <.001, partial eta-squared=.417 for LAP
emotions. In addition, although older adults experienced less
frequent HAP emotions than younger adults in underchal-
lenging and overchallenging activities, such affective differ-
ence was not observed in balanced activities. These findings
are consistent with flow theory that challenge-skill balance
is associated with high frequencies of HAP and LAP emo-
tions among both older and younger adults. More important,
engagement in sufficient but not overwhelming challenges
can offset the differences in HAP emotions between younger
and older adults. The study provides insight to older adults
and those who serve this population on the importance of
older adults maintaining sufficiently challenging activities to
maximize their positive emotional experience.
SUICIDE AMONG THE ELDERLY IN KOREA:
AMETA-ANALYSIS
J.Lee, J.Yang, J.Lyu, Hallym University, Chuncheon,
Gangwon-do, Korea (the Republic of)
Elderly suicide is a major public health issue in South
Korea. The aim of this study was to systematically exam-
ine the current knowledge about suicidal ideation among
Korean older adults with specific focus on risk and preven-
tive factors. In order to achieve this aim, a meta-analysis was
conducted using Korean academic peer-reviewed journals
published since 2001. A total of 97 articles were selected
that met the research criteria (e.g., original study findings
and key words of suicidal ideation, suicidal thought, and
suicide). Three domains were identified and used for further
analysis: individual, family, and society. Results showed that
among individual factors, depression and burden or stress
increased the risk of suicidal ideation, while better mental
health reduced the risk of suicidal ideation. Among family
factors, living alone was a risk factor for suicidal ideation,
while family cohesion was a preventive factor for suicidal
ideation. Among social factors, elderly discrimination, social
isolation, and negative relationships were significant risk
factors, while social support, social environment, and social
activities were significant preventive factors affecting suicidal
ideation. The results suggest several practical implications
for developing suicide prevention programs and counseling
approaches to address suicidal ideation. For example, depres-
sion and stress can be reduced by MBSR (Mindfulness-Based
Stress Reduction) program where meditation is used as a
coping strategy. In addition, counseling programs specifically
focused on improving family and social relations should be
implemented. Government should continuously support for
these programs to prevent suicide among older Koreans.
DAILY SOCIAL INTERACTION RELATES TO
SUBJECTIVE COGNITIVE FUNCTION
J.Kang, J.Hyun, M.Sliwinski, J.A.Mogle, Human
Development and Family Studies, The Pennslyvania State
Universtiy, State College, Pennsylvania
Self-reports of cognitive problems are required for the
clinical diagnosis of mild cognitive impairment (MCI).
Identifying factors affecting subjective evaluations of cog-
nition is essential to the early recognition of cognitive
IAGG 2017 World Congress
419
impairment. One such factor is social engagement, which
is an established protective factor for long-term cognitive
health. However, little is known about how recent social
interactions relate to reports of subjective cognitive func-
tion in everyday life. Therefore, we examined whether the
frequency and quality of daily social interactions predicted
day-to-day variability in reports of subjective cognition.
A systematic probability sample of 251 racially diverse
adults (age=2565) completed a 14-day ecological momen-
tary assessment protocol that measured social interactions,
mood and fatigue at 5 random times throughout each day. At
the end of each day, participants provided subjective reports
of their memory, speed, and attention, as well as their overall
appraisal of the quality of their social interactions on that
day.
Using multilevel modeling we found on days during which
they had more frequent social interactions, participants
reported better cognitive function (Estimate=1.56, p<.0001).
Moreover, on days they reported more pleasant interactions,
participants reported higher levels of subjective cognitive
function (Estimate=0.16, p<.0001). Both effects remained
significant after controlling for daytime affect and fatigue.
The effects of both daily social interaction and end-of-day
appraisal on subjective cognition were invariant across age.
This study illustrates that the frequency and quality of
social interactions has a proximal (same day) relationship to
subjective cognition. These results have implications both for
assessing subjective cognition and for interventions.
THE ROLE OF GRANDMOTHERS IN KOREAN
WOMENS WORK-LIFE BALANCE
S.Jeon, M.Gilligan, Iowa State University, Ames, Iowa
Although many Korean women want to pursue both suc-
cessful careers and families, Korean culture limits womens
ability to maintain work-family balance. Constrained by
their ability to both work and care for their children, working
Korean women tend to call on their aging mothers for assis-
tance. The purpose of this study was to better understand the
important role of grandmothers in working Korean womens
work-family balance. We conducted in-depth interviews with
22 married, working women living in Korea (M=35.9years)
who have at least one young child (infant / preschooler) and
who rely on their mothers (M=62.5 years) for child care.
Several themes emerged from these newly available data.
Women who had good relationships with their mothers
tended to be more appreciative of their mothers help. Several
women expressed feelings of guilt that their mothers took
care of grandchildren because several of the grandmothers
were experiencing health concerns of their own. However,
despite these feelings of guilt, the women indicated that they
hoped that their mothers would take care of their children
until their children enter elementary school. Also, the women
expressed the Korean governments childcare policy is unre-
alistic and they indicated that it would be beneficial if the
Korean government provided support to grandmothers car-
ing for grandchildren. Overall, our findings suggested that
work-family balance is an important concern of many work-
ing Korean women. Often these women rely on support from
their mothers in an attempt to obtain work-family balance.
However, many of these grandmothers experience their own
health concerns.
420
CARDIORESPIRATORY FITNESS BENEFITS VERBAL
MEMORY IN OLDER BUT NOT YOUNGER BREAST
CANCER PATIENTS
H.Derry, W.B.Malarkey, J.Kiecolt-Glaser, Institute for grandparents who provide a high share of household income
Behavioral Medicine Research, The Ohio State University
Wexner Medical Center, Columbus, Ohio
Breast cancer survivors often experience cognitive prob-
lems following surgery and prior to further treatment.
Cardiorespiratory fitness (CRF) benefits cognitive function
in healthy older adults. However, few studies address CRFs
effects among breast cancer survivors or consider how this
pattern may vary by age. As part of a larger study, 110 female
post-surgical breast cancer survivors (ages 26 to 75, stages
I-IIIA) completed a graded cycle ergometry test to measure
peak oxygen consumption prior to chemotherapy or radia-
tion treatment. Neuropsychological tasks assessed verbal
memory (Hopkins Verbal Learning Test), verbal fluency
(F-A-S), executive function (Trail Making Test, n-back task),
and sustained attention (Continuous Performance Test).
Regression models revealed that the relationship between
CRF and immediate verbal recall scores varied significantly
by age, above and beyond education, comorbidities, cancer
stage, and time since surgery (b=.013, SE=.006, p=.032). the malleability of motivation and behavior of older women
Among women ages 62 and older, those with better fitness
had better immediate verbal recall compared to those with
poorer fitness, using the Johnson-Neyman method. The age
by CRF interaction did not significantly predict performance
on other cognitive tasks in adjusted models. Accordingly,
older participants who were more fit had better immediate
verbal recall than those who were less fit, while younger
womens CRF was not significantly related to their verbal
memory performance. The fitness-cognitive function link
may be particularly relevant for older cancer survivors com-
pared to their younger counterparts. Longitudinal studies
would help discern if physical fitness prevents accelerated
cognitive aging among cancer survivors, and prompt relevant
interventions.
FACTORS SHAPING GRANDPARENTS
RESPONSIBILITY FOR GRANDCHILDREN IN THREE-
GENERATION HOUSEHOLDS
N.Velasco, J.E.Mutchler, Gerontology, University of
Massachusetts Boston, Boston, Massachusetts
The number of grandparents identified as primary
responsible for grandchildren is on the upswing. Data from
the American Community Survey (ACS) suggest that the
percent of coresident grandparents responsible for grand-
children increased from 11% in 2010 to 15% in 2015.
Additionally, estimations indicate that among the nearly
2.7 million U.S. grandparents who claimed responsibility
for their minor grandchildren in 2015, two-thirds lived in a
three-generation household, including minor grandchildren,
one or both of their parents, and one or more grandparents.
However, most of the literature on grandparent caregivers
has focused on the grandparents role in skipped-generation
households, and little is known about the grandparents role
in three-generation households. The purpose of this study is
to explore the factors that lead grandparents to be identified
as primarily responsible for grandchildren living with them
in three-generation households. The analysis was conducted
using the 2015 ACS 5-year estimates dataset. Household
Innovation in Aging, 2017, Vol. 1, No. S1
income and income balance between the grandparent and
parent generations are determinants of whether the grand-
parent is classified as being primarily responsible; specifically,
are more likely to be classified as primarily responsible for
the grandchild. As well, race and ethnicity are related to
the grandparents identification as primary caregiver, with
African American grandparents being more likely to be clas-
sified as primarily responsible for grandchildren. Together,
these findings suggest that a grandparents responsibilities in
the three-generation household are defined in part by eco-
nomic responsibility, but in part by cultural norms relating
to the grandparent role.
MANIPULATION OF EFFICACY AND FUNCTIONAL
MOTOR PERFORMANCE IN OLDER WOMEN
N.Roncesvalles1, M.Bregendahl2, 1. Texas Tech University,
KInesiology and Sport Management, Lubbock, Texas,
2. Stanford University School of Medicine, Division of
Primary Care, Palo Alto, California
Fall prevention remains a worthy goal for the aging popu-
lation (Ungar, etal., 2013). This study contributes by testing
beginning to exhibit the fear of falling. Will manipulation of
efficacy significantly affect both perceived fear (falls efficacy)
and behavior (i.e. gait, balance)?
Forty-two older women (N=42), between 55 to 75years
were administered with the Falls Efficacy Scale-International
(FES-I) and the Short Physical Performance Battery (SPPB)
on two occasions: 1)Initial screening (baseline), and, 2)Post-
manipulation. Baseline assessment included documentation
of health, mental state, heart rate, activity levels and other
demographic data. Those with low to moderate concern
for falling (FES-I) were included in the participant pool and
randomly assigned to three groups: enhanced efficacy (EE),
reduced efficacy (RE), and control (C). A rhythmic weight
shifting task (SMART Balance Master) was undertaken to
manipulate perception (efficacy). Fabricated verbal feedback
were tailored according to group: regardless of actual per-
formance, positive for EE, and negative for RE. Participants
in the C group were provided none. Comparison (Friedmans
Test) of the pre- and post-manipulation scores revealed that
provision of manufactured verbal feedback did not influence
FES-I or SPPB in any group examined (p0.05). In addition,
no significant relationship was found between the variables
before and after manipulation.
The non-significant results were likely attributable to the
short intervention protocol. Perhaps a longer and consistent
protocol, with specific focus on populations already expe-
riencing a significant level of fear will produce alternative
results.
DEPRESSIVE SYMPTOMS IN CHILD CAREGIVERS OF
VERY OLD MEXICAN AMERICANS
D.V.Flores1, S.Rote2, J.L.Angel3, N.Chen1, B.Downer1,
K.S.Markides1, 1. University of Texas Medical Branch,
Galveston, Texas, 2. University of Louisville, Kent School
of Social Work, Louisville, Kentucky, 3. University of Texas,
Austin, Texas
Objective: To study the effects of disability, cognitive
impairment, and neuropsychiatric disturbance among older
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Mexican Americans on depressive symptoms in their chil-
dren caregivers.
Methods: This study utilizes data from Wave 7 (201011)
of the Hispanic Established Populations for the Epidemiologic
Study of the Elderly to assess caregivers that provided direct
personal care with activities of daily living (ADL) and who
were children of the care recipient. Two hundred adult car-
egivers provided direct personal care (e.g., bathing, toileting,
dressing, etc.) to their older parents (average age=87). We
analyzed the influence of ADL disability, cognition (MMSE),
and neuropsychiatric symptoms (NPI) on depressive symp-
toms of the adult child caregiver. Across-sectional multivari-
able linear regression analysis was conducted to examine the
effect of neuropsychiatric disturbance on caregiver depres-
sive symptoms.
Results: ADL disability of the care recipient, cognitive
functioning of the care recipient, and caregiver health status
alone did not have a significant effect on depressive symp-
toms of the caregiver but NPI of the care-recipient did. Not
being married, high perceived social stress, and caregiver-
assessed NPI of the care recipient had a significant effect on
caregiver depressive symptoms.
Conclusions: In a Mexican American familistic culture,
disability and cognitive impairment might be better toler-
ated by families but neuropsychiatric behavioral symptoms
related to dementia may take an increased toll on family
member caregivers. The need to provide respite services,
mental health resources and community services for caregiv-
ers of care recipients with neuropsychiatric dysfunction is of
paramount importance to alleviate depressive symptoms and
burden among caregivers.
THE STRENGTH OF SOCIAL TIES: HOW COUPLES
FACE AD TOGETHER OR ALONE
R.L.Beard1, R.Daley2, M.OConnor2, S.Shirk2, 1. sample. Older adults with passive suicidal ideation had more
Sociology and Anthropology, College of the Holy Cross,
Worcester, Massachusetts, 2. Edith Nourse Rogers
Memorial Bedford VAMC, Beford, Massachusetts
Social and behavioral research on Alzheimers disease
(AD) has largely neglected the potential positive appraisals
of AD experiences relative to the so-called stress and bur-
den assumed to accompany the condition. The very word
caregiving implies a unidirectional and exclusively nega-
tive experience for everyone involved. Spouses provide the
majority of care for individuals with AD yet few prior studies
have examined the association between positive caregiving
appraisals and quality of marital relationship. The qualita-
tive literature suggests that these couples adopt either a We/
Us approach where they describe experiences as a composite
whole or an I/Me approach where they describe themselves
as experiencing the impact of AD separately. Little is known
about how these perspectives relate to the individual charac-
teristics of either party. Eleven spousal dyads were divided
into I/Me (n = 5) and We/Us (n = 6) groupings based on
qualitative analyses. Diagnosed individuals were given meas-
ures of cognitive and functional ability and caregivers com-
pleted anxiety, depression, burden, relationship satisfaction,
and positive aspects of caregiving measures. We found no
significant differences between groups on patient cognitive
or functional ability, or caregiver anxiety, depression, bur-
den, or relationship satisfaction. However, We/Us caregivers
IAGG 2017 World Congress
421
expressed more positive aspects of caring than I/Me couples.
These findings suggest the I/Me approach is not associated
with differences in cognitive status or functional ability or
carer emotional health, perceived burden, or relationship
satisfaction. Those taking a We/Us approach, however, were
able to identify more positive aspects of caring. This may be
related to mutual compassion and could be protective.
PASSIVE SUICIDAL IDEATION AMONG OLDER
ADULT INSOMNIA CLINIC PATIENTS WITH
INSOMNIA DISORDER
R.Cui, D.Richter, A.Fiske, Psychology, West Virginia
University, Morgantown, West Virginia
Up to 29% of older adults suffer from insomnia symp-
toms (Ancoli Israel & Cooke, 2005; Schubert etal., 2002).
Symptoms of insomnia have been found to be associated with
suicidal ideation among older adults (Nadorff, Fiske, Sperry,
Petts & Gregg, 2013). The present study seeks to investigate
factors associated with suicidal ideation within a sample of
51 older adults diagnosed with Insomnia Disorder seeking
treatment at an Insomnia Clinic. The sample was primarily
female (70.6%) and Caucasian (96.1%). Participants com-
pleted self-report measures of insomnia symptoms (Insomnia
Severity Index, ISI), daytime sleepiness (Epworth Sleepiness
Scale, ESS), anxiety symptoms (Beck Anxiety Inventory, BAI),
depression symptoms (Center for Epidemiologic Studies
Depression Scale Revised, CESD-R), emotion regulation
strategies (Emotion Regulation Questionnaire reappraisal
and suppression scales, ERQ reappraisal and ERQ suppres-
sion), and social support (Interpersonal Support Evaluation
List, ISEL). Passive suicidal ideation was assessed with
items 14, I wished Iwere dead and 15, I wanted to hurt
myself, from the CESD-R and coded as a dichotomous vari-
able. Passive suicidal ideation was endorsed by 9.8% of the
anxiety symptoms (F1,48=17.59, p < .01), more depression
symptoms (F1,49=21.39, p < .01), greater use of suppres-
sion strategies to regulate negative emotions (F1,36=7.24,
p=.011), and less social support (F1,31=6.37 p=.017).
These findings indicate the need to screen for suicidal idea-
tion among older adults seeking treatment for insomnia who
present with elevated depression or anxiety symptoms.
MINDFULNESS-BASED PROGRAM ENHANCES THE
QUALITY OF LIFE FOR COMMUNITY-DWELLING
OLDER ADULTS IN TAIWAN
H.Hsu1, S.Cheng1, Y.Hsu1, C.Chiu1, C.Kuo2, 1.
Yangsheng Foundation, Taipei, Taiwan, 2. National
Pingtung University, Pingtung, Taiwan
Aim: This study aimed to evaluate the impact of an eight
weeks mindfulness-based program on the quality of life for
older adults form community population.
Methods: The benefits of mindfulness research on
human well-being have accumulated much empirical evi-
dences. Several studies have also indicated that mindful-
ness training enhances cognitive functions. However, it is
unknown whether the positive effect can be generalized to
older adults. An eight-weeks mindfulness-based program
which was modified from Mindfulness-based Cognitive
Therapy(MBCT) that involve understanding mindfulness,
the benefits of mindfulness to increase self-awareness,
422
accept yourself and cultivate compassion minds through
the practice of body stretch, sitting meditation, body scan,
and breathing. In addition, role play, clam jar and ten-
finger appreciation activities were also included to enrich
the social element of the program. It is noteworthy that
this program is easy-to-implement for older adults. Eighty-
nine older adults recruited from a community center
volunteered for the present study. All participants were
over 60years old, and the mean age was 71.88years old
(SD=5.92). Before and after the program, the quality of
life, depression, cognitive states was measured by visual
analogue scale, Taiwanese Geriatric Depression Scale-5,
and modified Chinese Mindfulness Awareness Attention
Scale (mCMAAS), respectively.
Results: The results showed that the quality of life was
enhanced after the program, t(88)=3.15, p < .01. Both the
depression state and cognitive state were remained the same
(p=.841 for depression, p=.633 for cognitive state).
Conclusions: It is an exciting finding that the quality of
life was significant improved after the Mindfulness-Based
Program for community-dwelling older adults. It is likely
that the mood and cognitive measures reached the ceiling so
that they were insensitive to changes. The impact of a long-
term training program and more sensitive measures on mood
and cognitive ability should be further examined.
RESULTS OF AMINDFULNESS INTERVENTION
FEASIBILITY STUDY AMONG ELDER AFRICAN
AMERICAN WOMEN
J.Proulx, M.Hebert, R.Croff, B.Oken, Oregon Health &
Science University, Portland, Oregon
This study used mixed methods to examine the feasibil-
ity of implementing a 4-week mindfulness class with 10
elder African American women (aged 50 69). We meas-
ured changes in PSS, PANAS, LSI, Perseverative Cognition
Scale, and the Multidimensional Inventory of Black
Identity before and after the intervention. We also used
these measures as a means to assess the salience of these
scales to this population. Focus groups provided informa-
tion on motivation, effective strategies, preferences, and
perceived benefits of the mindfulness class. There was a sig-
nificant change in numbers of participants who reported a
meditation practice (1 person at time 1; 8 people at time 2,
chi2(1)=5.84, p < .05). There were marginally significant
improvements in PSS, t(18) = 1.99, p = .06, and PANAS
positive affect, t(18)=-1.99, p=.06. Stressors that moti-
vated participation in the mindfulness classincluded family
obligations and daily race-based microagressions. Effective
strategies to address stressors salient to our participants
included taking time for self-care, quiet prayer, removing
oneself from stressful people, remembering ones core self
in the face of discrimination (i.e., centering), and having a
positive mindset. Preferences included integration of faith-
based language, using a facility recognized as a community
center for the classes (e.g., church), and African American
classinstructors. Participants noted perceived benefits such
as mindfulness as calming and centering, better body and
pain awareness, an increased sense that one can better tune
out chaos, and that the mindfulness group can provide a
forum for race and diversity.
Innovation in Aging, 2017, Vol. 1, No. S1
COULD POSITIVE EFFECTS OF LIFE REVIEW ON
COGNITION LAST? THE FOLLOW-UP STUDY ON
LIFE REVIEW IN TOME
A.Hosokawa, National Center for Geriatrics and
Gerontology, Obu, Aichi, Japan
Life review could be defined as an evidence-based inter-
vention for secondary aging. Apart of the life review study
in Tome found that regular participation in group life review
session has positive effects on cognitive abilities in later life.
Can these positive effects of group life review be maintained?
The purpose of the current study was to follow the study in
Tome up to see effects of group life review on memory, cog-
nition, and QOL one year after intensive intervention. After
having completed 10-week intensive group life review ses-
sion, the life review group kept on participating in intermit-
tent group life review session. All the participants took tests
including Logical Memory and Verbal Paired Associates from
WMS-R, MMSE, and SF-36 before, after, and one year after
the intensive life review intervention. The life review group
improved their scores on immediate recall of propositions in
the short stories for Logical Memory subtest from WMS-R
immediately after the intensive intervention (M = 29.92,
SD=6.69) and even maintained their performance one year
after the intervention (M = 30.08, SD = 7.24). They also
associated more pairs in delayed recall immediately after the
intensive intervention (M=7.62, SD=.77) and still improved
their performance one year after the intervention (M=7.69,
SD=.63). There were no any significant differences in QOL,
however. The results suggested that the intermittent inter-
vention by life review contributed to maintaining improved
performance on memory test while the intensive intervention
could draw drastic improvement.
SELF-TALK ON HEALTH BY ASSISTED LIVING
RESIDENTS: NEW IMPLICATIONS FOR PROVIDERS
J.G.Schumacher1, R.Millar1, E.Stephenson1, H.Kim2,
1. University of Maryland, Baltimore County (UMBC),
Baltimore, Maryland, 2. University of Marland, Baltimore
(UMB), Baltimore, Maryland
Assisted living (AL) settings serve as a significant con-
gregate living environment for older adults worldwide and
continue to increase in scope. This research examines how
AL residents talk about their health issues in the context of
two newly integrated, large qualitative data sets from two
federally funded (NIA) ethnographic studies of ALs across
a total of 10 AL settings spanning a consecutive 10 year
period. Ethnographic interviews were collected and team
coded by an interdisciplinary group of researchers using
Atlas.ti software. Thematic analysis and interpretation of the
self-talk on health code was consensus driven and guided
by Levys stereotype embodiment theory. Analysis suggests
dominant self-talk on health themes that include: falls/fear of
falling, medications, function/mobility, memory, symptoms,
and pain. Notably, themes on health were almost completely
negative in tone with only isolated references to positive self-
talk on health by the AL residents. Stereotype embodiment
theory suggests the strongly negative self-talk on health can
gain salience in the lives of older adults and contribute to
lack of self-fulfillment and may accelerate overall physical
and mental health decline. Acknowledging the prevalence
of negative self-talk on health in ALs can provide insight to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
AL providers for new strategies in creating health-oriented
programs to address positive coping and appraisal strategies
including accommodation and adaptation. Providers proac-
tively addressing negative self-talk on health can contribute
to improving AL residents self-perception on their health
and well-being which can contribute to lengthening AL resi-
dents aging in place.
WHEN YOU LIMIT YOUR DRIVING: ASSOCIATION
WITH COGNITION AND FUNCTIONAL ABILITIES IN
OLDER AMERICANS
B.A.Fausto, D.J.Dobbs, H.Lee, University of South
Florida, Tampa, Florida
Driving is a complex functional task that allows partici-
pation in routine, community, and social activities. Driving
limitations in later life are associated with negative biopsy-
chosocial consequences including increased depression,
health declines, loss of independence, and social isolation.
Employing the Multifactorial Model of Driving Safety, we
hypothesized that older drivers who limited their driving
were more impaired than older drivers who drove long trips.
In addition, we examined changes in driving patterns. We
used data from the 2008 and 2012 Health and Retirement
Study. The sample included older drivers (M=73.6 years
of age, 53% women, 86.5% white) at baseline (n=7,992).
Descriptive statistics, MANOVA, and multinomial logistic
regression were conducted. At baseline, approximately 38%
limited their driving to nearby places. MANOVA results
indicated that, compared to those who drove long distances,
older drivers who limited their driving to nearby places
had significantly poorer cognition scores, poorer self-rated
hearing and eyesight, greater difficulties with activities of
daily living, poorer self-rated health and tended to be older,
female, and non-white, =.79, F(11, 7980)=189.40, p<.001,
partial 2=.21. About 27% of older drivers who limited driv-
ing at baseline stopped driving at four-year follow-up. Those
who stopped driving at follow-up also showed poorer cogni-
tive, sensory, and physical health status than those who did
not. Results suggest that older drivers with cognitive, sensory
and/or physical difficulties may regulate their driving behav-
ior. Such driving patterns can inform the driving capacity,
potential for rehabilitation, and risk of driving cessation of
the aging population.
THE DECISION TO WORK PAST STATE PENSION AGE
AND HOW IT AFFECTS QUALITY OF LIFE: EVIDENCE
FROM ENGLAND
G.Di Gessa1, K.Glaser2, L.Corna2, D.Price3, 1. self-rated childhood health. Nearly half of the sample had
Department of Social Policy, The London School of
Economics and Political Science, London, United Kingdom,
2. Kings College London, London, United Kingdom, 3.
University of Manchester, Manchester, United Kingdom
Introduction: Increasing numbers of older people in the
UK and other industrialised countries are now working
beyond state pension age (SPA). However, to date, little is
known about the motives beyond continued work at older
ages and whether the reasons for extending working lives are
associated with quality of life (QoL).
Aim: Our study examined whether, and to what extent,
reasons given for being in paid work beyond SPA are asso-
ciated, both cross-sectionally and longitudinally, with QoL.
IAGG 2017 World Congress
423
Data and Methods. We employed data from Waves 4 and
7 of the English Longitudinal Study of Ageing. Using lin-
ear regression models we assessed both cross-sectional and
longitudinal associations between reasons for being in paid
work beyond SPA and QoL among men aged 6574 and
women aged 6069 (N=2,306). Our cross-sectional analyses
controlled for baseline health and socio-economic charac-
teristics, as well as for social participation and the quality
of social relationships. In our longitudinal analyses we also
controlled for changes over time.
Results. Almost 23% of the sample is in paid work beyond
SPA. Of these, almost two thirds reported that they were in
paid work because they enjoy working or to keep active
and fit, whereas the other third reported financial issues as
the main reason for working beyond SPA. Reasons which
reflect a lack of control over the decision to work after SPA
(i.e. financial reasons) are associated with lower QoL. In con-
trast, those reasons which capture a degree of control (enjoy-
ment of the job or wanting to remain active) are associated
with higher QoL both cross-sectionally and over time.
CHILDHOOD DEPRIVATION AND LATER-LIFE
COGNITIVE HEALTH IN ASOUTH AFRICAN
COHORT STUDY OF AGING
L.C.Kobayashi1, M.Glymour2, K.Kahn3,5, R.Wagner3,5,
F.Mateen4, S.Tollman3,5, L.F.Berkman1, 1. Center for
Population and Development Studies, Harvard University,
Cambridge, Massachusetts, 2. University of California, San
Francisco, San Francisco, California, 3. University of the
Witwatersrand, Johannesburg, South Africa, 4. Harvard
Medical School, Boston, Massachusetts, 5. MRC/Wits
Rural Public Health and Health Transitions Research Unit,
Agincourt, South Africa
Although the populations of low-to-middle income coun-
tries are rapidly aging, very little research has evaluated the
drivers of cognitive aging in these settings. We aimed to inves-
tigate the relationship between fathers occupation during
childhood (a marker of childhood socioeconomic depriva-
tion) and later-life cognitive function, and whether educa-
tional attainment may explain this relationship among older,
rural South Africans. Data were from baseline assessments
in Health and Aging in Africa: ALongitudinal Study of an
INDEPTH Community in Rural South Africa (HAALSI),
a population-based cohort in Agincourt, South Africa. The
cohort included 5059 men and women aged 40 years in
2015. Aformal mediation analysis was conducted using lin-
ear models adjusted for age cohort, sex, country of birth, and
no education (45%) or were illiterate (40%). The total effect
of fathers occupation during childhood on z-standardized
latent cognitive function score was 0.134 (95% CI: 0.074
0.187 for skilled vs. unskilled labor) and the controlled
direct effect not explained by education was 0.104 (95%
CI: 0.0480.157). The indirect effect mediated by education
was 0.030 (95% CI: 0.0100.054), representing 22% of the
total effect. These results indicate that older South African
adults whose father worked in unskilled labor had, on aver-
age, worse cognitive outcomes than those with a father in
skilled work, partly because they received very little, if any
formal education. In this post-Apartheid context of aging in
rural South Africa, socioeconomic inequalities in cognitive
424
outcomes appear consistent with patterns observed in high-
income countries.
DUCHENNE SMILING AND STIGMA IN OLDER
ADULTS WITH PARKINSONS DISEASE
S.Gunnery, L.Tickle-Degnen, Tufts University, Medford,
Massachusetts
Older adults with Parkinsons disease (PD) often have
limited positive expressivity due to diminished ability to
activate facial muscles. People with this deficit appear more
depressed and withdrawn, which can lead to stigmatiza-
tion. The Duchenne smile, which includes crinkling around
the eyes, is the most potent way to express happiness. Older
adults with PD maintain some deliberate control of their
faces and could learn to compensate for loss of spontaneous
expression by deliberately posing the Duchenne smile. We
measured the ability to spontaneously and deliberately pro-
duce Duchenne smiles, and tested the relationship between
smiling and enacted stigma (experiencing unfavorable atti-
tudes from others) and felt stigma (internalizing negative ste-
reotypes about ones disease). Fifty-four participants with PD
(Mage=65) were videotaped posing four happiness scenar-
ios in which they were instructed to smile and say a phrase
(deliberate task), and while telling an interviewer about an
enjoyable activity (spontaneous task). The most expres-
sive clip from the spontaneous task and the four role-plays
were coded for Duchenne and non-Duchenne smiles. Forty
participants produced at least one Duchenne smile during
their spontaneous narrative (range: 12) and 36 produced
at least one Duchenne smile in the deliberate task (range:
14). Deliberate Duchenne smiling correlated with experi-
encing less felt stigma, r(52)=-.27, p=.05, while spontaneous
Duchenne smiling correlated with experiencing less enacted
stigma, r(52)=-.28, p<.05. These data indicate two possible
means by which older adults could reduce the stigmatization
of reduced facial activationdeliberately to reduce feeling
normatively inadequate and spontaneously to reduce experi-
encing the negative evaluations of others.
IMPROVING TECHNOLOGY-BASED BEHAVIOUR
CHANGE INTERVENTIONS: LEARNINGS FROM THE
GRAY MATTERS STUDY
I.Cleland1, C.Nugent1, S.McClean1, M.C.Norton2, 1. 10.4%, 7.7%, 4.4%, 19.2%, and 26.9%; whites: 11.7%,
Ulster University, Newtownabbey, United Kingdom, 2. Utah
State University, Logan, Utah
The potential of mobile and wearable technology to
encourage individuals to adopt and sustain healthy lifestyle
behaviours is receiving much attention. Indeed, if successful,
these technologies could have a major impact on reducing risk
factors and offering prevention strategies for a wide range
of age related health conditions such as Alzheimers Disease
(AD). This session presents findings from the Gray Matters
Study, a 6-month multi-domain lifestyle intervention for
middle-aged persons (4064years). The RCT recruited 146
participants (treatment n=104; control n=42) and tracked
lifestyle behaviours across six domains: physical activity,
food, social, cognitive stimulation, sleep quality and stress.
Users tracked their physical activity using a wearable activ-
ity monitor and self-reported lifestyle behaviours through
a smartphone app. The app aimed to increase knowledge
about AD prevention through daily recommendations of
Innovation in Aging, 2017, Vol. 1, No. S1
how lifestyle behaviours could be modified. Study findings
included increases in intrinsic motivation and actual changes
in healthy behaviours. Usage of the app impacted posi-
tively on clinical measures (serum glucose (p=0.015, Insulin
(p=0.011), HDL cholesterol (p=0.037) and BMI (p=0.048)).
On conclusion of the study, however, none of the participants
continued to use the app. This finding is in line with recent
research highlighting that, whilst the popularity of health
apps is increasing and their use is associated with improved
health outcomes, achieving sustained engagement with the
technology over time is more challenging. This session will
discuss findings and best practices from Gray Matters includ-
ing what technological improvements can be made in order
to better sustain these healthy improvements over time.
USING INTERVALS OF NEED TO BETTER MEASURE
FUNCTIONAL STATUS, SERVICE REQUIREMENTS,
AND DISPARITIES
J.N.Laditka1, S.B.Laditka1, C.Jagger2, 1. University of
North Carolina, Charlotte, North Carolina, 2. Newcastle
University, Tyne, United Kingdom
Older adults service needs are often assessed by count-
ing dependence in activities of daily living (ADLs) and
instrumental ADLs (IADLs). That approach lacks precision
and does not adequately consider service need levels. We
addressed those limitations with an approach adopted by
the World Health Organization, using cognitive status and
specific ADL/IADL combinations and impairment levels to
identify time intervals when help was needed (e.g. weekly,
daily, constant). Using Health and Retirement Study data
(n=29,933, 146,324 status transitions, 306,997 person-
years), we estimated seven-state multinomial logistic Markov
models predicting need intervals and death by age, sex, race/
ethnicity, and education. We then simulated populations,
each individual in one of 6 need intervals each year, age 50
through death. Interval I1 was independence; I2, periodic
standby help; I3, weekly IADL help, e.g., shopping; I4, regu-
lar guidance for cognitive impairment without ADL help;
I5, scheduled help daily; I6, nursing home or equivalent
care. Among women with high school education at age 80
African Americans averaged 13.5%, 9.5%, 2.9%, 18.2%,
and 22.6% of remaining life in I2-I6, respectively; Hispanics:
8.6%, 2.6%, 17.6%, and 17.5% (all p<0.01). Remaining
life in I6 for the same groups at age 90 was 37.4%, 44.0%,
and 30.1%, with 22.3%, 27.2%, and 16.7% of those at this
age in I6, respectively. Thus, at older ages more Hispanics
required the highest care level, for longer periods of life.
Measuring need intervals improves estimates of functional
impairment, needs for formal and informal care, and health
disparities.
CAN FAVOURABLE WORKING CONDITIONS HELP
CHRONICALLY ILL WORKERS TO EXTEND THEIR
WORKING LIVES?
M.Fleischmann, J.Head, Epidemiology & Public Health,
University College London, London, United Kingdom
As a result to the increase of retirement ages, more work-
ers with a chronic illness have to extend their working lives.
We study the relevance of favourable psychosocial working
conditions for workers with a chronic illness to extend their
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Innovation in Aging, 2017, Vol. 1, No. S1
working lives. Men and women (30%) aged 3555, working,
and having no chronic illness in phase 1 of the Whitehall II
study on civil servants in the United Kingdom were selected
(n=7,957). In the following 9 phases, spanning more than
20 years, we observe participants exit from work through
health-related retirement (n=538), other retirement (i.e. not
health-related; n=3,905), and other exit (i.e. unemployment,
inactivity; n=500). We investigate the impact of favourable
psychosocial working conditions, chronic illness, and their
interaction, for work exit. Competing risk models using
the subdistribution hazard function revealed that favour-
able working conditions related to work exit. More occa-
sions with high job control or work social support in midlife
were related to a lower risk of health-related retirement.
More work social support also decreased the risk of exit
through unemployment or inactivity. Having a chronic ill-
ness increased the risk of any type of work exit, but only for
health-related retirement this association was significant. The
effect of chronic illness on work exit was only partially mod-
erated by favourable psychosocial working conditions. Good
working conditions in midlife can contribute to extended
working lives, especially among those who exit young, e.g.
due to health-related reasons.
GOAL-ORIENTED COGNITIVE REHABILITATION
IN EARLY-STAGE DEMENTIA: RESULTS FROM THE
GREAT TRIAL
A.Kudlicka1, A.Bayer3, R.Jones2, M.Kopelman4, I.Leroi5, 9years after data collection, 52 participants were deceased.
J.R.Oyebode6, B.Woods7, L.Clare1, 1. Psychology,
University of Exeter, Exeter, United Kingdom, 2. Research
Institute for the Care of Older People, Bath, United
Kingdom, 3. Cardiff University, Cardiff, United Kingdom,
4. Kings College London, London, United Kingdom, 5.
University of Manchester, Manchester, United Kingdom,
6. University of Bradford, Bradford, United Kingdom, 7.
Bangor University, Bangor, United Kingdom
Cognitive rehabilitation (CR) is an individualised inter-
vention for people with early-stage dementia. CR aims to
improve management of everyday activities and reduce func-
tional disability through identifying personal goals, applying
a problem-solving approach and implementing evidence-
based rehabilitative strategies.
We tested this approach in the multi-centre GREAT trial.
Participants had early stage Alzheimers, vascular or mixed
dementia (ICD-10 criteria, MMSE score 18) and a fam-
ily carer willing to contribute. All participants identified
goals before being randomised to receive either treatment as
usual (TAU) or home-delivered CR (10 therapy sessions over
3months followed by 4 maintenance sessions over 6months).
Participants were followed up 3 and 9months post-randomi-
sation, with assessments conducted by a researcher blind to
group allocation. The primary outcome was self-reported
and carer-reported goal attainment at 3months. Secondary
outcomes were participant quality of life, mood, self-efficacy
and cognition, and carer stress, health status and quality of
life.
We randomised 475 participants, of whom 427 com-
pleted the trial (CR=209, TAU=218). There were statistically-
significant large positive effects at 3-month follow-up for
participant-rated goal attainment (d=.97, 95%CI .75-1.19),
corroborated by carers (d=1.11, 95%CI .89-1.34). These
IAGG 2017 World Congress
425
effects were maintained at 9-month follow-up for both par-
ticipant (d=.94, 95%CI .711.17) and carer ratings (d=.96,
95%CI .73-1.2). There were no significant differences in sec-
ondary outcomes.
This major randomised controlled trial demonstrates that
CR is effective in supporting functional ability in early-stage
Alzheimers, vascular or mixed dementia. CR offers a means
of enabling people with early-stage dementia to maintain
independence and engagement in everyday activities.
RELATIONSHIP BETWEEN SOCIAL SUPPORT AND
MORTALITY RISK IN OLDER BLACK ADULTS
A.Gamaldo1, R.J.Thorpe2, A.T.Aiken Morgan3, J.Allaire4,
K.Whitfield5, 1. Penn State University, State College,
Pennsylvania, 2. Johns Hopkins University, Baltimore,
Maryland, 3. NC A&T State, Greensboro, North Carolina,
4. North Carolina State University, Raleigh, North
Carolina, 5. Wayne State University, Detroit, Michigan
The current study examined the relationship between
social support and mortality risk utilizing data from the
Baltimore Study of Black Aging (BSBA; n = 602; Mean
age = 69.12). Participants were administered a battery of
demographic (e.g., age, sex, income, education), social (e.g.,
social support), and health surveys (e.g., perceived stress,
depressive symptoms, and diagnosed health conditions).
Participants were also administered a global mental sta-
tus test (Mini-Mental State Examination). Approximately
A logistic regression tested whether reports of social sup-
port given/received at BSBA wave 1 data collection predicted
mortality risk (living or deceased) following the wave 1 visit.
High levels of social support given was associated with lower
odds of morality (OR=.89; 95% CI 0.810.99) even after
adjusting for demographic and health covariates (i.e., age,
sex, education, income, stress, depression, number of health
conditions, and global mental status). No significant associa-
tion was observed between social support received and lower
odds of morality (OR=1.02; 95% CI 0.931.12). These
results suggest the ability to provide (and not necessarily to
give) social support is an indicator for morality risk in older
Black adults.
COPD CACHEXIA IN AMURINE MODEL
T.Graber, B.Rawls, B.Tian, W.Durham, A.Brasier,
B.Rasmussen, C.Fry, University of Texas Medical Branch,
Galveston, Texas
Chronic Obstructive Pulmonary Disease (COPD) has a
6.3% prevalence in the USA (hundreds of millions world-
wide), has an age-associated onset, features progressively
declining lung function, and is currently incurable. Cachexia
of varying severity is indicated in up to 40% of COPD
patients, leading to significant loss of muscle, strength,
and function--perhaps contributing to sarcopenia or frailty
development. Our poly(I:C)-induced mouse model (male
C57BL/6; 5 months old) was representative of inflamma-
tory/fibrotic COPD. We hypothesized that some treated mice
would present with cachexia. We tested a subset (two groups,
n=4, one treated with Poly I:C and one a PBS sham) for func-
tion, contractile physiology and cellular morphology. The
treated group showed significant (two-tailed t-test, p<0.05)
reductions compared to the sham in function (grip test -50%,
426
treadmill -36%), body mass (-25%), muscle wet-weight (gas-
trocnemius -26%, soleus -33%), and in vitro soleus isometric
contraction (-35%). Furthermore, with treatment, we found
evidence of muscle remodeling, such as cellular cross-sec-
tional area loss (-26% gastrocnemius, -29% soleus), fiber-
type shift (diaphragm increased oxidative fibers, IIx to IIa
+ 22%), increased mitochondrial density/oxidative capac-
ity and mitochondrial biogenesis (succinate dehydrogenase
activity, PGC1-a protein content). In conclusion, 75% of
the treated mice showed at least some overt signs of COPD
cachexia, with one very similar to a frail elderly mouse.
This model will serve as the basis for future investigation
into mechanisms and treatments for COPD-related cachexia,
with the hope to eventually discover strategies to mitigate
progression and improve the quality of life for older adults
living with this disease.
ADVANCED GLYCATION END PRODUCTS IN
HEMATOPOIETIC DEVELOPMENT
N.Huber, K.L.Rudolph, Stem Cell Aging, Fritz Lipmann
Institute - Leibniz Institute on Aging, Jena, Germany
Advanced glycation end products (AGEs) are posttrans-
lational protein modifications that emerge from glycation,
a non-enzymatic reaction between the protein and a sugar.
AGEs are reported to have negative effects on proteins, cells,
tissues and organisms and are linked to several age-related
diseases such as Alzheimers disease, diabetes, inflammation
signaling and cardiovascular diseases, among others. AGEs
are also linked to nutrition, as research indicates that AGE-
high diets could have negative effects on the body. We inves-
tigate AGEs in the hematopoietic system, a tissue strongly
relying on stem cell function and differentiation, which is
compromised in older individuals. We find that throughout
hematopoietic development, populations show different AGE
levels, depending on their lineage (myeloid or lymphoid) and
differentiation stage (early progenitor or fully matured). In
T cell development, these population-dependent levels are
unchanged upon old age and caloric restriction, which indi-
cates them to be conserved and potentially inevitable during
differentiation. The differences in AGE levels point towards
a possible relationship between glycation and differentiation
within the hematopoietic system. This begs the question if
differentiation drives glycation or if AGEs could actually
contribute to differentiation. This would argue for an impor-
tant role of AGEs and could help to rethink the dogma that
renders AGEs simply harmful. Though focused on aging,
the field of glycation research neither concentrates on stem
cells nor the hematopoietic system, thereby neglecting their
importance. Our studies serve to gain a better understanding
of the biological role of glycation during aging and in stem
cells, starting with the hematopoietic system.
ASSOCIATIONS BETWEEN METABOLITES AND
PHYSICAL FUNCTION IN OLDER BLACK MEN
R.A.Murphy1, S.C.Moore4, M.Playdon4, S.B.Kritchevsky5, ated a systemic AT-1 Tg mouse model that ubiquitously
A.Newman2, H.Ayonayon6, C.Clish7, T.B.Harris3, 1. overexpresses human AT-1. The animals demonstrate a
School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada,
2. University of Pittsburgh, Pittsburgh, Pennsylvania,
3. National Institute on Aging, Bethesda, Maryland, 4.
National Cancer Institute, Rockville, Maryland, 5. Wake
Innovation in Aging, 2017, Vol. 1, No. S1
Forest School of Medicine, Winston-Salem, North Carolina,
6. University of California, San Francisco, California, 7.
Broad Institute of MIT, Cambridge, Massachusetts
Functional decline is a common condition among older
adults but mechanisms that give rise to functional decline
and disability are incompletely understood. To identify
metabolic perturbations that may impact functional decline,
non-targeted metabolomics was used to measure 350 metab-
olites in baseline plasma from 313 black men in the Health,
Aging and Body Composition Study (median age 74 years,
median BMI 26.7). Usual gait speed was measured over 20
meters. Cross-sectional relationships between gait speed
and metabolites were explored with Pearson partial cor-
relations adjusted for age, study site and smoking status.
Risk of incident mobility disability (2 consecutive reports of
inability to walk mile or climb 10 stairs) over 13 years
of follow-up was additionally explored with cox regression
models among 307 men who were initially free of mobil-
ity disability. Significance was determined at p0.01 and
q0.30. Ten metabolites were correlated with gait speed. The
most strongly correlated were hydroxyglutarate (r=-0.18),
gluconurate (r=-0.18), homogentisate (r=-0.16), salicylurate
(r=-0.19), and tryptophan (r=0.15). Sixteen metabolites; all
uniqe from gait speed-correlated metabolites, were associ-
ated with incident mobility disability. The top metabolites
were creatine (HR 5.21, 95% CI 1.8514.7); symmetric
dimethylarginine, a biomarker of kidney function (HR=3.30,
95% CI=1.467.48); inositol (HR 2.73, 95% CI 1.485.02)
and quinolate; a metabolite of tryptophan degradation (HR
2.54, 95% CI 1.643.93). This hypothesis generating study
identified 26 involved in biological mechanisms includ-
ing tryptophan metabolism, prospectively associated with
functional decline in older men. The novel function-related
metabolites identified here may help target future investiga-
tion of perturbed metabolic pathways.
SYSTEMIC OVEREXPRESSION OF AT-1/SLC33A1
CAUSES APROGERIA-LIKE PHENOTYPE
Y.Peng, S.Shapiro, K.Hewitt, G.Kong, E.Bresnick,
J.Zhang, L.Puglielli, University of Wisconsin- Madison,
Madison, Wisconsin
The import of acetyl-CoA into the lumen of the endoplas-
mic reticulum (ER) by AT-1/SLC33A1 regulates N-lysine
acetylation of ER-resident and -transiting proteins. Mutations
or increased expression of AT-1/SLC33A1 have been associ-
ated with diseases such as familial spastic paraplegia, devel-
opmental delay with premature death, and autism spectrum
disorder with intellectual disability and dysmorphic features.
Additionally, increased gene dosage and protein levels have
been reported in patients with late-onset Alzheimers disease.
Our lab has demonstrated that the imbalance of acetyl-CoA
influx into the ER lumen affects the induction of autophagy
and mitochondrial adaptation (J Neurosci 2014; 34: 6772
and J Exp Med 2016; 213: 1267). In this study, we gener-
progeria-like phenotype that mimics an accelerated form of
aging. The phenotype includes short lifespan, osteoporosis,
skin changes, anal prolapse, reduced stemness of stem cells,
and reduced proliferation potential of mitotically competent
cells. At the mechanistic level, the phenotype is caused by
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
defective proteostasis and reduced cell proliferation poten-
tial, which appears to be linked to aberrant mitochondria
metabolic adaptation. Funding: NIH.
PRODUCTION OF TNF EX VIVO IS PREDICTIVE OF
AN IMMUNE RESPONSE TO FLU VACCINATION IN
ELDERLY SUBJECTS
F.Bloch1, B.Charmeteau3, M.Tovey4, J.Meritet2,5,
C.Desaint2,6, O.Launay2,5,6, P.Lebon5, 1. CHU Amiens-
Picardie, Amiens, Hauts de France, France, 2. Hpitaux
Universitaires Paris Centre (APHP), Paris, France, 3.
INSERM institute, Paris, France, 4. Biomonitor SAS,
Villejuif, France, 5. Universit Paris Descartes, Sorbonne
Paris Cit, Paris, France, 6. INSERM, CIC 1417, F-CRIN,
I-REIVAC, Paris, France
Objective: To investigate the relationship between the
response to influenza vaccination and the ability to produce
proinflamatory cytokines in elderly subjects.
Methods: Peripheral blood mononuclear cells (PBMC)
of 25 elderly subjects collected before flu vaccination were
stimulated with the influenza vaccine in order to evaluate the
secretion of five specific cytokines: TNF, IFN, IFNg, IL2
and IL10. The results were correlated with the increased HAI
antibody titres three weeks after vaccination.
Results: Only 30% of elderly individuals seroconverted
after flu vaccination. Although 50 to 70% of the cohort
did not produce TNF, IFN, IFNg, IL2 or IL10, All the
individuals who seroconverted were able to produce TNF
. Furthermore production of IFN gamma, with or with-
out production of IFN/b, was not associated with a better
response to the vaccine.
Conclusion: Production of TNF appears to be primor-
dial for an efficient vaccine response and may provide a pre-
dictive marker for the humoral response to vaccination. It
may also provide the basis for evaluating agents designed
to rescue TNF producing cells. This study emphasizes the
necessity and the timing to rescue the function the TNF pro-
ducing cells.
VITAMIN C DEFICIENCY LEADS TO SKELETAL
MUSCLE ATROPHY AND MUSCLE FIBER
TRANSFORMATION
Y.Kondo1, S.Takisawa1, Y.Noda1, S.Machida2, T.Aigaki3,
A.Ishigami1, 1. Molecular Regulation of Aging, Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan, 2.
Juntendo University, Chiba, Japan, 3. Tokyo Metropolitan
University, Tokyo, Japan
Recently, we have reported that plasma L-ascorbic acid
(AA, reduced form of vitamin C) concentrations in com-
munity-dwelling elderly women were related well to their
muscle strength and physical performance (Saito, K. et al.,
2012, J.Gerontol. ABiol. Sci. Med. Sci.). To clarify the physi-
ological functions of AA in skeletal muscle, we investigated
the effect of AA deficiency in skeletal muscle using senes-
cence marker protein-30 (SMP30)/gluconolactonase (GNL)-
knockout (KO) mice that lacks AA biosynthesis ability just
like a human being.
SMP30/GNL-KO female mice at age of 8 weeks were
divided into two groups: AA-deficient group (AA-) given tap
water and AA-sufficient group (AA+) given 1.5g/L AA water.
At 16-week of experimental period (age of 24 weeks), AA
IAGG 2017 World Congress
427
was not detected at all in skeletal muscles of AA-deficient
mice. The gastrocnemius, soleus, plantaris, and tibialis ante-
rior muscle weight of AA-deficient mice were significantly
lower than those of AA-sufficient mice, but EDL muscle
weight showed no difference. In soleus muscle, the area of
muscle fibers and the percentage of type Ifiber (slow-twitch
fiber) were decreased in AA-deficient mice when compared
to AA-sufficient mice. In contrast, the percentage of type IIa
fiber (fast-twitch fiber) was increased in AA-deficient mice.
These results strongly suggested that vitamin C deficiency
in skeletal muscle leads to muscle atrophy and switches mus-
cle fiber types from slow to fast.
FRAILTY EFFECTS ON COGNITIVE CHANGES IN
AGING ARE MODERATED BY DOMAIN, GENETIC
RISK, AND SEX
S.Thibeau2, K.McDermott2, G.McFall2, S.Wiebe2,
K.Rockwood1, R.A.Dixon2, 1. Dalhousie, Halifax, Nova
Scotia, Canada, 2. University of Alberta, Edmonton,
Alberta, Canada
Introduction: Age-related frailty reflects cumulative mul-
tisystem physiological and health decline. Frailty increases
risk of adverse brain and cognitive outcomes, including
differential decline and dementia. In a longitudinal sam-
ple of non-demented older adults, we examine whether (a)
frailty predicts trajectories across three cognitive domains
(memory, executive function (EF), and speed) and (b) pre-
diction patterns are modified by Alzheimers genetic risk
(Apolipoprotein E (APOE)) or sex.
Methods: Participants (n = 655; M age = 70.7, range
5395; 3 waves) were from the Victoria Longitudinal Study.
After computing a frailty index, we used latent growth mod-
eling and path analysis to test frailty effects on level and
change in three latent cognitive variables. We tested two
potential moderators by stratifying by APOE risk (e4+, e4-)
and sex.
Results: First, frailty levels predicted speed and EF perfor-
mance levels, and differential memory change slopes. Second,
change in frailty predicted rate of decline for both speed and
EF. Third, genetic moderation analyses showed that APOE
risk (e4+) carriers were selectively sensitive to frailty effects
on memory change. Fourth, sex moderation analyses showed
that females were selectively sensitive to (a) frailty effects
on memory change and (b) frailty change effects on speed
change. In contrast, the frailty effects on EF change were
stronger in males.
Conclusion: In non-demented older adults, increasing
frailty is associated with differential decline in cognitive
trajectories. These effects vary by cognitive domain and are
moderated by both genetic risk and sex.
AMYLOID- RISK FACTOR FOR AGE-RELATED
MACULAR DEGENERATION
A.P.Bobrov, V.V.Ermilov, A.Smirnov, Forensic medicine
and Pathology, Volgograd State Medical University, Russia,
Volgograd, Russian Federation
Age-related macular degeneration (AMD) is the leading
cause of severe visual impairment in the elderly. The appear-
ance of amyloid- in eye tissues makes it possible to see in a
new light the problem of eye amyloidosis. Amyloidosis and
aging is fundamental biological problem. The appearance
428
of amyloid- in eye tissues is related with development of
some gerontoophtalmological diseases. Histological, immu-
nohistochemical, and electron microscopic studies of the 137
eyes with AMD revealed amyloid- in the drusen, Bruchs
membrane, and between the basal membrane of the retinal
pigment epithelium (RPE) and internal collagen layer of
Bruchs membrane. Comparative analysis of morphological
changes in tissues of the macular and paramacular areas and
the incidence of amyloid- incorporations in them permit
us to propose that accumulation of local senile amyloid-
is conductive to development and aggravation of AMD.
Ultrastructural studies of Bruchs membrane in the macu-
lar region have shown that amyloid- fibrills are localized
in inner collagenous zones of Bruchs membrane with frag-
ments of degrading RPE cells closely attached to them. By
reason not clear yet, a portion of the damaged photoreceptor
membrane material resists the enzymatic digestion. The fact
results in partial degradation, autophagy and accumulating
in the cytoplasm of RPE cells of some material except lipids
out of which amyliod- fibrils may be formed. The authors
put forward a hypothesis of the pathogenesis of AMD, in
which the principal role in the formation and deposition of
abnormal protein-amyloid-, is played by degenerative cells
of RPE.
REPEATED ELECTROMAGNETIC FIELD
STIMULATION LOWERS A PROTEIN LEVELS IN
HUMAN NEURONAL CULTURES
F.Perez1, J.P.Bandeira1, J.Bailey2, J.Morisaki3, D.Lahiri2,
N.Chopra2, 1. Depatment of Medicine, Division of General
Internal Medicine and Geriatrics, Indiana University School
of Medicine, Indianapolis, Indiana, 2. Department of
Psychiatry, Institute of Psychiatric Research, Neuroscience
Research Center, Indiana University School of Medicine,
Indianapolis, Indiana, 3. Department of Bioengineering,
University of Illinois at Chicago, Chicago, Illinois
Former studies in AD mouse model demonstrated that
Repeated Electromagnetic Field Stimulation (REMFS)
reversed cognitive impairment by decreasing A levels (1).
However, extrapolation of data that would allow safe utili-
zation in humans has been limited by the increased potential
risk of thermal injury. Previously, we determined that fre-
quencies of 50 to 70 MHz were more appropriate for human
exposure (2). The present work presents the effects of REFMS
on A levels in primary human fetal brain (HFB) cultures,
and determines the minimal energy to induce this biologi-
cal effects (MEBE) without secondary toxicity. The results
obtained suggest a new therapeutic strategy to decrease A
in humans.
Methods: Primary human fetal brain (HFB) cultures were
treated with REMFS at different frequencies, powers, spe-
cific absorption rates (SAR), and times. Exposures were per-
formed using a TEM cell chamber. Levels of A 140 and
142 levels were measured using ELISA.
Results: Compared to untreated cultures, exposure of
HFB cultures to REMFS resulted in a 58.35 percent reduc-
tion (P=0.001) in A140 levels when treated with a fre-
quency of 64 MHz at a SAR of 0.6W/Kg for 1 hour/day
during 21 days. Lower energy (SAR 0.4W/Kg) exposure at
64 and 100 MHz for 1 and 2 hours/day during 14days also
resulted in significant reduction of A levels. Further data
Innovation in Aging, 2017, Vol. 1, No. S1
demonstrated that REMFS exposure at 64 MHz with a SAR
of 0.4 and 0.9W/Kg at 4, 8 and 14days did not cause a sig-
nificant change in A Precursor Protein secretion, but rather
increased A degradation. Notably, all results were achieved
with no signs of cellular toxicity in treated cultures, as would
be suggested by differences in LDH levels, cell number, cell
morphology, cell attachment, or neurite extension.
Conclusion: This study confirms that REMFS reduces A
levels in human neurons. Our results suggest that REMFS at
64 MHz/SAR of 0.4W/Kg for one hour during 14days may
be the MEBE required to induce degradation of A peptides,
this effect likely occurring via up-regulation of the main con-
troller of proteostasis, Heat Shock Factor1(1). These findings
are encouraging, given the EMF frequency and power used
in our experiments make REMFS both suitable and safe for
human trials.
REFERENCES
1.Arendash, G.PLos One (2012)
2.Perez, F.Exp. Geront. (2008)
VITAMIN E BOOSTS NEUTROPHIL ELASTASE
ACTIVITY AND THEIR ABILITY TO KILL
STREPTOCOCCUS PNEUMONIAE
E.Bou Ghanem, J.N.Lee, S.Meydani, J.M.Leong,
A.Panda, Molecular Biology and Microbiology, Tufts
University, Boston, Massachusetts
Streptococcus pneumoniae (pneumococcus) remain a
leading cause of life-threatening infections such as pneumo-
nia, bacteremia and meningitis in the elderly. Neutrophils are
innate immune cells that are key determinants of disease fol-
lowing infection as their presence is initially required to con-
trol bacterial numbers, but their persistence in the lungs can
lead to tissue destruction and bacterial spread. We previously
found that vitamin E (VE) supplementation reverses the
age-associated increase in susceptibility to S.pneumoniae in
mice by modulating pulmonary recruitment of neutrophils.
The objective of this study was to test the effect of VE on
the ability of neutrophils isolated from young (2235years)
or elderly (6569 years) volunteers to migrate across lung
epithelial cell in response to S. pneumoniae and to kill
complement-opsonized bacteria in vitro. We found no dis-
tinguishable differences in neutrophil migration from young
and elderly donors and that VE diminished transepithelial
migration across all ages. Surprisingly, unlike previous stud-
ies showing defective killing of antibody opsonized bacteria
with aging, we found that when compared to young donors,
neutrophils of older donors were better at killing comple-
ment opsonized pneumococci ex vivo. This increased anti-
bacterial response in neutrophils from elderly individuals
correlated with elevated activity of the antimicrobial serine
protease neutrophil elastase. Exposure of neutrophils to VE
elevated enzymatic activity of neutrophil elastase in young
donors and increased pneumococcal killing by these cells.
These findings demonstrate that VE is an effective modulator
of innate immune cell function with potential to fight bacte-
rial pneumonia.
INFLUENZA-INDUCED MUSCLE DEGRADATION:
APATHWAY TO AGE-ASSOCIATED DISABILITY
J.Bartley, S.R.Keilich, G.Kuchel, L.Haynes, UConn
Health Center, Farmington, Connecticut
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Influenza (flu) is problematic for the elderly with
increased severity of infection and greater risk for hospi-
talization and death. Flu infection is limited to pulmonary
epithelial cells; yet myalgias are a common symptom and
elderly are at increased risk for disability post-flu. Recent
studies from our laboratory were the first to demonstrate
a molecular link for this interaction by characterizing the
impact of flu infection on muscle health. We demonstrated
declines in mobility and altered gait kinetics in both young
and aged mice during infection with more prolonged defi-
cits with aging. Gastrocnemius gene expression of inflamma-
tory cytokines (IL-6, IL-6R, TNF, CXCL10) was upregulated
with flu with more dramatic and prolonged alterations in the
aged mice. Similarly, genes involved in muscle degradation
and proteolysis (Atrogin1, MuRF-1, Ubiquitin B, Ubiquitin
C) were upregulated with infection and remained elevated
for longer in the aged mice. In contrast, positive regulators
of muscle mass and myogenesis (IGF-1, Pax7, MyoD) were
downregulated during infection and to a greater extent in
aged mice. This may indicate that flu infection is a previously
unrecognized contributor to sarcopenia and frailty in the
elderly. Recent studies just completed in our laboratory have
shown that vaccination with recombinant flu nucleoprotein
can partially protect mice from functional decrements and
muscle gene alterations. Thus, despite decreased vaccine effi-
cacy with aging, vaccination may be a potential strategy to
prevent flu-induced disability with aging. Mechanisms are
currently being investigated; however, these initial findings
provide preliminary highly translational advancements to
protect the aging population.
RISK FACTORS FOR OLFACTORY DYSFUNCTION IN
MIDDLE-AGED AND OLDER U.S. ADULTS
G.Bello1, G.Dumancas2, 1. Icahn School of Medicine at
Mount Sinai, New York, New York, 2. Louisiana State
University Alexandria, Alexandria, Louisiana
Olfaction is a key sensory mechanism in humans, play-
ing important roles in multiple facets of daily life. Deficits in
this chemosensory function have wide-ranging impacts on
overall health, wellbeing and quality of life. In the United
States, olfactory dysfunction is considered a significant pub-
lic health issue. More than 2 million Americans suffer from
smell disorders. Various risk factors for olfactory dysfunc-
tion have been identified, with age being the primary one.
Impairments in chemosensory perception (both smell and
taste) are a hallmark of aging, and begin to manifest around
middle age. This study examines the role of environmental,
biological and lifestyle factors as determinants of olfac-
tory dysfunction among middle aged and older adults in a
large, randomly selected national sample. We examine the
association of environmental exposures (pthalates, volatile
organic compounds, phenols, heavy metals and polycylic
aromatic hydrocarbons [PAHs]), measures of physiological
function and various lifestyle/behavioral characteristics on
olfactory function. Evaluation of olfactory function was car-
ried out using a short 8-item test, and was limited to basic
scent-identification tasks. Penalized ordinal regression mod-
els were used to test for associations between the explana-
tory variables and olfactory assessment scores, adjusting
for potentially confounding covariates. Our results identi-
fied metabolic parameters with significant association with
IAGG 2017 World Congress
429
olfactory deficits, suggesting their putative roles as risk fac-
tors for this condition. Further, increased urinary levels of
environmental phenols were found to be associated with
olfactory impairment.
INCREASED PLASMA PROLINE CONCENTRATION
IS ASSOCIATED WITH SARCOPENIA OF ELDERLY
PEOPLE
K.Toyoshima1, M.Nakamura1, T.Hakamada1, Y.Adachi2,
A.Imaizumi2, Y.Abe1, E.Kaneko1, K.Shimokado1, 1. Tokyo
Medical and Dental University, Tokyo, Japan, 2. Institute
for Innovation, Ajinomoto Co., Inc., Kawasaki, Japan
Background and purpose: Metabolome analyses have
shown that plasma amino acid profiles reflect various patho-
logical conditions, such as cancer and diabetes mellitus. It is
not known, however, whether the plasma amino acid pro-
file changes in patients with sarcopenia. This study aimed to
investigate whether sarcopenia-specific changes occur in the
plasma amino acid profile.
Methods: A total of 153 community-dwelling elderly
individuals and 7 institutionalized elderly individuals (male.
n=56; female, n=104 women; age, 77.77.0years old) were
recruited for this cross-sectional analysis. We performed a
comprehensive geriatric assessment, which included an eval-
uation of the subjects hand grip strength, gait speed, muscle
mass and blood chemistry, including the concentration of 18
amino acids.
Results: Twenty-eight of the 160 participants met the cri-
teria for sarcopenia established by the Asian Working Group
on Sarcopenia in Older People. Aunivariate analysis showed
that lower plasma concentrations of glutamine, histidine and
tryptophan, and a higher concentration of proline were asso-
ciated with sarcopenia. Amultivariable analysis revealed that
a higher concentration of proline was the only variable to be
independently associated with sarcopenia.
Conclusions: The plasma concentration of proline may
therefore be useful for understanding the underlying patho-
physiology of sarcopenia.
PARADOXICAL ADVERSE ASSOCIATION BETWEEN
HIGH VITAMIN D LEVEL AND MUSCLE STRENGTH
T.Auyeung, J.Lee, J.Leung, N.Tang, R.Yu, T.Kwok,
J.Woo, The Chinese Univerisity of Hong Kong, Hong Kong,
China
Introduction: High vitamin D level is believed to be
advantageous for muscle. However, much of the studies were
cross-sectional and its effect on cardiovascular outcomes
was opposite. We therefore examined the cross-sectional and
longitudinal association between vitamin D level and muscle
mass and strength.
Methods: 2815 community-dwelling older adults
65years of age had baseline 25(OH) vitamin D level meas-
ured by liquid chromatography and mass spectrometry.
In addition, baseline and 2-year muscle mass and strength
were measured by DXA and handgrip strength (dynamom-
eter) respectively. The baseline appendicular muscle mass
and strength and their changes in 2 years were compared
with respective to 3 vitamin D levels, namely <50, 5069.9
and 70nmol/L, adjusted for age and physical activity level
(PASE).
430
Results: At baseline, women with higher vitamin D level
had a stronger grip strength (p-for-trend=0.017), which
remained significant after adjustment for age and physical
activity (PASE). After 2 years, in women, a higher vitamin
D level was associated with a faster decline in handgrip
strength (p-for-trend<0.0001), which remained signifi-
cant after adjustment for age and physical activity (p-for-
trend<0.0001). No association was observed in men.
Conclusion: There exists a paradoxical adverse associa-
tion between vitamin D and muscle strength in women. High
vitamin D level is not always advantageous for health.
REGULATION OF LIPOLYTIC CONTROL BY
NEUROPEPTIDE Y PROMOTES SURVIVAL IN
CALORIE-RESTRICTED MICE
S.Park, T.Komatsu, S.Kim, H.Hayashi, R.Mori, rather than an irreversible process and transitions among dif-
I.Shimokawa, Nagasaki University, Nagasaki, Japan
Neuropeptide Y (NPY) is an orexigenic peptide that
plays an essential role in caloric restriction (CR)-mediated
lifespan extension. However, the mechanisms underlying
the NPY-mediated effects in CR are poorly defined. Here,
we report that NPY deficiency in mice during CR increases
mortality in association with lipodystrophy. NPY-/- mice
displayed a rapid decrease in body weight and fat mass as
well as increased lipolysis during CR. These alterations in fat
regulation were inhibited by the lipolysis inhibitor, acipimox
(ACM), a treatment associated with reduced mortality. The
lipolytic signaling pathway, 3-adrenergic receptor/hormone
sensitive lipase was markedly activated in white adipose tis-
sue of NPY-/- mice compared with that of NPY+/+ mice, and
NPY administration reduced thermogenesis in fasted NPY-
/- mice. These results demonstrate the critical role of NPY in
the regulation of lipid metabolic homeostasis and survival
via control of lipolysis and thermogenesis in a state of nega-
tive energy balance.
ROLES FOR FOXO1 AND FOXO3 IN REGULATION OF
CANCER AND LIFESPAN IN DIETARY-RESTRICTED
MICE
I.Shimokawa, T.Komatsu, Nagasaki University, Nagasaki,
Japan
Forkhead box O (Foxo) transcription factors may be
involved in the salutary effect of dietary restriction (DR). We
investigated roles for Foxo1 and Foxo3 in regulation of can-
cer and lifespan in mice. The preventive effect of DR on can-
cer was diminished in Foxo1-knockout heterozygotic (+/)
mice, although the life-extending effect of DR remained in
Foxo1 (+/) mice. By contrast, the life-extending effect of DR
was abrogated in Foxo3 (+/) mice; the incidence of cancer
was diminished by DR in Foxo3 (+/) mice. These findings
indicate differential roles for Foxo1 and Foxo3 in regula-
tion of cancer and lifespan in the DR condition. To eluci-
date a mechanism by which Foxo3 affects the life-extending
effect of DR, we analyzed a metabolome in liver tissues and
bioenergetics of mitochondria isolated from 24-month-old
mouse liver. The metabolome revealed that some metabolites
in the glycolysis/ gluconeogenesis were lower; and that the
ratio of lactate: pyruvates and the ratio of NADH: NAD+
were greater in Foxo3+/ DR mice, compared to WT DR
mice. The findings suggest a peudohypoxic condition in
Innovation in Aging, 2017, Vol. 1, No. S1
Foxo3+/ DR mouse tissues. The mitochondrial membrane
potential was greater in Foxo3+/ DR mice than in WT-DR
mice. These findings suggest that Foxo3 is required for meta-
bolic adaptation to DR, and that the impairment diminishes
the life-prolonging effect of DR.
THE ASSOCIATION OF FRAILTY WITH RECOVERY
FROM DISABILITY AMONG NEWLY DISABLED
OLDER ADULTS
C.Wu1, D.Kim2,3, D.Lee4,1, M.Odden1, 1. Oregon State
University, Corvallis, Oregon, 2. Beth Israel Deaconess
Medical Center, Boston, Massachusetts, 3. Institute for
Aging Research, Hebrew SeniorLife, Boston, Massachusetts,
4. Oregon Health and Science University, Portand, Oregon
Research has demonstrated that disability is a dynamic
ferent disability states are common. However, little is known
about factors that affect recovery from disability. We ana-
lyzed data from the Health and Retirement Study to test the
hypothesis that frailty, a physiologic state of decreased resil-
ience to stressors, was associated with lower recovery from
disability in the newly disabled adults (65years). Disability
was defined as having difficulty in any of the six activities of
daily living (ADLs; dressing, eating, toileting, bathing, trans-
ferring, walking across a room). Frailty was assessed using
five criteria measured two years before disability: weakness,
slowness, exhaustion, inactivity, and shrinking. We classified
individuals as robust (0 criteria; n=355), prefrail (12
criteria; n=650), and frail (35 criteria; n=161). Recovery
was defined as regaining independence in all ADLs within
two years of disability. Of the 1166 participants with inci-
dent disability, 43.9% of the robust, 35.7% of the prefrail,
and 16.8% of the frail recovered from disability. After adjust-
ing for socio-demographics, lifestyle, chronic conditions,
self-rated health, cognitive function, and severity of disabil-
ity, frail individuals were less likely to recover compared
with the robust (risk ratio [RR]=0.57, 95%CI: 0.390.83).
We found no difference between the robust and the prefrail
(adjusted RR=0.99). In summary, frailty is an independent
predictor of poor recovery of ADL disability among newly
disabled elders. These findings validate frailty as a marker
of decreased resilience, and may offer new opportunities
for individualized interventions and geriatric care based on
frailty assessment.
THE RELATIONSHIP AMONG TYPES OF DAILY
LIVING ASSISTANCE AND LONG HOURS OF
INFORMAL CARE
H.Ueshima1, N.Tamiya1, H.Noguchi3, F.Sandoval
Garrido3,1, H.Takahashi2, 1. University of Tsukuba,
Tsukuba, Ibaraki, Japan, 2. Fukushima Medical University,
Fukushima, Japan, 3. Waseda University, Tokyo, Japan
Long hours of informal care cause adverse events among
family caregivers. However, it is not certain what type of
daily living assistance prolong time of informal care. The
aim of this study is to determine the types of daily living
assistance related to extensive time of informal care. We used
the Comprehensive Survey of Living Conditions from 2007,
2010, 2013. It is a cross-sectional survey by the Ministry of
Health, Labor and Welfare, Japan. The subjects were care
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
recipients over 65years and their main family-caregiver, for
a total of 6094 dyads included. Among them, there were
1638 care recipients with stroke and 1245 care receivers
with dementia. We used ordered logistic regression analysis
stratified by stroke patients and dementia patients to exam-
ine the relationship between the hours of informal care (lend-
ing a hand when needed, 2 to 3 hours or around half a day,
and almost all day) and each daily living assistance adjusted
for the characteristics of caregivers and care recipients. Our
finding was that the daily living assistances associated with
extensive time of informal care were: wiping the body, chang-
ing position, and taking medicine in stroke patients, while
oral health, taking bath, and changing clothes in dementia
patients. Toileting and feeding in both kind of patients. In
conclusion, the types of assistance associated with long hours
of informal care were different between stroke patients and
dementia patients. It seems better to make separate plans to
support family caregivers of stroke patients and dementia
patients.
COGNITIVE DEFICITS IN CHRONIC STROKE
PATIENTS: NEUROPSYCHOLOGICAL ASSESSMENT
AND SELF-REPORTS
A.Nakling1,2, E.Wehling2,4, D.Aarsland1,3, H.Naess2,4, 1. der, race, education, marital status, and health-related vari-
SESAM, University Hospital of Stavanger, Bergen, Norway,
2. University of Bergen, Bergen, Norway, 3. Kings College,
London, United Kingdom, 4. Haukeland University
Hospital Bergen, Bergen, Norway
The aim of this study was to assess cognitive function-
ing 12 months after stroke, using screening instruments
and comprehensive neuropsychological assessment, and to
compare self-reported problems with neuropsychological
testing.
106 stroke patients (62 males, 44 females, 75 (71%) were
aged 60 and older) performed cognitive testing 12 months
following stroke. The self-reporting Stroke Impairment Scale
(SIS2), MMSE, HADS (Hospital Anxiety and Depression
Scale) were administered, as well as neuropsychological
tests of visual memory, executive function, verbal skills and
processing speed. Ascore of 1.5 SD below age-, gender- and
educational level adjusted scores was regarded as cognitive
impairment.
59 (56 %) of these stroke patients had cognitive impair-
ment in at least one domain, mostly visual memory and
executive function. The proportion of impairment was sig-
nificantly higher in those aged >60 years. 32 patients (36
%) reported no cognitive problems on the SIS2-scale. Of
these, 23 (72 %) showed cognitive impairment on neuropsy-
chological testing, 18 males, 5 females. 19 patients (21 %)
reported of cognitive problems on the SIS2, but showed no
cognitive impairment on neuropsychological testing, thus
over-reporting; 10 males, 9 females. Among these, only 3 (16
%) had depression, compared to 13 (17 %) of participants
over 60years. HADS scores were not correlated with cogni-
tive test scores.
Cognitive impairment 12 months after stroke is com-
mon, and is mainly affecting executive function, visuospatial
memory, and processing speed. More men than women self-
reported no problems, though having measurable cogni-
tive impairment.
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431
LONGITUDINAL EFFECTS OF SOCIAL NETWORK
DIVERSITY ON MORTALITY AND DISABILITY
AMONG ELDERLY
T.Ali1, C.Nilsson2, J.Weuve3, K.B.Rajan4, C.F.Mendes
de Leon1, 1. University of Michigan, Ann Arbor, Michigan,
2. University of Copenhagen, Copenhagen, Denmark,
3. Boston University, Boston, Massachusetts, 4. Rush
University, Chicago, Illinois
Having a larger social network has beneficial effects on
health and survival in adults, but few studies have evaluated
the role of network diversity, in addition to network size. We
aim to determine whether social network diversity is asso-
ciated with mortality, physical function, and disability in a
population of older black and white adults. We used data
from the Chicago Health and Aging Project, a longitudinal,
population-based study of adults aged 65 years and older.
We estimated hazard ratios (HRs) of mortality using Cox
proportional hazards models (N=6,595), mean difference (b)
in physical function using generalized estimating equations
(N=4,304), odds ratios (ORs) of disability onset using logis-
tic regression (N=5,318), and relative risk (RR) of disability
progression using Poisson regression (N=5,318), associated
with network diversity. Models were adjusted for age, gen-
ables. In adjusted models, elderly with more diverse social
networks had a lower risk of mortality (HR=0.76; 95%
CI = 0.620.92) and higher physical function at baseline
(b=0.85; p<.001) compared to elderly with less diverse net-
works. Increased diversity in social networks was also asso-
ciated with lower odds of disability onset (OR=0.58; 95%
CI=0.360.91) but not with progression of disability. Social
networks are particularly important for older adults as they
face the greatest threats to their health, and depend on their
network relationships, more than younger individuals, to
meet their needs. Increasing diversity, and not just increasing
size, of social networks may be essential for improving health
and survival among the elderly.
SEX DIFFERENCES IN THE CIRCUMSTANCES OF
FALLS AMONG OLDER ADULTS IN LONG-TERM
CARE
Y.Yang1,2,3, K.S.van Schooten3,2, J.Sims-Gould1,2,
H.A.McKay1,2, F.Feldman4,3,2, S.N.Robinovitch3,2, 1.
Family Practice, University of British Columbia, Vancouver,
British Columbia, Canada, 2. Centre for Hip Health and
Mobility, Vancouver, British Columbia, Canada, 3. Simon
Fraser University, Burnaby, British Columbia, Canada, 4.
Fraser Health Authority, Surrey, British Columbia, Canada
Introduction: Falls are a major health concern for both
older men and women. However, few studies have examined
sex differences in the circumstances of falls. We analyzed
real-life falls captured on video to compare scenarios lead-
ing to falls between men and women in two long-term care
(LTC) facilities.
Methods: Between 2008 and 2016, we video-captured
1738 falls experienced by 231 men and 298 women (mean
age=839 years). We focused our analysis on the biome-
chanical causes of imbalance and the activities at time of fall-
ing, and compared these to sex and health status.
Results: Men were more likely than women to fall from
loss of support with an external object (odds ratio 1.37; 95%
432
CI 1.081.73) and less likely to fall from tripping (0.72;
0.540.96). Men were more likely to fall while seated (1.42;
1.071.87) or while rising from sitting (1.49; 1.111.99),
and less likely to fall while walking (0.61; 0.500.75). Falls
in men were more likely to involve wheelchairs (1.50; 1.16
1.93), and less likely to involve walkers (0.57; 0.430.76).
Falls from loss of support were more common among indi-
viduals who were less independent in performing activities of
daily living (ADL), who used multiple medications, and who
used mobility aids. Individuals with independent ADL and
intact cognition were more likely to fall while walking, but
less likely to fall while seated or while rising.
Conclusion: Our results elucidate differences between
older men and women in the scenarios that lead to falls, to
inform strategies to prevent falls in the LTC setting.
OPTIMIZING MEDICATION USE AMONG OLDER
PEOPLE RESIDING IN AGED CARE FACILITIES
K.Thiruchelvam1, S.Hasan1, P.Wong1, T.Kairuz2, 1.
International Medical University, Kuala Lumpur, Wilayah
Persekutuan Kuala Lumpur, Malaysia, 2. The University of
Newcastle, Newcastle, New South Wales, Australia
Medication reviews are essential in the optimization of
pharmacotherapy among the older population. This study
developed a comprehensive approach to medication man-
agement among older people in aged care facilities. The
framework is centered on medication appropriateness and
comprises a five-step medication review algorithm that is
supplemented with a 10-component tool, the Medication
Appropriateness Index-Geriatric version (MAI-G). This ver-
sion incorporates geriatric components and detects changes
in medication use. The MAI-G supplements the algorithm
and quantifies the appropriateness of medications, determin-
ing improvements and permitting measurable outcomes. The
components in the MAI-G closely correspond to compo-
nents in the algorithm to allow for quick and unequivocal
extrapolation. The algorithm and MAI-G were implemented
in a 6-month prospective study among 202 residents aged
60years and above across 17 aged care facilities in Malaysia.
The proportion of residents with inappropriate medications
detected by the MAI-G were 55.0% at baseline, 50.5% at
3-months and 46.5% at 6-months. The number of inappro-
priate medications detected by the MAI-G also decreased
from 0.830.93 at baseline, to 0.760.92 at 6-months. The cognitive function and brain structure is limited. This study
MAI-G average scores decreased from 1.191.03, at base-
line, to 1.160.98, at 6-months (MAI-G scores range from
021). This study supports the need for a comprehensive
medication review process that is supplemented by quan-
tification of medication appropriateness which identifies
changes in medication use. This study also provides an over-
view of the medication appropriateness among older people
residing in aged care facilities in Malaysia.
ASSESSING THE MEALTIME ENVIRONMENT IN
CANADIAN LONG-TERM CARE HOMES USING THE
MEALTIME SCAN
S.Iuglio1, H.H.Keller1,2, H.Chaudhury3, J.M.Morrison1,
S.E.Slaughter4, C.Lengyel5, N.Carrier6, V.Boscart7,2, 1.
Kinesiology, University of Waterloo, Schomberg, Ontario,
Canada, 2. Research Institute for Aging, Waterloo, Ontario,
Canada, 3. Simon Fraser University, Burnaby, British
Innovation in Aging, 2017, Vol. 1, No. S1
Columbia, Canada, 4. University of Alberta, Edmonton,
Alberta, Canada, 5. University of Manitoba, Winnipeg,
Manitoba, Canada, 6. University of Moncton, Moncton,
New Brunswick, Canada, 7. Conestoga College, Waterloo,
Ontario, Canada
The mealtime environment in long term care (LTC) may
influence food intake of residents, and could improve food
intake. Making the Most of Mealtimes (M3) is a cross-
sectional, multi-site study with data collected from 82 din-
ing rooms in 32 LTC homes in 4 Canadian provinces. The
Mealtime Scan (MTS) was developed to quantify the overall
dining atmosphere and includes items that assess the physi-
cal and social environments and person-centred care prac-
tices. MTS was completed 46 times in each dining room
and average values used for analysis. Protein and energy
intake of residents (n=639) was collected with non-consec-
utive weighed 3-day records. Units were stratified based on
whether or not they specialised in dementia care. Regression
analyses were used to identify MTS items adjusted for age,
gender and cognitive status that predicted individual energy
and protein intake (p<0.05).
In dementia care units, number of residents eating alone
was positively associated with energy intake; while meal
length, number of residents eating alone, and person-directed
care practices were negatively associated with protein intake
in designated dementia units. In general units, none of the
mealtime environment characteristics, as measured by the
MTS, were associated with energy intake; protein intake was
positively associated with number of persons in the dining
room and negatively associated with person-directed care
practices towards residents that required eating assistance.
This analysis suggests that environmental features of desig-
nated dementia and general units differ in their association
with residents food intake. Strategies to support food intake
should be tailored to the target population.
ASSOCIATION OF PSYCHOSOCIAL WORK
STRESS WITH COGNITIVE DECLINE AND BRAIN
STRUCTURE DIFFERENCES
K.Pan, W.Xu, G.Kalpouzos, L.Bckman, F.Mangialasche,
L.Fratiglioni, H.Wang, NVS, Karolinska Institutet, Solna,
Sweden
Evidence on the influence of psychosocial work stress on
examined whether work-related stress is associated with
structural brain changes and cognitive decline in old age. In a
population-based prospective cohort study, 2876 dementia-
free participants aged 60 years were followed-up for up
to 9years. Asubsample (n=436) underwent brain magnetic
resonance imaging (MRI) at baseline. Global cognitive func-
tion was measured by the Mini-Mental State Examination
at baseline and all follow-ups. Levels of job control and
demands in the longest held job over the whole working life
were assessed by a validated matrix. Data were analyzed
using mixed-effects linear regression. People with low lev-
els of job control and demands exhibited greater cognitive
decline (: -0.13, 95% CI: -0.19 to -0.07; : -0.10, 95% CI:
-0.16 to -0.04), compared to those with high levels. Relative
to persons who had active job strain, faster cognitive decline
was found in those who had high job strain (: -0.11, 95%
CI: -0.18 to -0.05,) and passive job strain (: -0.16, 95%
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
CI: -0.23 to -0.09). MRI data showed that low levels of job
demands and passive job strain were both related to smaller
total hippocampal volume (: -0.23, 95% CI: -0.39 to -0.08;
: -0.19, 95% CI: -0.37 to -0.01). Work-related psychosocial
stress is associated with smaller hippocampal volume and
may accelerate cognitive decline even in the eight decade of
life, suggesting that neural alterations play a role in the work
stress-cognitive decline link.
NEIGHBORING GREEN SPACE AND TRANSITIONS
BETWEEN FRAILTY STATES AMONG CHINESE
ELDERLY IN HONG KONG
D.WANG1,2, K.Lau4,5, R.Yu3, S.Wong2, T.Kwok3, presented moderate to low risk of bias. Five studies had a
J.Woo1,3, 1. CUHK Jockey Club Institute of Ageing, The
Chinese University of Hong Kong, Shatin, Hong Kong,
2. Jockey Club School of Public Health and Primary
Care, Shatin, Hong Kong, 3. Department of Medicine &
Therapeutics, The Chinese University of Hong Kong, Shatin,
Hong Kong, 4. Institute of Future Cities, The Chinese
University of Hong Kong, Shatin, Hong Kong, 5. Institute
of Environment, Energy and Sustainability, The Chinese
University of Hong Kong, Shatin, Hong Kong
Frailty is a clinically recognizable and prevalent geriatric
syndrome predicting adverse health outcomes for the elderly.
Green space has been identified as a health-benefiting factor
via multiple pathways. We explored the effects of green space
on transitions in frailty states.
Three frailty phenotypes (robust, pre-frail, frail) for 3,355
community-based Chinese elderly (65years) were identified
at baseline (20012003) and at subsequent two-year follow-
up (20032005), adopting the 5-item Fried Criteria (weight
loss, exhaustion, low physical activity, muscle weakness, and
slow walking speed). Two-year transitions in frailty states
were determined as improved, stable, or deteriorated. With
the Normalized Difference Vegetation Index assigned to pix-
els (1515m) within 600m buffered around each validated
address, the percentage of green space was calculated as a
continuous independent variable. Ordinal logistic regres-
sion models were used to estimate the effects of green space
on transitions in frailty states, controlling for demograph-
ics, lifestyle, housing type, proximity to major roads, living
height, and PM2.5 concentration.
During the two-year period, frailty status was identified as
improved for 273 (8.1%) and deteriorated for 856 (25.5%)
subjects. Mean coverage of green space within 600m buffer was
26.8%, with every 10% increase in green space, there was a
significant decrease in the odds of deteriorated frailty state (OR
0.95, 95%CI 0.910.99; p-value=0.038), regardless of demo-
graphics, lifestyle, and other environmental characteristics.
Increasing coverage of neighboring green space could be
an applicable approach in developing age-friendly environ-
ment in high density urbanized cities, therefore protecting
the elderly from becoming frail and improving their individ-
ual independence and wellness.
THE BERG BALANCE SCALE AS ASCREENING
TEST TO PREDICT FALLS IN OLDER ADULTS:
ASYSTEMATIC REVIEW
C.A.Lima, M.Perracini, E.Nogueira, N.Ricci,
Universidade Cidade de So Paulo, So Paulo, Brazil
Although the Berg Balance Scale (BBS) is widely used in
daily practice, there is no consensus about its value to predict
IAGG 2017 World Congress
433
falls. This systematic review aims to verify the BBS ability to
predict fall risk in older adults through the analysis of pro-
spective studies. Manual and electronic searches (Medline,
EMBASE, CINAHL, Ageline, Lilacs, Web of Science,
Cochrane and PEDro) were conducted without language
restriction and with publication date after 1989 (BBS devel-
opment year). We included prognostic studies with older
people sample that evaluated the BBS (predictive factor) and
the fall event in the last 6 or 12months (outcome measure-
ment). The studies methodological quality was assessed using
the Quality In Prognosis Studies tool. We found 509 stud-
ies. This review included 8 studies from ten articles and they
6months follow-up period and 3 had a 12months. The BBS
average score for non-fallers was 49.4 and 52.5 points; and
for fallers 44.5 and 51 points in 6 and 12 months, respec-
tively. The BBS cut-off ranged from 45 to 51 points. Only in
three studies the BBS score was able to discriminate fallers
and non-fallers. It was not possible to define a BBS cut-off
score due to studies lack of homogeneity, adequate sample
size and absence of subgroup analysis. Evidence is insuffi-
cient to determine an adequate BBS cut-off score to predict
falls in older adults. Ultimately, BBS should not be used as a
prediction tool for falls in clinical practice.
PREVENTION OF ADVERSE DRUG REACTIONS
IN HOSPITALIZED OLDER PATIENTS: PHYSICIAN
VERSUS PHARMACIST
K.Dalton1, D.OSullivan1, M.N.OConnor1, S.Byrne1,
D.OMahony1,2, 1. University College Cork, Cork, Ireland,
2. Cork University Hospital, Cork, Ireland
Potentially inappropriate prescribing (PIP) in the multi-
morbid elderly is a major healthcare problem. Explicit cri-
teria such as Screening Tool of Older Persons Prescriptions
(STOPP) and Screening Tool to Alert to Right Treatment
(START) are well recognized for identifying PIP instances,
and the application of STOPP/START criteria has been
shown to reduce adverse drug reactions (ADRs) in older
people. Two randomized controlled trials were conducted
in the same hospital whereby a pharmacist and physician
individually applied the STOPP/START criteria to older
patients medication lists at hospital admission and made
recommendations to the attending teams. All of the physi-
cians recommendations were delivered in both oral and
written forms. All of the pharmacists recommendations were
delivered in written form, and approximately one third com-
municated orally. Attending teams accepted 37.8% of the
pharmacists STOPP/START recommendations compared to
83.4% of the physicians STOPP/START recommendations.
Whilst the physicians intervention focused solely on STOPP/
START recommendations, the pharmacists intervention was
multifaceted - other than the pharmacists STOPP/START
recommendations, the remainder addressed medicines rec-
onciliation, renal dose adjustment, and other prescribing
criteria issues. With the same control cohort (n=372), the
physicians intervention resulted in a significantly greater
absolute risk reduction in ADRs than the pharmacists (9.3%
vs 6.8%) in comparable intervention cohorts (360 patients
vs 361 patients). The greater acceptance rate for the physi-
cians recommendations was attributed to having a narrower
intervention focus, communicating the recommendations
434
in both oral and written form, and the physician having an
already recognized prescribing role within the hospital.
SEASONAL CHANGES IN BLOOD PRESSURE AND
SERUM ELECTROLYTES FOR OLDER PATIENTS
WITH HOME MEDICAL CARE
E.Koujiya1, M.Kabayama1, K.Sakanoue1, Y.Huang1, is OA in Japanese home cancer care. For OA and CA, visit-
M.Akiyama1, M.Yamamoto1, H.Rakugi2, K.Kamide1, ing nurses had more desirable responses and actively handled
1. Osaka University Graduate School of Medicine, Suita,
Osaka, Japan, 2. Department of Geriatric Medicine
and Nephrology, Osaka University Graduate School of
Medicine, Suita, Osaka, Japan
We investigated seasonal variations of blood pressure (BP)
and serum electrolytes in order to obtain suggestions about
future effective treatments or nursing care in old patients
with home medical care. Study subjects were 78 patients age
65years or older receiving home medical care participating in
Osaka home medical care registry (OHCARE), a prospective
cohort study. Two seasons data were collected in summer(1st
June-31th August) and winter(1st December-28th February).
The mean age of the subjects was 84.4(8.6) and male was
37%. About 60% subjects in present study were very frailty
or bedridden. Mean Systolic BP (SBP) and diastolic BP (DBP)
was higher in winter than in summer (122.417/65.410 cognition in older adults with excellent memory capacity
vs. 124.520/68.410mmHg) and there was statistically (a.k.a., Supernormals), and revealed that a unique brain map
significant difference in DBP (p=0.007). Especially, high
SBP group(SBP130mmHg) had greater changes both in
SBP and DBP than low SBP group(SBP130mmHg). About
changes of serum electrolytes, sodium level was lower and
potassium level was higher in summer than in winter. Patients
who showed changed potassium level were Older and had
Lower renal function than patients with unchanged potas-
sium level. The present study revealed the seasonal changes
in BP and serum electrolytes in old patients receiving home
medical care. Doctors and visiting nurses should pay atten-
tion for these variabilities in patients with home medical
cares.
ASSOCIATION OF VISITING NURSES RESPONSE
WITH CANCER PATIENTS GOOD DEATH BY
AWARENESS OF DYING TYPE
M.Akiyama1,2, M.Kabayama1, K.Kuyama2, K.Kamide1, left middle temporal gyrus, right middle frontal gyrus, right
1. Osaka University Graduate School of Medicine, Suita,
Osaka, Japan, 2. School of Nursing, Mukogawa Womens
University, Nishinomiya, Hyogo, Japan
The Awareness of Dying (AOD) theory has been investi-
gated worldwide; however, there are few studies investigate
the association of good death (GD) with visiting nurses
response (VNR) based on the types of AOD. AOD is com-
posed of closed-awareness (CA), suspected-awareness (SA),
mutual-pretense-awareness (MPA), and open-awareness
(OA). The aim of this study was to determine the association
of VNR with GD in four types of AOD for end-stage home
cancer patients.
We sent self-administered questionnaire to visiting nurses
in order to assess their response with end-stage cancer
patients and statistically analyzed with one-way ANOVA
and t-test.
Participants average age (N=386) was 46.87.6 years. of Science, Tokyo, Japan
The proportions of AOD type were OA (67.1%), CA
(10.6%), SA (8.8%), and MPA (7.3%).
Innovation in Aging, 2017, Vol. 1, No. S1
The GD score of OA was higher than SA (p=.01) and the
CA was higher than the SA (p=.01). In dealing with informa-
tion related to patients death, the VNR score was higher for
OA than for SA (p=.01). The higher VNR score was signifi-
cantly associated with the higher GD scores.
The study findings suggest that the most frequent AOD
information on death compared to SA. When visiting nurses
regard the patients death as good, they took more desirable
responses. This suggests that VNR may be involved in the
association between AOD and GD. This is the first report on
the association between AOD, VNR, and GD in end-stage
cancer patients with home care.
SUPERNORMALS OVER-TIME BRAIN MAP LINKS
TO ALZHEIMERS PATHOLOGY: AMULTIVARIATE
PATTERN ANALYSIS
X.Wang2, T.Baran1, P.Ren1, R.D.Raizada2, F.V.Lin1, 1.
University of Rochester Medical Center, Rochester, New
York, 2. University of Rochester, Rochester, New York
We recently investigated a cross-sectional relationship
between the function of a selected set of brain regions and
covering anterior and posterior regions in Supernormals
protected their cognition from Alzheimers disease (AD)
pathology (Lin et al., 2017, Cortex). In the present study,
we continued the validation of the longitudinal relationship
between the brain map and cognition and AD pathology
in Supernormals. We hypothesized that an over-time stable
brain map involving anterior and posterior regions would
differentiate Supernormals from their cognitively normal or
abnormal counterparts, and such a brain map would link
to AD pathology. Here, we identified 22 Supernormals, 25
with normal cognition (NC), 70 with amnestic mild cogni-
tive impairment (MCI) and 28 with AD. Multivariate pat-
tern based searchlight analysis of resting-state functional
MRI data was applied to identify brain regions with con-
stantly high discriminative powers between Supernormals
and NC over 2years. The regions included right cerebellum,
precuneus, right precentral gyrus. The brain map composed
by these regions predicted multiple cognitive assessments
and their longitudinal changes with 51% to 82% accuracy,
discriminated NC, MCI and AD at 62% to 78%, and pre-
dicted beta-amyloid/pTau at 71%. Our findings suggest that
applying searchlight analysis with longitudinal resting-state
imaging data from Supernormals construct a brain map that
sheds lights on understanding Alzheimers disease associated
neurodegeneration.
EFFECTS OF REALLOCATING TIME IN SEDENTARY
BEHAVIOR WITH PHYSICAL ACTIVITIES ON SLEEP
IN ELDERLY
J.Seol1, Y.Fujii1, T.Abe1,2, K.Joho1, T.Okura1, 1.
Comprehensive Human Sciences, University of Tsukuba,
Tsukuba, Ibaraki, Japan, 2. Japan Society for the promotion
Previous studies showed that sedentary behavior (SB) and
physical activity (PA) are linked to sleep. Recent research
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Innovation in Aging, 2017, Vol. 1, No. S1
suggested that an isotemporal substitution (IS) model ena-
bles an estimate of the effect of displacing one activity by an
equivalent amount of time in another activity. However, it
is unclear how the reallocation of time from one activity to
another affects sleep outcomes.
This study aimed to examine the effects of reallocating
time to SB and various intensities of PA on objective sleep
parameters in older adults. The participants were seventy-six
community-dwelling older Japanese adults (70.94.5 yrs).
We measured SB, intensity of PA (light-intensity PA (LPA),
moderate-to-vigorous PA (MVPA)), and objective sleep
parameters using ActiGraph accelerometry for a week. In this
study, SB, LPA, and MVPA were 316.2175.3, 517.978.7, services has been associated with increased deaths in hospi-
and 23.312.0min, respectively. After adjusting confound-
ing factors, the IS models showed that replacing one hour of
SB with LPA was favorably associated with sleep efficiency
(=1.155; 95% confidence interval (CI), 0.234, 2.075) and
wake after sleep onset (=-0.114; 95% CI, -0.187, -0.040).
Replacing one hour of MVPA with LPA was favorably asso-
ciated with sleep efficiency ( = -7.405; 95% CI, -13.417,
-1.394) and wake after sleep onset ( = 0.488; 95% CI,
0.006, 0.970).
Substituting time spent in SB and MVPA with LPA may
be beneficial to sleep in older people.
PHYSICAL RESTRAINT REDUCTION IN LONG-TERM
CARE: IMPLEMENTATION OF AGUIDELINE-BASED
PROGRAM
A.Rahn1, A.Buhl2, A.Behncke3, S.Koepke3, 1. Unversity
of Hamburg, Unit of Health Sciences and Education,
Hamburg, Hamburg, Germany, 2. Workers Welfare
Association, Kiel, Schleswig-Holstein, Germany, 3.
University of Lbeck, Institute of Social Medicine and
Epidemiology, Nursing Research Unit, Lbeck, Schleswig-
Hostein, Germany
Despite evidence on unintended consequences, physical
restraints continue to be part of standard care. We imple-
mented a successfully tested guideline-based multicompo-
nent program on physical restraints reduction into routine
long-term care.
We performed a before-after study in home care services
and nursing homes of one health care provider in northern
Germany. The intervention, originally developed for nursing
homes, was adapted for use in home care.
Four one-day nurse training courses were conducted.
Participating facilities received the evidence-based guideline,
associated materials and structured telephone counselling.
Prior to the first training and after one year, the percentage
of care recipients with at least one physical restraint was
assessed by direct observation.
Nine home care facilities and 15 nursing homes with
1,490 care recipients took part in the study and 34 nurses
were trained. In nursing homes, the number of residents with
physical restraints was reduced from 11.1% to 5.7% (reduc-
tion 5.4%, 95%CI: 2.18.6, p=0.001).
In home care, the number was reduced from 6.1% to
3.8% (reduction 2.3%, 95%CI: 0.44.3, p=0.021).
In conclusion, the guideline-based program was success-
fully adapted and implemented for the needs of home care
services and nursing homes of one large care provider in
Germany. However, not all services could be equally reached
IAGG 2017 World Congress
435
by the intervention. Regular training and updates are neces-
sary for permanent implementation.
BRIDGING BARRIERS: CHINESE AMERICAN
SENIORS END-OF-LIFE DECISION-MAKING
T.Dzou, A.A.Guzman, S.Balcha, J.C.Mentes, H.Pieters,
University of California, Los Angeles, Los Angeles,
California
In the United States (US), the underutilization of hospice
resources by Asian Americans is evident in the low rates of
hospice enrollment, 2.4%, where they comprise 5.6% of
the US population. The low utilization of end-of-life (EOL)
tals and increased costs to Medicare, revealing a significant
health disparity within the Asian American community.
Chinese Americans represent the largest subgroup of
Asian Americans with a population of 4.5 million in the
US. Seminal studies on Chinese American Seniors EOL have
accentuated the taboo nature of the topic, and recommended
health care professionals to prevaricate EOL discussions to
promote cultural sensitivity. In contrast, recent findings in
literature suggests Chinese American Seniors lack of knowl-
edge as a main contributor to the underutilization of EOL
resources. A pilot study using semi-structured interviews
was conducted to understand the preferences and EOL deci-
sion-making processes of Chinese American Seniors. Using
Constructivist Grounded Theory methodology, data from
the interviews was analyzed in an iterative process to reveal
the emergent themes of trust / distrust towards health care
professionals and health care systems, the role of religion
in decision-making, and protecting the family. Synthesis of
the findings reveal the role of health care professionals in
bridging barriers to EOL decision-making among Chinese
American Seniors.
A QUALITATIVE SYSTEMATIC REVIEW EXPLORING
ROLES, RISKS, AND SOCIAL PATTERNS OF
DRINKING IN LATER LIFE
B.K.Bareham, E.Kaner, L.P.Spencer, B.Hanratty, Institute
of Health and Society, Newcastle University, Newcastle
upon Tyne, United Kingdom
Older adults may be at risk from even moderate levels of
drinking, due to conditions and medications that are prob-
lematic when combined with alcohol. Current cohorts of
older adults may have consumed alcohol regularly through
most of their adult life. This represents additional risk of
chronic disease linked to their drinking. Alcohol policy
and practice has therefore turned to focus on this older
group. However, in combatting alcohol use amongst older
adults, we must first consider the roles of alcohol in their
lives. This recently completed systematic review synthesises
qualitative research evidence on older adults perceptions of
non-dependent drinking in later life. Medline, PsychINFO,
Scopus, ASSIA and CINAHL databases were systematically
searched for relevant articles. The principles of thematic
analysis were applied to synthesise findings. Twenty-four
studies were identified from ten different countries, includ-
ing the USA, Canada and the UK. Four key themes were: i)
Routines and Rituals, ii) Self-image as a Responsible Drinker,
iii) Alcohol and the Ageing Body, iv) Access to Alcohol.
Differences in roles and patterns of drinking between genders
436
and age groups, across cultures and socioeconomic status,
are explored. Drinking creates social and leisure opportuni-
ties, which may have depleted due to retirement and other
factors in later life. Health concerns and issues surrounding
purchasing alcohol or getting to drinking settings are impor-
tant considerations for older drinkers. These roles and prac-
ticalities are contrasted against those identified for younger
age groups in other qualitative studies. Recommendations
for alcohol-related policy and practice are presented given
these findings.
COMBINED LOW MUSCLE MASS AND STRENGTH
AFFECT MOBILITY LIMITATION IN THE ELDERLY:
A4-YEAR FOLLOW-UP
M.Kim1, T.Abe1, T.Jindo2, S.Shen1, A.Sato1, K.Fujii1,
T.Okura1, 1. University of Tsukuba, Tsukuba, Ibaraki,
Japan, 2. Physical Fitness Research Institute, Meiji Yasuda
Life Foundation of Health and Welfare, Tokyo, Tokyo,
Japan
The study aimed to investigate which combined muscle
mass and strength among four different combinations might
be a risk factor for mobility limitation and falls in older adults.
A total of 284 older adults participated in this study from
baseline until the 4-year follow-up. We assessed the appen-
dicular skeletal muscle mass index (AMI) using bioelectric
impedance analysis. Additionally, the appendicular strength
Z-score (ASZ) based on the hand-grip strength for the upper
extremity and peak reaction force during sit-to-stand move-
ment for the lower extremity were measured at baseline. The
participants were classified into 4-group according to their
AMI and ASZ score: Low AMI and Low ASZ; Low AMI;
Low ASZ; and Normal. Mobility limitation and falls were
assessed by a self-reported questionnaire at baseline and dur-
ing follow-up. We used a Cox regression analysis with an
adjustment for sex, age, body mass index, knee pain, and
back pain. Among participants with no mobility limitation
at baseline, the hazard ratio of any new mobility limitation
was 5.54 (95% CI 2.2413.69) in Low AMI and Low ASZ
compared with Normal. As for participants with no falls at
baseline, the hazard ratio of any new incident falls was 4.01
(95% CI 1.838.82) in Low AMI and Low ASZ, 2.05 (95%
CI 1.113.77) in Low ASZ compared with Normal. These
results suggest that the type of combined low muscle mass
and low strength is an important risk factor for mobility
limitation and falls. Moreover, low strength alone may inde-
pendently predict incident falls in older adults.
ASSESSMENT OF HEALTH-PROMOTING
BEHAVIORS BEFORE AND AFTER AN ALZHEIMERS
PREVENTION PROGRAM
A.Laffer1, R.Sandoval2, E.Blocker2, E.Vidoni2, A.Watts1,
J.Burns2, D.K.Sullivan2, 1. University of Kansas, Lawrence,
Kansas, 2. University of Kansas Medical Center, Fairway,
Kansas
With the rapidly aging population and associated
increased risk of Alzheimers disease (AD), interventions
aimed at preventing AD are crucial. We investigated whether
older adults would benefit from empirically supported psy-
choeducation targeting strategies to prevent or delay AD.
Twenty-seven older adults (Mean age (SD)=81.93(5.68)),
Innovation in Aging, 2017, Vol. 1, No. S1
completed a six-month group psychoeducation program
created by the University of Kansas Alzheimers Disease
Center. Twelve sessions occurred twice monthly in a local
retirement community, led by an interprofessional team
with expertise in AD prevention. Sessions focused on modi-
fiable risk factors for AD (i.e., physical activity, nutrition,
sleep, stress). We used paired t-tests to measure changes in
Health Promoting Lifestyle Profile subscale scores (nutri-
tion, physical activity, spiritual growth, and stress manage-
ment) from pre-intervention to post-intervention. There
was statistically significant improvement in stress manage-
ment (p = .004). There were no differences on nutrition
or physical activity subscales. There was a trend toward
significance for spiritual growth (p=.059), though our
study was underpowered due to small sample size. Average
physical activity scores were lowest across the subscales.
Our group-based psychoeducation program targeting pro-
motion of healthy lifestyle behaviors resulted in improved
self-reported stress management. This is an important out-
come for an older adult population seeking to be proac-
tive about their brain health. Future research will explore
how this stress reduction may occur (e.g., reduced helpless-
ness, internal locus of control). The average lower scores
on physical activity compared with other subscale scores
suggest that strategies aimed at increasing physical activity
show the greatest room for improvement.
A MEDIATIONAL MODEL OF STRESS IN
HIPPOCAMPAL NETWORKS IN MILD COGNITIVE
IMPAIRMENT
K.McDermott, F.V.Lin, P.Ren, School of Nursing,
University of Rochester, Rochester, New York
The hippocampus regulates learning and memory for-
mation and storage, while also playing a significant role in
regulating the Hypothalamic-Pituitary-Adrenal axis and
stress responses. AD-associated neurodegeneration is known
to affect all of these aspects. However, its still unclear how
different types of stress (chronic vs. acute) mediate the hip-
pocampal regulation of learning and memory, especially in
AD associated neurodegeneration. The present study com-
bined neuropsychological testing, resting state functional
MRI, structural MRI, acute stress tests, and self-report
chronic stress questionnaires to compare MCI subjects
(n=18) to their age-, sex-, and education-matched healthy
controls (HC, n = 21). The MCI group had significantly
smaller right hippocampal grey matter volumes (t = 2.50,
df = 30, p = .018) than the HC group. The connectivity
between the right hippocampus and the inferior frontal gyrus
(Rhipp-IFG) was significantly positively related to both acute
and chronic stress for the entire sample. After testing our
mediation model for the two groups separately, we found
that acute and chronic stress showed significant mediating
effects in the association between Rhipp-IFG and learning
(before adding mediators: t=-2.56, p=.022; when includ-
ing mediators: t=0.21, p=.84) in the HC group, but not in
the MCI group. This suggests that chronic and acute stress
act as mediators for the right hippocampus-involved neural
network for learning and memory, and this mediating effect
may be disrupted in the AD-associated neurodegeneration
process.
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Innovation in Aging, 2017, Vol. 1, No. S1
COGNITIVE STATUS, CO-MORBID CONDITIONS,
AND UNPLANNED READMISSIONS IN OLDER
SURGICAL PATIENTS
M.Gehring1, E.A.Burns1, G.Telford1, J.Whittle1,
L.Copeland3, M.Morris4, M.Hawn2, 1. Medical College
of Wisconsin, Milwaukee, Wisconsin, 2. Stanford University
School of Medicine, Stanford, California, 3. VA Central
Western Massachusetts Healthcare System, Leeds,
Massachusetts, 4. University of Alabama at Birmingham
School of Medicine, Birmingham, Alabama
Unplanned hospital readmissions are associated with
poor patient outcomes and incur increased resource uti-
lization and costs. Cognitive impairment, greater bur-
den of comorbidity, and increased age are associated with
unplanned hospital readmissions of medicine patients, but
are not well-studied among surgical patients. To-date a
cohort of 331 patients undergoing elective gastrointestinal,
thoracic or vascular surgery, have been enrolled in a prospec-
tive longitudinal study at three VA Medical Centers. Patients
were interviewed on day of discharge, and administered the
Short Blessed Test to screen for cognitive dysfunction. Length
of stay and 30-day readmissions were determined via chart
review, and a Charlson Comorbidity Index (CCI) score cal-
culated for 62 patients. 146 underwent abdominal/colorec-
tal or hernia repair, 123 vascular, 62 thoracic procedures.
Mean age was 65.8 + 9.9 years, and length of stay (LOS)
6.3 + 4.4days; neither was significantly different by surgery
(F=3.20, p=0.15). Age was positively associated with CCI
(i.e. higher risk of mortality; r= -0.68, p<.0001), with worse
SBT and LOS (z=15.77, p<.0001). There were 52 unplanned
readmissions (15.7%), with readmitted patients being older
(66.4 vs. 65.6 years, p<.0001), having worse scores on the
SBT (F=6.16, p <.003), and higher CCI (F=4.27, p<.02) after
controlling for type of surgery. In older adults, greater co-
morbid burden and cognitive impairment may confer a risk
for unplanned surgical readmission similar to that seen for
medical readmissions.
VALIDATION OF ASCREENING TOOL (GERIATRIC-
CHECK) FOR GERIATRIC PATIENTS
M.A.Hobert1,2, F.P.Bernhard2, J.Sartor2, K.Bettecken2,
W.Maetzler2,1, M.Jamour3, 1. Department of Neurology,
Christian-Albrechts-University of Kiel, Kiel, Germany, 2.
Center for Neurology and Hertie Institute for Clinical Brain
Research, Department of Neurodegeneration, University of
Tuebingen, Tuebingen, Germany, 3. Geriatric Rehabilitation
Clinic of Ehingen (Krankenhaus GmbH Alb-Donau dis-
trict), Ehingen, Germany
Introduction: The Geriatrie-Check is a short screening tool
to identify geriatric patients. According to recent recommen-
dations from the Baden-Wrttemberg Hospital Association,
the test should be performed in all patients aged 70 and older
who are referred to a hospital. It consists of two parts. If part
Ais positive, the patient is identified as a probable geriatric
patient. Part Aassesses age, care level, presence of dementia
and whether the person is living in a nursing residency. Part
B is performed in case part Ais negative. Part B covers the
domains mobility, autonomy, cognition, depression, and hos-
pital stays during the last year. Although regularly used in
German hospitals, this test has to our best knowledge not yet
been validated.
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437
Methods: We included 107 inpatients of the Neurological
Department of the University of Tuebingen, aged 70 and
older in a cross-sectional study. We performed part A and
B of the test in all patients and compared the results with a
comprehensive geriatric assessment.
Results: Twenty-three patients (22%) showed a posi-
tive part A. Twenty of these patients (87%) also showed a
positive part B. Compared with the patients without posi-
tive results, patients with positive results in both parts of the
Geriatrie-Check were older, had lower gait speed and grip
force, and had greater fear of falling.
Conclusion: This analysis shows that the results of the
Geriatrie-Check are in concordance with the results of the
comprehensive geriatric assessment. It can thus be consid-
ered as a useful screening tool for the identification of geri-
atric patients.
EFFECTIVENESS OF MOTOR SKILL OF WALKING
GROUP EXERCISE IN OLDER ADULTS: ACLUSTER
RANDOMIZED TRIAL
J.Brach1, S.Perera1, J.M.Van Swearingen1, S.Gilmore2,
N.Nadkarni1, E.Ricci1, D.Brodine2, 1. University of
Pittsburgh, Pittsburgh, Pennsylvania, 2. University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Many standard group exercise programs emphasize mus-
cle strengthening, flexibility and general conditioning because
of the association of such impairments with walking difficul-
ties, but do not emphasize the ability to walk or the timing
and coordination of movement that is critical to walking.
We developed a group exercise program that includes timing
and coordination exercises for walking called On the Move
(OTM). In a single blind cluster-randomized trial, we evalu-
ated the effectiveness of OTM and standard group programs
to improve mobility, function and disability in 32 independ-
ent living facilities, community centers and senior apartment
buildings. Programs were 1 hour, twice weekly for 12 weeks
and 10 participants per class. OTM consisted of warm-up,
timing and coordination (stepping and walking patterns),
strengthening and stretching exercises. The standard program
consisted of warm-up, aerobic, strengthening and stretching
exercises. 298 participants (mean age 80.08.1years) were
randomized, and groups were not significantly different at
baseline. Despite a lower rate of attending 80+% of classes
(50% vs 65%; p=0.0324), OTM elicited greater gains than
the standard program in gait speed (0.05 m/s; p=0.0022)
and 6-minute walk distance (16.7 m; p=0.0344), but not
in function and disability (Late Life Function/Disability
Index). Exploratory subgroup analyses suggest those with
better mobility at baseline (gait speed > 0.8 m/s and 6-min-
ute distance farther than 300m) may elicit greater benefits
from OTM than the standard program. A group exercise
program that addresses the motor skill of walking is more
effective than a standard strength and conditioning program
in improving mobility.
ASSOCIATIONS OF QUADRICEPS TORQUE
PROPERTIES WITH MUSCLE SIZE AND ADIPOSITY IN
OLDER ADULTS
A.Frank-Wilson2,1, D.Chalhoub2,1, P.Figueiredo2,1,
P.V.Jonsson3, V.Gudnason4, L.J.Launer2,1, T.Harris2,1, 1.
National Institutes of Health - National Institute on Aging,
438
Bethesda, Maryland, 2. Laboratory for Epidemiology and
Population Sciences, Bethesda, Maryland, 3. University of
Iceland, Reykjavik, Iceland, 4. Icelandic Heart Association
Research Institute, Reykjavik, Iceland
Atrophy and fatty infiltration of muscle with aging is
associated with fractures and fall-related health outcomes.
This study examined the association between CT-derived
quadriceps muscle measures and function in a population-
based cohort of older adults. It was hypothesized that par-
ticipants with lower muscle attenuation (HU), area, and
greater intra-muscular adipose tissue (%IMAT) will exhibit
both slower rates of torque development (RTD) and lower
peak knee torques. Participants (N=4863 [2060:2803
male:female]) from the Age Gene/Environment Susceptibility
Reykjavik Study with a mean age of 760.1y had complete
imaging and isometric torque knee testing. Linear regression
models were adjusted for 16 covariates related to muscle
size and function, health, behavior & comorbidities. After
adjustment for covariates, the knee RTD was independently
associated with HU (men =0.06, 95% CI [0.01, 0.11]; and
women =0.06, 95% CI [0.02, 0.10]); as well as muscle area
(men =0.14, 95% CI [0.08, 0.20]; women =0.1, 95% CI
[0.06, 0.15]). Additionally, peak torque was independently
associated with HU (men =0.11, 95% CI [0.07, 0.15]; and
women =0.12, 95% CI [0.09, 0.16]); as well as muscle area
(men =0.38, 95% CI [0.34, 0.43]; women =0.33, 95% CI
[0.29, 0.37]). With the exception of RTD in women (=-0.06,
95% CI [-0.10, -0.02]), and peak torque in men (=-0.05,
95% CI [-0.09, -0.01]), %IMAT was not associated with
function after adjusting for muscle HU and area. These novel
results suggest that muscle HU is associated with the RTD
independent of muscle area, further elucidating a potential
pathway underpinning previously described relationships of
muscle HU with falls, fractures, and poor balance.
MULTI-LEVEL DETERMINANTS OF LONG-TERM
CARE RESIDENT ENERGY INTAKE: MAKING THE
MOST OF MEALTIMES
H.H.Keller1,2, S.Slaughter3, N.Carrier4, C.O.Lengyel5,
J.M.Morrison1, L.Duizer6, C.Steele7,8, 1. Kinesiology,
University of Waterloo, Waterloo, Ontario, Canada, 2.
Schlegel-University of Waterloo Research Institute for
Aging, Waterloo, Ontario, Canada, 3. University of Alberta,
Edmonton, Alberta, Canada, 4. Universite de Moncton,
Moncton, New Brunswick, Canada, 5. University of
Manitoba, Winnipeg, Manitoba, Canada, 6. University of
Guelph, Guelph, Ontario, Canada, 7. University Health
Network, Toronto, Ontario, Canada, 8. University of
Toronto, Toronto, Ontario, Canada
The Making the Most of Mealtimes (M3) prevalence
study collected data from a representative Canadian sample
of residents (n=639), staff (n=461), dining rooms (n=82), and
homes (n=32). Three non-consecutive days of weighed and
estimated food intake was used to determine energy intake.
Mealtime and dining room observations, home management
and staff questionnaires, health records, and physical assess-
ments were collected by research staff. Mini-Nutritional
Assessment-SF was used to determine nutritional risk. The
Edinburgh-Feeding Questionnaire (Ed-FED) was used to
identify eating challenges and eating independence. Dining
environments were assessed for physical features using the
Innovation in Aging, 2017, Vol. 1, No. S1
Dining Environment Audit Protocol and a derived homelike-
ness summary score. The Mealtime Scan was used to record
mealtime experience and ambiance, and three summative
scores were derived on physical, social and person-centered
practices. Hierarchical multivariate regression determined
predictors of energy intake. Mean age of participants was
86.67.8 years and 31% were male. Mean energy intake
was 1571.9 - 411.9 kcal. Age, more eating challenges,
requiring some eating assistance, and homelikeness scores
were negatively associated (p<0.05) with energy intake. Male
gender, MNA-SF, often requiring eating assistance, being on
a dementia unit and a more person-centred meal enviorn-
ment were positively (p<0.05) associated with energy intake.
There was also a significant interaction (p<0.05) between
being prescribed a pureed/liquidized diet and requiring eating
assistance. These findings indicate that interventions focused
on pureed food, restorative dining, eating assistance and
person-centered care practices may improve food intake and
should be targets for further research. (Funded by Canadian
Institutes of Health Research)
EFFECT OF AGING AND GLUCAGON-LIKE PEPTIDE 2
ON INTESTINAL MICROBIOTA IN SD RATS
J.Wu, Department of Geriatrics, Zhongshan Hospital,
Fudan University, Shanghai, China
Objective: To study the influence of aging and GLP-2 on
intestinal microbiota in rats. Methods: Twelve 3months old
male SD rats were randomly divided into two groups: group
C and group G.Twelve 26months old male SD rats were ran-
domly divided into two groups: group L and group T.GLP-2
was intraperitoneally injected into rats from group G and
group T for 14days. The fecal bacterial compositions were
investigated by Miseq high-throughput sequencing. Results:
Diversity of intestinal microbiota in group L was lower than
that in group C.There was no obvious difference about the
diversity of intestinal microbiota between group C and group
Ggroup L and group T.At the phylum level, the relative
abundance of Bacteroidetes, Firmicutes and Proteobacteria
were higher in all rats. There was no obvious difference
about the relative abundance at the phylum level except
Spirochaetae. At the genus level, the relative abundance of
Allobaculum and Bifidobacterium in group L was lower.
The relative abundance of Anaerovibrio, Thalassospira,
Streptococcus and Treponema in group L was higher. The
relative abundance of Desulfovibrio, Intestinimonas and
Oscillibacter in group G was higher. The relative abundance
of Parasutterella, Prevotella and Psychrobacter in group G
was lower. Conclusions: Aging significantly decreases the
diversity of intestinal microbiota in SD rats, while GLP-2 has
no significant effect. Aging reduces the probiotic bacteria,
increases pathogenic bacteria of rats. GLP-2 increases parts
of probiotic bacteria, reduces parts of pathogenic bacteria in
young rats.
FUNCTIONAL ABILITIES AND GOALS IN POST-
ACUTE CARE: AN EARLY LOOK AT STANDARDIZED
ASSESSMENT DATA
L.A.Palmer1, A.Deutsch1, T.McMullen2, A.Levitt2,
S.Mandl2, T.Le1, M.Toth1, T.Mota2, 1. RTI International,
Raleigh, North Carolina, 2. Centers for Medicare &
Medicaid Services, Baltimore, Maryland
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Innovation in Aging, 2017, Vol. 1, No. S1
Functional status is tied to important health outcomes,
yet the collection of functional status data has not been
standardized across post-acute care (PAC). The IMPACT
Act of 2014 required the submission of standardized assess-
ment data by PAC providers, including data related to
function. Previously, functional assessment data collected
in skilled nursing facilities (SNFs), inpatient rehabilitation
facilities (IRFs), and long-term care hospitals (LTCHs) con-
sisted of different assessment instruments, scales, and items.
Standardization of functional data across PAC settings has
the potential to improve care coordination. We present a
preliminary review of recently implemented standardized
self-care and mobility data by examining the cross-setting
quality measure, Application of Percent of Long-Term Care
Hospital (LTCH) Patients with an Admission and Discharge
Functional Assessment and a Care Plan That Addresses
Function.
We analyzed the first quarter of assessment data avail-
able for all three PAC settings (October December, 2016).
Data sources with these standardized data elements include
the Minimum Data Set, IRF-PAI, and LTCH CARE Data Set.
We examined the reporting of patient and resident functional
abilities and goals across PAC settings. For example, among
404 LTCH facilities, the average hospital completed an
admission and discharge functional assessment and assigned
at least one discharge goal for 95.5% of patients. Results
were slightly higher for the average IRF facility (98.7%,
n=1,105). Analysis of the SNF setting data as well as within
setting variability by geographic regions, urbanicity, owner-
ship, and number of discharges will also be presented. Policy
implications of these findings will be discussed.
ASSOCIATION BETWEEN PERCEIVED SOCIAL
SUPPORT AND DEPRESSIVE SYMPTOMS AMONG
OLDER CHINESE AMERICANS
Y.Chao1, N.Zhang2, X.Dong3, 1. Rutgers, the State
University of New Jersey, Somerset, New Jersey, 2. Seton
Hall University, Newark, New Jersey, 3. Rush Institute for
Healthy Aging, Rush University Medical Center, Chicago,
Illinois
Purpose: Depressive symptoms are common among older
immigrants. Social support is an important factor that can
relieve the stress due to the process of acculturation. This
study was to examine the association between social support
and depressive symptoms among U.S. Chinese older adults.
Methods: Data were from the Population Study of
Chinese Elderly in Chicago (PINE) study. Independent vari-
ables were positive social support and negative social sup-
port. Dependent variable was depressive symptoms. Logistic
regression analyses were performed.
Results: Atotal of participants were 3,157 Chinese older
adults with the mean age of 72.8years (range 60105). After
controlling for age, gender, income, marital status, the number
of children, and the number of medical comorbidities, higher
positive social support was associated with fewer depressive
symptoms (mild vs. minimum odds ratio [OR]=0.88, 95%
confidence interval [CI]: 0.850.92; moderate-severe vs mini-
mum OR = 0.82, 95% CI: 0.790.86). In contrast, higher
negative social support was associated with more depressive
symptoms (mild vs. minimum OR = 1.34, 95% CI: 1.24
1.46; moderate-severe vs minimum OR = 1.38, 95% CI:
1.261.52).
IAGG 2017 World Congress
439
Conclusion: Future prevention and intervention programs
should incorporate valuable cultural insight to improve men-
tal health among older Chinese immigrants. In addition to
enhancing family and spousal support, the negative interac-
tions (e.g. abuse, demands, and criticism) should be avoided
to alleviate the severity of depressive symptoms.
GLYCEMIC CONTROL AND CLINICAL OUTCOMES
IN INSTITUTIONALIZED DIABETIC OLDER ADULTS
C.Shum, K.Leung, Y.Kwan, C.Mok, Department of
Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong,
Hong Kong
In institutionalized diabetic older adults, the harms
of intensive glycemic control may outweigh the benefits.
However, evidence-based data are lacking.
A retrospective cohort of older adults (age 65 years)
with diabetes mellitus living in nursing homes with HbA1c
measurements were identified. They were divided into groups
according to their HbA1c: <7.0%, 7.08.4%, 8.59.9% and
10.0%. Baseline characteristics included demographics,
clinical, functional and laboratory parameters and study out-
comes (mortality and hospitalizations) were evaluated.
376 institutionalized diabetic older adults (mean age
81.66.7 years) were included. The majority had multiple
comorbidities (Charlson Comorbidity Index 4.72.1) and
functional limitations (70.8% with impaired mobility). The
lowest 1-year mortality and hospitalization rate were found
in the group with HbA1c 8.59.9%. Multivariate analy-
ses showed that there were J-shaped associations between
HbA1c and hazard ratio for mortality and between HbA1c
and odds ratio of recurrent hospitalization with best out-
comes in those with HbA1c 8.59.9%. Advanced age, pres-
ence of stage 5 chronic kidney disease and peripheral vascular
disease, impaired mobility, polypharmacy and lower albumin
level were independent predictors of mortality. Among those
with intensive glycemic control (HbA1c <7.0%), 55.9%
received glucose-lowering therapy with high hypoglycemia
risk (sulfonylurea and/or insulin).
Institutionalized diabetic older adults with HbA1c 8.5
9.9% had the lowest 1-year mortality and hospitalization
rate. This may provide a reference for the recommended
HbA1c in this population. Comprehensive geriatric assess-
ment can prognosticate clinical outcomes in this population.
Our findings suggested that a substantial proportion of this
population was potentially over-treated and de-intensifica-
tion of drug treatment should be considered.
CAN PROTEIN AND VITAMIN D ENHANCE THE
COGNITIVE BENEFITS OF RESISTANCE TRAINING
IN TYPE 2 DIABETICS?
H.Macpherson1, E.G.Miller1, D.W.Dunstan2, C.Nowson1,
D.Kerr3, D.Menzies4, R.M.Daly1, 1. Deakin University,
Melbourne, Victoria, Australia, 2. Baker IDI, Melbourne,
Victoria, Australia, 3. Curtin University, Perth, Western
Australia, Australia, 4. South Eastern Melbourne Primary
Health Network, Melbourne, Victoria, Australia
Type 2 Diabetes (T2DM) is associated with an increased
risk of cognitive impairment. Exercise and nutrition are the
cornerstone of T2DM management and can improve cog-
nition, but whether they produce additive benefits remains
unknown. This 24-week RCT examined whether protein-
vitamin D supplementation could enhance the effects of
440
progressive resistance training (RT) on cognition in adults
aged 5075 with T2DM. All participants (n=198) were pre-
scribed RT and randomized to receive a whey-protein drink
(20g/d before breakfast plus 20g/d after RT) plus vitamin D
(2000 IU/d) (RT+ProD, n=98), or no additional powder/sup-
plements (RT, n=100). Cognition was assessed at baseline, 12
and 24 weeks using three composite z-score measures [global
cognitive function; working memory/learning (WML), atten-
tion/psychomotor function] from the Cogstate computerised
battery. All results were adjusted for age, gender, education
and diabetes duration. Overall 177 (89%) and 168 (85%)
completed the 12- and 24-week assessment. Exercise com-
pliance was 68% in RT+ProD and 58% in RT (P<0.05).
Mean compliance with the whey-protein and vitamin D
supplements was 79% and 92%, respectively. For global
cognitive function, both groups experienced similar signifi-
cant improvements after 24-weeks (0.170.19 SD, P<0.001).
For WML, there was a 0.19 SD greater improvement in
RT+ProD versus RT after 12-weeks (P<0.05), but by week
24 both groups displayed a similar significant improvement
(0.220.24 SD, P<0.01). Attention/psychomotor scores did
not change in either group. In conclusion, protein-vitamin
D supplementation initially enhanced the effects of exercise
on working memory/learning in older people with T2DM,
but does not appear to provide additional long-term benefits.
BMI, INFLAMMATION, AND PHYSICAL
FATIGABILITY IN OLD AGE: SHARED OR
INDEPENDENT PATHWAYS?
R.Cooper1, M.Popham1, A.J.Santanasto2, N.W.Glynn2, of falls, medical history, motor FIM score and number of
D.Kuh1, 1. MRC Unit for Lifelong Health and Ageing
at UCL, London, United Kingdom, 2. University of
Pittsburgh, Pittsburgh, Pennsylvania
Physical fatigability, the level of fatigue experienced while
undertaking specified physical tasks, increases with age.
These age-related changes, which reflect reductions in energy
availability, precipitate declines in function and activity par-
ticipation. Cross-sectional analyses suggest that obesity and
inflammation may be modifiable risk factors for fatigability
which require further investigation in longitudinal studies.
Using data on 2095 participants from the MRC National
Survey of Health and Development, a nationally representa-
tive British birth cohort, we aimed to assess whether body
mass index (BMI) and inflammatory markers were associ-
ated with physical fatigability and, if so, whether these act on
shared pathways. Linear regression models were used to relate
BMI from age 36 and inflammatory markers (C-reactive pro-
tein (CRP) and interleukin-6 (IL-6)) at age 6064 to physical
fatigability scores on the Pittsburgh Fatigability Scale (PFS) at
age 68. Women had higher mean PFS scores than men (16.0
(SD=9.3) vs 13.4 (SD=9.0), p<0.01), with higher scores indi-
cating greater perceived physical fatigability. In sex-adjusted
analyses, higher BMI across adulthood and higher levels of
CRP and IL-6 were associated with higher PFS scores. For
example, participants with BMI30kg/m2 at age 36 had a
sex-adjusted mean PFS score 6.1 (95% CI: 3.98.2) points
higher than those with BMI 2024.9kg/m2. When these
associations were mutually adjusted, BMI and IL6 remained
associated with PFS scores, whereas associations with CRP
were fully attenuated. These findings highlight that BMI and
inflammatory markers earlier in adulthood are associated
Innovation in Aging, 2017, Vol. 1, No. S1
with physical fatigability in old age and act on both shared
and independent pathways.
THE EFFICACY OF AFALLS CLINIC FOR ELDERLY
AND THE ADDED ROLE OF THE TILT TABLE
TEST
A.Rabinovich1,2, N.Vislapu1, I.Rasooly1,3, Y.Lerman1,2,
1. Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv,
Israel, 2. Tel Aviv University, Tel Aviv, Israel, 3. Israel
Ministry of Health, Geriatric Division., Jerusalem, Israel
Background: Many geriatric centers include special fall
clinics for evaluating elderly patients who fall in an attempt
to prevent such events that pose a threat to patients inde-
pendence. Few studies have assessed the added value of the
Head-Up Tilt Table (HUTT) test in the elderly.
Objective: In a fall clinic we evaluated the impact of
HUTT test and the efficacy of structured instructions to
patients.
Methods: This descriptive comparative study included
150 consecutive patients presenting with falls due to diz-
ziness or suspected syncope. All participants underwent a
comprehensive evaluation and were referred to HUTT test.
Seventy-five underwent the test and the other 75 who did not
comprised the comparison group. Each participant received
personal guidance to prevent falls. Clinical data, including
HUTT results, were collected retrospectively from patients
files. A follow-up telephone interview was conducted
6months later.
Results: The two groups were similar in gender, number
medications. Those in the HUTT test group were 6 years
younger (average). The response rate to the follow-up tel-
ephone survey was 87.3%, and 75.6% of responders were
the patients themselves. There was good adherence to the fall
clinics recommendations and a significant decrease in diz-
ziness. Syncope, fall rates and hospitalizations due to falls.
These findings did not differ between the study groups nor
according to HUTT results.
Conclusion: Our study demonstrates the impact of
comprehensive evaluation and structured instructions in a
specialized fall clinic for elderly patients, beyond a single
diagnostic test.
FACTORS ASSOCIATED WITH FUNCTIONAL
DECLINE AMONG ADULTS AGE 50 YEARS OR
OLDER: A4-YEAR FOLLOW-UP
M.A.Cabrera1, M.U.Vieira1,2, A.R.Silva1, M.A.Bortolleto1,
A.A.Lopes1, 1. Universidade Estadual de Londrina,
Londrina, Paran, Brazil, 2. UNOESTE, Guarapuava,
Paran, Brazil
This is a prospective 4-year follow-up study (20112015)
in a population-based sample of 713 adults aged 50 years
or older residing in a medium-sized city in Southern Brazil.
In this analysis, only 412 individuals, who were considered
independent for instrumental activities of daily living (IADL),
were included in the baseline assessment. The outcome was
the functional decline (FD), defined as the functional loss of
at least two IADL after 4years of follow-up. The independ-
ent variables associated with FD were sociodemographic,
lifestyle, and comorbidities. The results showed that 78 of
the 412 subjects (18.9%) were considered dependent for
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Innovation in Aging, 2017, Vol. 1, No. S1
IADL after 4years of follow-up. When adjusted for sex, age,
economic class, and schooling, the following variables were
identified as having significant associations with high FD:
absence of spouses, relative risk (RR)=1.75 [95% confidence
interval (CI): 1.082.95]; low consumption of vegetables and
fruits, RR=1.85 (95% CI: 1.113.07); diabetes, RR=1.69
(95% CI: 1.133.28); hearing impairment, RR=2.06 (95%
CI: 0.243.43); and falls, RR=1.61 (95% CI: 1.012.57).
In conclusion, we observed an overall worsening of func-
tional status in a population aged 50years or older within
a short period of 4years, especially in groups at higher risk
such as those without spouses, those having diabetics, those
with low consumption of fruits/ vegetables, and those hav-
ing hearing impairment. Therefore, it is important to adopt
measures to maintain the functional capacity in these specific
populations.
VALIDITY OF FRUIT AND VEGETABLE
INTAKE ASSESSED BY AFOOD FREQUENCY
QUESTIONNAIRE IN OLDER ADULTS
C.Neville, M.C.McKinley, F.Kee, I.Young, C.Cardwell,
J.Woodside, UK CRC Centre of Excellence for Public
Health, Queens University Belfast, Belfast, United Kingdom
Accurately assessing dietary intake in older populations
is vital to determine the potential role of diet in healthy age-
ing. Based on the uncertainty over the utility of a food fre-
quency questionnaire (FFQ) to determine dietary intake in
older people, the objective of this study was to validate fruit
and vegetable (FV) intake from a FFQ, using a food diary
(FD). A sub-sample of 50 participants (aged >50y) from
the Northern Ireland Cohort for the Longitudinal Study of
Aging completed a FFQ and 4-day FD (reference method) at
two time-points (Month 0 and Month 6). Estimates of FV
intake were compared between methods using Spearmans
correlation coefficients, cross-classification, weighted kappa
and Bland-Altman plots. At both time-points, median fruit,
vegetable and total FV intake were higher (all p<0.001) in
the FFQ than the FD. Positive correlations (all p<0.05) were
observed between the FFQ and FD estimates at both time-
points (Mo 0, r=0.44, 0.52 and 0.46 for fruit, vegetables,
total FV, respectively; Mo 6 r=0.49, 0.44 and 0.44, respec-
tively) while weighted kappa showed fair-moderate agree-
ment between methods for FV intake. Cross-classification
indicated that 79% of participants were classified into the
same or adjacent quartile. Bland-Altman plots revealed a
widening in limits of agreements, between the FFQ and FD,
with higher FV intakes. While over-reporting is evident with
the FFQ compared to the FD, the results show good compa-
rability in ranking older adults according to their FV intake.
Analysis of FV biomarkers within this sample will provide a
more objective assessment of FV intake.
A CASE FOR DEVELOPING AN EXERCISE-BASED
PREVENTIVE SWALLOW HEALTH MAINTENANCE
PROGRAM IN THE ELDERLY
D.Agrawal, M.Kern, A.Wilson, S.Gao, F.Edeani,
G.Balasubramanian, P.Sanvanson, R.Shaker,
Gastroenterology and Hepatology, Medical College of
Wisconsin, Milwaukee, Wisconsin
Oropharyngeal dysphagia (OPD) associated with
frailty is an important national healthcare concern with
IAGG 2017 World Congress
441
serious consequences, enormous cost and limited therapeu-
tic options. Despite positive health outcomes with strength
training exercises for locomotive health maintenance in the
elderly, to date there has been no systematic approach for
an exercise-based swallow function maintenance program.
Aim: To determine the effect of a swallow exercise program
on the oropharyngeal deglutitive biomechanics in healthy
elderly and dysphagic patients using a novel technique of
Swallowing Against Laryngeal Restriction (SALR). Methods:
We studied 24 healthy elderly(76+/-7yrs,10M) by videofluor-
oscopy before and after six-weeks of real exercise. 12 of
these volunteers also underwent pre and post-exercise high-
resolution pharyngeal manometry. 10 elderly(81+/-6yrs,1M)
were studied by videofluoroscopy before and after six-week
of sham exercise. We also studied a heterogenous group of
21 OPD patients(64+/-10yrs,10F) with videofluoroscopy
before and after a minimum of six-weeks of real exercise.
Real exercise consisted of 30 swallows at 15 second intervals
TID using a device hindering deglutitive laryngeal excursion.
Results: In healthy elderly, real exercise, but not sham exer-
cise, significantly improved upper esophageal sphincter (UES)
opening, posterior pharyngeal-wall thickness, anterosuperior
laryngeal excursion and pharyngeal contractile integral. In
patients, UES opening, anterior laryngeal excursion and
symptom-specific outcome EAT-10 improved significantly
post-exercise. Conclusions: Strength training facilitated by
SALR technique safely improves deglutitive biomechanics,
function, and reverses pharyngeal sarcopenia. In addition to
developing similar program for deglutitive rehabilitation of
OPD, the findings of this study provide the basis for devel-
oping an exercise-based preventive swallow health mainte-
nance program for the elderly.
RESPIRATORY MUSCLE STRENGTH IS ASSOCIATED
TO PARITY AMONG LOW-INCOME WOMEN FROM
NORTHEAST BRAZIL
S.Cmara1, I.G.Azevedo1, C.Pirkle2, N.T.Rosendaal2,3,
A.Maciel1, E.d.Viana1, 1. Universidade Federal do Rio
Grande do Norte, Natal, Brazil, 2. University of Hawaii,
Honolulu, Hawaii, 3. Johns Hopkins Bloomberg School of
Public Health, Baltimore, Maryland
High parity is common in low-income settings and it
is related to chronic conditions among women. This study
investigated associations between parity and respiratory
muscle strength in low-income women (Northeast Brazil).
In a cross-sectional study, 204 community-dwelling women
(4080 years-old) were evaluated regarding the number
of lifetime childbirths and ability of generating maximal
inspiratory (MIP) and expiratory (MEP) pressures with a
digital manometer. We performed multiple linear regression
analyses to model the effect of multiple births on MIP and
MEP, adjusting for covariates (current age, age at first birth,
income, education, smoking, BMI, time seated during a day
and walking per week). Forty four percent of the sample had
3 births, 30.4% had 4 to 6 births and 25.5% had 7 births or
more. There is a clear gradient in relation to MEP and parity
groups; those with a higher number of births had lower MEP
values. In the fully adjusted model, women with 7 births
and women with 46 births presented lower mean MEP (=
-17.79 cmH2O; p=0.01 and = -12.46 cmH2O; p=0.02,
respectively) than women with 3 births. No relation was
442
observed between parity and MIP. We hypothesized that
multiparity may affect the abdominal strength due to impair-
ment in the muscles biomechanics. Diastasis recti is common
after multiple pregnancies and may cause disadvantage in
strength generation, reducing expiratory pressures. Lower
expiratory pressures are related to higher incidence of lung
diseases including atelectasis and recurrent pneumonia,
which are important debilitating conditions for elderly.
IMPROVING AIR QUALITY AND CARDIOVASCULAR
HEALTH FOR LOW-INCOME ELDERLY IN DETROIT,
MICHIGAN
R.A.Ziemba1, R.D.Brook2, R.L.Bard2, C.Spino3, viduals who complete a survey have demonstrated that they
S.Adar3, M.Morishita4, 1. Independent Researcher, Ann
Arbor, Michigan, 2. Division of Cardiovascular Medicine,
University of Michigan, Ann Arbor, Michigan, 3. School
of Public Health, University of Michigan, Ann Arbor,
Michigan, 4. Department of Family Medicine, East Lansing,
Michigan
Ambient fine particulate matter (PM2.5) compromises
cardiovascular health (CV) by stimulating inflammatory
reactions in blood vessels. We tested the effectiveness of
indoor air filtration to reduce PM2.5 exposure and improve
CV health in seniors living in a government-subsidized
low-income apartment building. This facility is located in
downtown Detroit, Michigan, where documented average
indoor PM2.5 concentrations are more than twice the cur-
rent annual US National Ambient Air Quality Standard.
This facility is in an area where we have previously demon-
strated that exposure to both ambient and personal PM2.5
is significantly associated with elevated blood pressure
within 13 days after exposure. For the current study, we
conducted a randomized crossover intervention study with
repeat health and exposure measurements from 39 seniors
exposed to unfiltered, low-efficient (LE) filtered, and high-
efficiency (HE) filtered air. Preliminary results indicate that
both LE and HE indoor filtration effectively reduce indoor
and personal PM2.5 concentrations by 3551%. Effects
on cardiovascular outcomes and inflammation markers are
pending. If shown to be effective, in-room air filtration offers
a relatively inexpensive intervention to improve air quality
and CV health in seniors living in areas of high air pollution.
A SHORT SURVEY TO ASSESS HEALTH STATUS
AMONG OLDER ADULTS
T.Wells1, G.R.Bhattarai1, K.Hawkins1, S.Musich1, were found for upper- and lower-body strength (z=6.81, p <
S.Kraemer2, Y.Cheng1, D.Armstrong3, 1. OptumInsight,
Ann Arbor, Michigan, 2. Healthcare Transformation,
UnitedHealthcare, Minnetonka, Minnesota, 3. AARP
Services, Inc., Washington, District of Columbia
The purpose of this study was to test the feasibility of
fielding a short survey to a large older population to learn
about their self-rated health, compliance with annual flu vac-
cinations, and willingness to participate in population health
programs. 675,772 older adults were contacted to partici-
pate in the survey. Responses were linked to eligibility, medi-
cal claims, and pharmaceutical data to identify: 1)those who
responded to the survey; 2)those whose self-rated health was
different than their Hierarchical Condition Category (HCC)
risk score measured with claims data and; 3) those that
reported not having a flu vaccination. The survey response
Innovation in Aging, 2017, Vol. 1, No. S1
rate was 14%, and 32% of respondents reported no flu vac-
cination. Among those rating their health as poor-fair, 1/3
had an HCC score indicating they were healthy (HCC<1.0).
Among those rating their health as good-excellent, 4% had
HCC score indicating they were sick (HCC>2.8). This tel-
ephonic short survey outreach to a large population suc-
cessfully gathered important population health metrics not
available in claims data. First, the flu vaccination informa-
tion can be used to effectively target an intervention for those
not vaccinated. Second, using self-rated health to prioritize
those being considered for a population health intervention
may be more effective than using claims data. Finally, indi-
are more likely to join a population health program when
offered, and therefore given a high priority when determin-
ing whom to target for these programs.
EFFECTS OF ASIX-WEEK STRENGTH TRAINING
PROGRAM ON FUNCTIONAL FITNESS LEVELS
AMONG OLDER ADULTS
K.Caillouet2, A.Nelson1, M.E.Livingston2, 1. University
of West Florida, Pensacola, Florida, 2. Georgia Gwinnett
College, Lawrenceville, Georgia
Introduction: Muscular strength, flexibility, aerobic
endurance, and balance are well-known contributors to
health and quality of life among older adults. Prior research
has indicated older adult participation in resistance training
provides foundational strength for performance of activities
of daily living. Purpose: To investigate the effects of a six-
week progressive resistance training program on strength,
flexibility, aerobic endurance, and dynamic balance and agil-
ity among community-dwelling older adults. Methods: From
20102015, ten separate sessions of a six-week progressive
resistance training program were implemented and resulted
in a total of 95 community-dwelling older adult participants
(37 male, 58 female; M=73.5 + 7.2). The resistance-training
program included bi-weekly, 1-hour sessions targeting all
muscle groups. Assessments included 30-second arm curl,
30-second chair stand, back scratch, chair sit-n-reach, 2-min-
ute step test, and 8-foot up-and-go. Statistical Analysis: The
Wilcoxon Signed-Rank Test was performed to evaluate group
differences between baseline and post-program for upper-
and lower-body strength, upper- and lower-body flexibility,
aerobic endurance, dynamic balance and agility. Results:
Significant differences between pre- and post-assessments
.001; z=6.46, p < .001, respectively); upper- and lower-body
flexibility (z=3.81, p < .001; z=4.85, p < .001, respectively),
aerobic endurance (z=6.04, p < .001), and dynamic balance
and agility (z = 5.52, p < .001). Conclusion: The six-week
progressive resistance-training program targeting all muscle
groups resulted in significant improvements in strength, flex-
ibility, aerobic endurance, balance, and agility among com-
munity-dwelling older adult participants.
IMPACT ON CARDIORESPIRATORY OUTCOMES OF
HIGH VS. STANDARD DOSE INFLUENZA VACCINE IN
U.S. NURSING HOMES
S.Gravenstein1,2, J.Ogarek2, M.Taljaard4, L.Han3,
H.Davidson3, P.Gozalo2, V.Mor2, 1. Case Western
Reserve University, Cleveland, Ohio, 2. Brown University,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Providence, Rhode Island, 3. Insight Therapeutics, Norfolk,
Virginia, 4. University of Ottawa, Ottawa, Ontario, Canada
Age and multiple morbidities increase susceptibility to
influenza whilst responsiveness to vaccination declines.
However, Fluzone High-Dose, Influenza Vaccine (HD)
reduces clinical influenza more than Fluzone vaccine stand-
ard dose (SD) among outpatient elderly. In 20132014 we
randomized 823 nursing homes (NHs) to either SD or HD
as their care standard. HD significantly reduced hospitaliza-
tions. We now report on diagnoses for hospitalization, using
Medicare Fee-For-Service (FFS) discharge data. We com-
pared primary and secondary discharge diagnoses for index
hospitalizations for cardiac and respiratory illnesses using
ICD-9 codes (acute myocardial infarction: 410.xx, 411.
xx; heart failure: 428.x, 429.0, 429.1, 419.7; atrial fibrilla-
tion: 427.x; stroke: 433.xx-436.xx; and respiratory illness:
460466, 480488, 490496, 500518). We used marginal
Poisson regression, accounting for clustering of NH residents
and for pre-specified resident and facility baseline covariates:
age and average age of NH residents, ADL and average ADL
of NH residents, cognitive function, hospitalizations in prior
year, and patients chronic heart failure. On 11/1/2013, of
38,256 FFS NH residents living in their NH >3 months,
and 65 years old, 19,126 were offered HD and 19,129
were offered SD. From November through April, 7,297 FFS
residents were hospitalized (3509 HD, 3788 SD, p=0.0110).
The difference in all-cause hospitalization was accounted
for largely by hospitalization for the combination of cardio-
respiratory outcomes (unadjusted RR=0.918, 0.8610.980
95% CI, p=0.0098; adjusted RR=0.908, 0.8580.961 95%
CI, p=0.0009). In our prospective cluster-RCT, HD provided
better protection than SD against both respiratory and cer-
tain cardiac conditions that lead to hospitalization.
Funding: Sanofi Pasteur, Swiftwater, PA
EARLY FRAILTY TRANSITION PREDICTS 17 YEARS
OF MORTALITY AMONG NON-DISABLED OLDER
MEXICAN AMERICANS
C.Li, S.Al Snih, K.J.Ottenbacher, Rehabilitation Sciences,
University of Texas Medical Branch, Galveston, Texas
Understanding frailty transitions over time and its impact
on mortality is crucial for early prevention and long-term
care for any individual who is going through aging pro-
cess. We used 1995/96 to 2012/13 data from the Hispanic
Established Populations for the Epidemiological Study of
the Elderly (EPESE) survey to investigate the effect of early
frailty status transition on 17-year mortality. This study
included 1688 Mexican Americans aged 67years and older
and were non-disabled at baseline. Frailty was defined
as meeting two or more following criteria: unintentional
weight loss> 10 pounds, weakness, self-reported exhaustion,
and slow walking speed. According to the frailty transition
between 1995/96 and 1998/99, participants were divided
into 9 transition groups: non-frail-non-frail, non-frail-pre-
frail, non-frail-frail; pre-frail-non-frail, pre-frail-pre-frail,
pre-frail-frail; frail-non-frail, frail-pre-frail and frail-frail.
Using Cox proportional hazards regression, we estimated
mortality as a function of early frailty transitions control-
ling for socio-demographics, comorbidities, and cognitive
impairment. Participants who transitioned from pre-frail
to non-frail status had 20% lower mortality risk [Hazard
IAGG 2017 World Congress
443
Ratio (HR) = 0.80, 95%CI=0.640.99] compared to those
who remained non-frail. Non-significant reduction in risk of
mortality was seen among those who transitioned from frail
to non-frail (HR=0.67, 95%CI=0.381.19). Non-significant
high risk of mortality was found among those who transi-
tioned from pre-frail to frail, frail to pre-frail and remained
frail. This study demonstrated that non-disabled older
Mexican Americans who transitioned from pre-frail to non-
frail had significant lower risk of mortality over 17-years of
follow-up. Intervention targeting older Mexican Americans
in pre-frail status could potentially decrease mortality in a
long run.
A CHOICE-BASED PHYSICAL ACTIVITY AND ACTIVE
TRAVEL INTERVENTION FOR OLDER MEN
D.C.Mackey1,2, A.Perkins2, K.Hong Tai2, J.Sims-Gould2,
H.A.McKay2, 1. Biomedical Physiology and Kinesiology,
Simon Fraser University, Burnaby, British Columbia,
Canada, 2. University of British Columbia, Vancouver,
British Columbia, Canada
Low levels of physical activity contribute to loss of
mobility and independence in older men. We conducted a
12-week randomized controlled feasibility trial of choice-
based physical activity (PA) and active travel. Participants
were community-dwelling low active men aged 60+ (n=29
intervention (INT), n=29 waitlist control). Trained activity
coaches delivered: 1) one-on-one participant consultations
to develop personal action plans for PA and active travel;
2) monthly group-based motivational meetings; 3) weekly
telephone support; 4)complimentary recreation and transit
passes; and 5) pedometers and diaries for self-monitoring.
INT chose a wide range of group-based and individual PAs
(e.g., group exercise classes, walking, cycling) and destina-
tions (e.g., parks, cities, shops/restaurants) for their personal
action plans. At 12 weeks, INT achieved 9.0 more minutes/
day of moderate-to-vigorous PA (p=0.06) and 1140 more
steps/day (p=0.04), engaged in 5.2 more moderate intensity
PAs/week (p<0.01), and expended 1493 more kcal of energy/
week from moderate PAs (p=0.02). INT was 4.2 times more
likely to take at least one transit trip/week (95%CI:1.218.0)
and 3.3 times more likely to meet national guidelines of 150
minutes/week of moderate-to-vigorous PA in bouts of 10
minutes (95%CI:0.7516.3). At 24 weeks follow-up (12
weeks after intervention end), INT benefits relative to base-
line were sustained for minutes/day of moderate-to-vigorous
PA, number of moderate intensity PAs/week, and kcal of
energy/week from moderate PAs. In conclusion, a choice-
based model of PA paired with active travel may be an effec-
tive approach to promote PA among older men.
NUTRIENT INTAKE OF FEMALE RESIDENTS
CONSUMING APUREED DIET IN CANADIAN LONG-
TERM CARE (LTC) HOMES
V.Vucea1, H.H.Keller1,3, J.M.Morrison1, A.M.Duncan2,
L.Duizer2, 1. Kinesiology, University of Waterloo, Waterloo,
Ontario, Canada, 2. University of Guelph, Guelph,
Ontario, Canada, 3. Schlegel-UW Research Institute for
Aging, Waterloo, Ontario, Canada
Older adults residing in long-term care (LTC) face
increased risk of malnutrition because of many factors,
including decreased appetite, difficulty eating, and cognitive
444
impairment. Issues associated with pureed texture diets (e.g.,
dysphagia, poor dentition, lack of appeal, and extra menu
planning) further contribute to this risk. The current study
examined the adequacy of nutrient intake among female
LTC residents prescribed a pureed texture diet. Making the
Most of Mealtimes (M3) is a cross-sectional study of 639
residents from 32 LTC facilities across four Canadian prov-
inces (AB, MB, NB, ON). Of these, 67 residents (10.5%) were
prescribed a pureed texture diet, 51 of which were female
(888 years old). Weighed food intake was measured on 71years), combined with environmental audits, explored the
three non-consecutive days and analyzed using ESHA Food
Processor software. Intake of energy and 25 nutrients were
adjusted for intra-individual variability and compared to
their corresponding Estimated Average Requirement (EAR)
or Adequate Intake (AI) value. Mean energy intake among
female consumers of pureed diets was 1487376 kcal/day. for age, gender, past occupation, race/ethnicity, living alone,
Estimated inadequacies were found for vitamins D, E and
folate (>95% of individuals below EAR); and vitamin B6,
calcium and magnesium (>50% but <90% below EAR). For
nutrients with an AI, median intakes of dietary fibre, potas-
sium and vitamin K were below their AI. These findings indi-
cate that female residents prescribed a pureed texture diet in
Canadian LTC homes have low intake of several micronutri-
ents. Careful menu planning and nutrient-dense options for
pureed texture diets in LTC are recommended. (Funded by
Canadian Institutes of Health Research).
SKILLED NURSING FACILITY TO HOME CARE
TRANSITIONS: OUTCOMES OF EARLY OUTPATIENT
FOLLOW-UP
J.Carnahan, J.Slaven, C.M.Callahan, W.Tu, A.Torke, lematized the quantitative results. Linear trends generated by
Indiana University, Indianapolis, Indiana
As hospital lengths of stay have decreased, more older
adults have discharged to skilled nursing facilities (SNFs)
prior to returning home. Patient characteristics and factors
that prevent post-discharge adverse outcomes, such as hos-
pital readmissions, are poorly understood. This study uti-
lized a database comprised of data from one health systems
Electronic Medical Record, matched to Medicare, Medicaid
and the Minimum Data Set. Among patients who transi-
tioned from hospital to SNF to home, we used survival anal-
ysis to examine whether a home health visit or outpatient
visit within one week of SNF discharge was associated with
reduced hospital admission. Out of 8,754 community dwell-
ing, hospitalized older adults with a hospital stay of 3 or
more days, 4,577 were discharged home (52.3%; hospital to
home group) and 3,025 (34.6%) were discharged to a SNF, of
whom 1,543 (51.0%) returned home (SNF to home group).
Patients discharged after SNF stay were older (median age
77.82 years v. 73.75, p<0.0001), had more comorbidities
(median 6 v. 5, p<0.0001) and a longer hospital length of
stay (median 7 v.4days, p<0.0001). After SNF discharge, a
home health visit within a week was associated with reduced
hazard of 30-day hospital readmission (adjusted hazard ratio
(aHR) 0.61, p<0.0001) but outpatient physician visits were
not (aHR=0.67, p=.8214). Patients discharged to a SNF prior
to returning home are a high risk group. The finding that a
home health visit within a week of discharge is associated
with reduced hazard of 30-day hospital readmissions sug-
gests a potential avenue for intervention.
Innovation in Aging, 2017, Vol. 1, No. S1
AGING IN CONTEXT: AMIXED METHODS
INVESTIGATION OF PERSON-PLACE INFLUENCES
ON WELL-BEING
J.Finlay1, L.C.Kobayashi2, 1. University of Minnesota,
Minneapolis, Minnesota, 2. Harvard University, Cambridge,
Massachusetts
Aging occurs in context; yet, too often environmental
characteristics are ignored. Seated and mobile interviews
with community-dwelling older adults (n=124, mean age
everyday contexts of older adults living in three distinct areas
of the Minneapolis (USA) metropolitan area. Convergent
parallel analyses examined four constructs of wellbeing: (1)
self-rated health, (2) isolation and loneliness, (3) sense of
safety, and (4) happiness. Logistic regression models adjusted
street type, residential location, and building density were
used to predict the wellbeing constructs. Qualitative the-
matic analyses probed individual perspectives and personal
experiences. The sociodemographic qualitative findings gen-
erally converged with the quantitative results. For instance,
the most consistent predictor of wellbeing in the quantita-
tive models was living alone, which was negatively associ-
ated with all four aspects of wellbeing (e.g. odds ratio [OR]
for moderate/poor/very poor vs. good/very good self-rated
health=3.08; 90% confidence interval [CI]: 1.317.20). This
estimate paralleled the qualitative findings, in which numer-
ous participants living alone voiced struggles with vulner-
ability, isolation, and poor health. However, individualized
qualitative perspectives on environmental contexts prob-
regression modelling, which indicated that wellbeing stead-
ily decreased when moving outwards from the city center
toward suburban zones, diverged from nuanced qualitative
data that captured significant variation in wellbeing within
each residential context. Findings advance scholarship on
health-place interconnections, and elucidate how interact-
ing personal variables and environmental contexts get under
our skin to shape the experience of aging.
PNEUMONIA READMISSION IN OLDER ADULTS
WITH DEMENTIA
S.Knox, 1. Physical Therapy, MGH Institute of Health
Professions, Charlestown, Massachusetts, 2. Nova
Southeastern University, Ft. Lauderdale, Florida
Pneumonia readmissions have significant quality of care
and policy implications for patients and health care provid-
ers. Research suggests that initiatives to decrease readmis-
sions should target high-risk subgroups. Older adults with
dementia are known to be at an increased risk of contract-
ing pneumonia and have higher hospitalization rates due to
pneumonia, suggesting that older adults with dementia may
be at high-risk of pneumonia readmissions. There is a lack
of research addressing the relationship between dementia
and pneumonia readmissions. The purpose of this retro-
spective study was to investigate pneumonia readmission
rates and predictive factors of older adults with and with-
out dementia. Anationally representative sample of 389,198
discharge records was extracted from the 2013 Nationwide
Readmission Database. Significant differences were found
(p<.001) when comparing patient characteristics of older
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
adults with and without dementia who were readmitted
within 30days of discharge. Older adults with dementia had
a readmission rate of 23.5% and were 2.9 times more likely
to be readmitted (OR; 95% CI, 1.93,4.40) than older adults
without dementia. Predictive factors were calculated using a
generalized linear model with dementia included as an inter-
active effect. Dementia significantly modified (p<.05) the
relationship between pneumonia readmissions and four fac-
tors; (a) discharge disposition, (b) chronic conditions, (c) risk
of mortality, and (d) median household income. Classifying
older adults with dementia as a high-risk sub-group for
pneumonia readmissions is supported by the findings of
this study. Development of strategies to reduce pneumonia
readmissions that are tailored to individuals with dementia
should be considered.
HEALTH EQUITY PREDICTORS AMONG AGING
PARENTAL CAREGIVERS OF ADULTS WHO HAVE
AUTISM
H.Church1, C.Marsack2, 1. Western University, London,
Ontario, Canada, 2. Eastern Michigan University, Troy,
Michigan
The principles guiding initiatives related to aging among
individuals with intellectual disabilities (i.e., independence,
participation, care, self-fulfilment and dignity) are based on
the principles adopted in the United Nations Principles for
Older Persons (resolution 46/91) (United Nations, 1991).
This resolution must implicitly include their aging parental
caregivers. Aging parental caregivers of adults with Autism
Spectum Disorder (ASD), may be particularly vulnerable as
they balance their own needs that change as they age and care
for their adult child. Policies and funding decisions directed
at meeting the needs of people with ASD have tended to
focus on the individual with the developmental disorder, yet
implementation relies heavily on family caregivers, primarily
parents. Little is known about the health impacts, both posi-
tive and negative, among aging parents caring for an adult
with ASD.
It is necessary to consider the health of the parents of
adults with ASD, as they are aging themselves. The prov-
ince of Ontario has developed the Health Equity Impact
Assessment (HEIA), a five-step model designed to identify
the unintended health impacts, both positive and negative,
of policies. The purpose of this research is to use the HEIA
as a framework to identify the health impacts of community-
based policy on aging caregivers of adults who have ASD.
Participants (N= 320), completed the World Health
Organization Quality of Life Brief, Caregiver Burden
Inventory, ENRICHD Social Support Instrument, Caregiver
Reaction Assessment, and demographic questionnaires were
analyzed using multiple regressions. Interviews were also
conducted among parents (N= 50), age 50 years old and
older, of adults diagnosed with to explore how the services
and supports provided influenced the social determinants of
health (SDOH).
Results: The findings demonstrated a negative correla-
tion between burden experienced by the parents and various
aspects of social determinants of health. Caregiver burden
was a predictor of QOL. Subthemes, identified using line-
by-line analysis of transcribed interviews used a grounded
theory perspective, included: stress, fatigue, physical assaults,
IAGG 2017 World Congress
445
worsening of chronic conditions, fear and helplessness expe-
rienced by these parents. This study highlights impediments
to SDOH experienced by aging parental caregivers of adults
who have ASD, which can be mitigated by service providers.
CHARACTERISTICS OF RESIDENTS IN NEED
AND FAMILY PERCEPTIONS OF FAMILY CARE
CONFERENCES IN LTC
P.M.Durepos1, S.Tamara2, S.Kaasalainen1, J.Ploeg1,
D.Parker3, G.Thompson4, 1. School of Nursing, McMaster
Universtiy, Hamilton, Ontario, Canada, 2. McGill
University, Montreal, Quebec, Canada, 3. University of
Technology Sydney, Sydney, Western Australia, Australia, 4.
University of Manitoba, Winnipeg, Manitoba, Canada
Few long-term care (LTC) homes follow a systematic pro-
cess for communicating with families of residents near end
of life (EOL). Barriers to communicate may include limited
resources and difficulty prognosticating. A new program
called Strengthening a Palliative Approach to Care (SPA-
LTC) examined Family Care Conferences (FCC) for residents
who were nearing EOL as a way to increase communication
between staff and families. The purpose of this study was to
explore: 1)characteristics of residents who had FCCs com-
pared to those who did not, and 2) family perceptions of
FCCs through a mixed methods approach.
At study end, there were 39 families enrolled and 28%
(n=11) of residents had died, all in the LTC setting. FCCs
were held for 24 families and three additional residents
died before an FCC occurred. Descriptive statistics showed
residents who had an FCC tended to have dementia, higher
Charlson Comorbidity Index, and were hospitalized more
often during the last year. Eight families attending FCCs
agreed to be interviewed. Participants reported feeling well-
supported during FCCs, found conferences beneficial and all
had identified EOL preferences. One interviewed participant
recommended holding FCCs earlier in the course of illness.
Findings suggest that families of residents with specific
characteristics (e.g., dementia diagnosis) may have increased
need for communication or acceptance of FCCs at EOL.
Overall, family members perceived FCCs as beneficial sup-
porting the value of this intervention and participant sugges-
tions can contribute to tailoring FCCs. Analysis of resident
characteristics in particular should be repeated in additional
studies to confirm findings.
THE EFFECT OF HEALTH ON THE TIMING OF
RECEIVING RETIREMENT BENEFITS
F.Huang, University of Florida, Gainesville, Florida
Health is one of major factors that cause people to retire.
However, referring to the gender gap in pensions, empirical
studies mostly focus on the influence of working years, occu-
pation and education on the gap, instead of gendered health
disparity. This study aims to understand how the effect of
health on the timing of receiving retirement benefits are con-
ditioned by gender, cohort and the institution.
This study will use the 19921998 and 20042014 waves
of Health and Retirement Study (HRS) data and the 1989
1999 and 19962011 waves of the Taiwan Longitudinal
Study in Aging (TLSA) to examine the effects of gender dis-
parity in late adulthood health on the timing of SSB and pen-
sion receipts. Discrete-time event history analysis by logistic
446
regression models are adopted to investigate the hazard
rate of receiving retirement benefits across individuals and
cohorts.
Based on cumulative disadvantage or advantage approach
in life course perspective, this study suggests the mechanisms
work incapacity, wage depressing, the limitation of job English composition course and a world human geography
opportunity and anticipation of shorter life expectancy
could lead gender and cohorts to have dissimilar patterns
of retirement income receipt timing. Additionally, the social
policies and the institutions such as cash benefits and health
insurance system could be pathways to change the opportu-
nities structure and incentive structure in the timing of retire-
ment benefit receipt. This study not only enriches life course
perspective but also provides the implication of the policy
delaying retirement ages for full SSB for the U.S.and the
East Asia countries like Taiwan.
INSTITUTIONAL LTC FOR ELDERS IN ASIA AND
AFRICA: OWNERSHIP, RESIDENT CHARACTERISTICS,
AND STAFFING
S.Balaswamy1, M.E.Adamek2, 1. Ohio State University,
College of Social Work, Columbus, Ohio, 2. Indiana
University, School of Social Work, Indianapolis, Indiana
The population aging is occurring at a faster pace in devel-
oping countries than in developed countries. By 2030, 80%
of the worlds elders will be living in developing countries.
The demand for congregate long term care (LTC) in develop-
ing countries will accelerate due to the growing number of
frail elders, limited financial security, and lack family sup-
port. Currently, little is known about the policies, programs,
and characteristics of institutional LTC (ILTC) for elders in
developing countries as defined by the UNO. To fill this gap, a
systematic review was conducted using 9 databases and other
non-peer review data sources with various combinations
of the keywords elder care homes, old age homes, nursing
homes and residential facilities to identify research published
since 2000. Data was analyzed from 83 empirical sources on
ILTC for elders in developing countries to assess the resident
characteristics, funding source, and staffing. Findings confirm
great diversity in provision of ILT among developing coun-
tries. Asian countries far excel in ILTC polices and program
(e.g. Hong Kong, Singapore, Taiwan) than other countries
in Asian (e.g. Bangladesh, Pakistan, India, Philippines) and
Africa. However, the characteristics of ILTC elderly residents
(women, poor, chronic illnesses, disabled, very old, dementia
diagnosis, developmental disabilities, mental illness), lim-
ited skilled staff (nurses, physicians), funding sources (gov-
ernment, NGO & Private) are common in most countries.
Based on this review, recommendations are made for future
research, policy, practice and educational training to improve
LTC. Collaborative international partnerships are needed to
develop solutions to the global gap in LTC.
COMMUNITY-ENGAGED SERVICE LEARNING
HELPS RECENT REFUGEE ELDERS RECONSTRUCT
IDENTITY AND WORTH
L.M.Holley, M.Patton, M.Marx, Gerontology, University
of Nebraska Omaha, Omaha, Nebraska
During Fall 2016 the University of Nebraska at Omaha
partnered with a local non-profit branch of a worldwide
faith-based refugee relief organization to design and test
Innovation in Aging, 2017, Vol. 1, No. S1
a project to facilitate recent refugee elders adjustments to
America and to speed and deepen student understanding
of human geography and the refugee experience. Student
project participants were an honors cohort of freshmen
enrolled in a gerontology course that was linked with an
course. Elder refugee participants were from Afghanistan,
Bhutan, Burma, and Sudan four different regions of
the world. The theoretical foundation of the project was
Butlers basic work in the therapeutic value of life review.
The goal of the project was for each student team (with
an interpreter and a faculty member) to conduct lifespan
review interviews of their elder that explained how and
why the elder came to America, and to develop the elders
story into a brief but expandable book. Results of the first
phase of project evaluation indicate that outcomes of the
project include strengthening the elders feelings of worth
and agency, and deepening student understandings of
both their home culture and that of the elder. This poster
describes the model sufficiently to support consideration
of its replication by other educational institutions in other
communities. Given the domestic and global impact of
recent developments in US immigration policies and prac-
tices, dissemination of this useful model seems imperative.
RESIDENTS STRENGTHS AND INFLUENCING
FEATURES IN ASUPER-AGED SOCIAL HOUSING
COMMUNITY
Y.Matsuoka4, M.Saito2, R.Wada3, M.Akiyama1, 1. Health
Consultation Center KURASHI NO HOKENSHITU,
Tokyo, Japan, 2. Tokyo kasei University, Department
of Nursing, Tokyo, Japan, 3. Tokyo Kasei University,
Department of Home Economics, Tokyo, Japan, 4. Tokyo
Kasei University, Department of Humanities and Science,
Tokyo, Japan
Purpose: This study aims to clarify the perceived dif-
ficulties and strengths of residents for aging in place in a
super-aged social housing community and to explore the fea-
tures influencing those difficulties and strengths. The Social
housing community studied has been owned by the Tokyo
Metropolitan Government since 1960, and its residents have
a greater than 50% aging rate.
Data Collection: Using a mixed method approach, we
conducted five focus group interviews with 44 residents and
examined this result with a quantitative questionnaire survey
given to all 3,150 households.
Methods and Results: The response rate was 33.9%,
1,069 respondents. Through factor analysis with varimax
rotation, we found four valid factors: desire to age in place,
mutual aid spirit, difficulties due to super aged society, and
ambiguous anxiety, which were composed from 24 concepts
derived from the interviews. All Cronbachs alpha were over
0.6. We also found five features of the residents: long term
residence, many old single households, good social contact,
little use of public facilities, and low income. After multi-
variable step-wise regression analysis between each factors
score (dependent variable) and the five features (independ-
ent variables), the long term residence showed a significant
influence on the aging in place factor (beta=.214, p<.01), and
good social contact showed a significant influence on the
mutual aid factor (beta=.174, p<.01).
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Implications: Many researchers investigate super-aged
societies without focusing on the residents strengths, which
we can empower efficiently for aging in place by promoting
good social contacts among long-term residents.
INVESTIGATING COMMUNITY PSYCHOSOCIAL
CARE FOR RURAL ELDERS WITH EARLY-STAGE
DEMENTIA
F.Chen, National Chung Cheng University, Chiayi County,
Taiwan
Early intervention for dementia is beneficial, but provid-
ing adequate care for elders with early-stage dementia is
challenging, especially in rural areas. The study focuses on a
newly developed and well-received program in Taiwan where
intervention is delivered via a community care station in
rural communities. To unpack the inner workings of the pro-
gram and to derive a blueprint for the care model, the study
aims to: (a) identify the goals and objectives of the commu-
nity care station, (b) investigate the roles and functions of
the stakeholders, and (c) construct conceptual frameworks
of practice in the model, taking into account influences at
both individual and structural levels. This qualitative study
was conducted in a community care station primarily led
by a community development center and local volunteers.
The researcher conducted field observation and in-depth
interviews with people from the primary stakeholder groups
involved in the care station, including the elders, their car-
egivers, professionals, and volunteers for their perceptions
and experiences. Findings showed that the station relied
heavily on the collaboration among stakeholder groups,
and their interactions created an uplifting atmosphere and a
healing environment. They used various approaches to inte-
grating local customs and mobilizing community resources.
By recruiting professionals support, the community care
station provided health promotion activities. Additionally,
the station provided family caregivers with respite support.
Essentially, it was a model developed in the community and
delivered by the community, which materializes aging-in-
place, and fosters the potential of sustainability, important
qualities to target in the search of long-term care models.
CAREGIVERS BURDEN AND EDUCATION LEVEL:
DOES SUBJECTIVE HEALTH MEDIATE THE
ASSOCIATION?
S.Schnitzer2, M.Oedekoven2, K.Amin-Kotb2, P.Gellert2, in-depth interviews with three tiers of facilities. The prelimi-
K.Balke1, A.Kuhlmey2, 1. National Association of
Statutory Health Insurance Physicians, Berlin, Germany, 2.
Department of Medical Sociology, Charit Berlin, Berlin,
Germany
The present study investigated the following hypoth-
eses: (1) Caregivers with high educational attainment show
lower levels of perceived physical and mental burden than
caregivers with low education. (2) The association between
the caregivers perceived burden and their education level
is mediated by their subjective health status. The analy-
sis was based on a population survey of 6087 residents of
Germany aged 18 and over. 966 persons were identified as
caregivers. Burden of caregiving, socio-demographic char-
acteristics and subjective health were assessed using stand-
ardised questionnaires. Logistic regression and mediation
analyses were performed. 50% of all caregivers reported
an increased physical burden, while 71% felt mentally
IAGG 2017 World Congress
447
burdened. Caregivers with a higher level of education had
lower odds of feeling physically burdened by caregiving
(OR: 0.66; CI: 0.480.92). This association diminished,
if additionally adjusted for health status. Persons with a
higher education level had increased odds of feeling men-
tally burdened by caregiving compared with caregivers with
lower education level even after adjustment for health
parameters. In both models, subjective health was found
to have a significant mediation effect, explaining 55% and
22%, respectively, of the total effect. Better educated car-
egivers had lower odds of feeling physically burdened by
caregiving; this was related to their good health status. The
greater mental burden of caregivers with a higher educa-
tion level may result from feared losses of autonomy, which
increase with higher investment in education. Support and
counselling services should therefore be optimised, taking
account of socioeconomic status, so that solutions tailored
to caregivers individual circumstances are provided.
MOVING FROM FRAGMENTED TOWARD AN
INTEGRATED SYSTEM: ANEW LONG-TERM CARE
POLICY IN FAST-AGING COUNTRY
T.Chiu1, H.Yu1, W.Lai2, H.Li3, E.Tsai4, Y.Chen1, 1.
Institute of Health Policy and Management, National
Taiwan University, Taipei, Taiwan, 2. Central Taiwan Joint
Services Center, Executive Yuan, Taichung, Taiwan, 3.
Quixotic Implement Foundation, Nantou, Taiwan, 4. Shuan
Lien Social Welfare Foundation, Taipei, Taiwan
Taiwan, one of the fastest aging countries in the world,
started its first long-term care (LTC) plan, version 1.0, in
2008. In 2017, the LTC plan version 2.0 began a new era
with the goal of integrating Taiwans fragmented LTC ser-
vice system. The new plan aims to establish an integrated
community-based LTC system with health care and disabil-
ity prevention care included. The model comprises three tiers
of service agencies, including community-based integrated
service centers with a day care center as base (Tier A: flag-
ship stores); service centers with specialties (Tier B: specialty
stores); and LTC stations targeting frail community-dwelling
older adults and providing drop-in services toward prevent-
ing further disabilities (Tier C: corner stores). In the new plan,
the role of Tier Astores needs to coordinate the LTC services
provided by Tier B and Tier C stores. Our study explored the
challenges to implementing LTC plan version 2.0 through
nary findings show four major challenges to implementing
LTC plan version 2.0: (1) First, although three tiers of ser-
vice are defined, the plan lacks a mechanism for integration
across tiers. (2) The mechanism for payment across different
tiers was unclear, which may jeopardize the integration of
services. (3) The role and function of Tier C stores in the new
plan also seemed unclear. (4) LTC plan version 1.0 remains a
challenge for version 2.0.
PARTICIPATORY RESEARCH WITH MOBILITY
ASSISTIVE TECHNOLOGY USERS: AUDITS AND
PHOTO DOCUMENTATION
A.N.Mahmood1, C.Bigonnesse1, T.Mahal1,
L.Kleinschroth1, B.Mortenson2, K.Martin Ginis2,
1. Gerontology, Simon Fraser University, Vancouver,
Manitoba, Canada, 2. University of British Columbia,
Vancouver, British Columbia, Canada
448
Context: The neighbourhood environment influences
mobility and participation of older adults especially those
using mobility assistive technology (AT). Documentation
of environmental barriers/facilitators in neighbourhoods
by AT users can enable them to vocalize and advocate
their needs for mobility and participation. Methods: The
89-item Stakeholders Walkability/Wheelability Audit in
Neighbourhoods (SWAN) tool was developed to collect
objective built environmental data across five domains: func-
tionality, safety, destinations, aesthetics and social aspects.
The tool was used by 24 participants with mobility disability
to collect data in three municipalities of Metro Vancouver,
British Columbia in Spring/Summer 2016. The audit was
supplemented by photographs of barriers and facilitators
in these five domains. Results: Audit and photographic data
demonstrated that slopes, absence of or improperly designed
curb cuts posed mobility hazards. This was further aggra-
vated by uneven and poorly maintained sidewalks. AT users
felt unsafe in areas shared with cars and bikes. Public spaces,
amenities and street furniture, when present, were not always
accessible creating participation barriers. Participants show-
cased these findings to other stakeholders at forums in their
cities to highlight the need for more accessibly designed
streets, sidewalks and infrastructure. The forums helped start
the dialogue among different stakeholders to identify oppor-
tunities for partnerships and interventions. Conclusion: The
SWAN tool is a resource for diverse groups of older adults to
systematically document their neighbourhood environment
with audits and photographs and engage other stakeholders
to initiate environmental changes in their communities. The
process can help them to be informed partners in neighbour-
hood physical planning and decision-making processes.
VOLUNTEERING AS PRO-SOCIAL BEHAVIOUR IN
OLDER ADULTS: APHOTOVOICE EXPLORATION OF
PARTICIPATION
A.N.Mahmood1, J.C.Lay2, S.Petrozzi3, C.A.Hoppmann2, 1.
Gerontology, Simon Fraser University, Vancouver, Manitoba,
Canada, 2. University of British Columbia, Vancouver, British
Columbia, Canada, 3. Kitsilano Neighbourhood House,
Vancouver, British Columbia, Canada
The purpose of this community based research is to bet-
ter understand the motivations and facilitators of volunteer-
ing as older adults engage in their typical life routines and
environments. As part of a mixed-method multi-year project,
this paper presents findings from the participatory photo-
elicitation part of the study. Data from a community sample
of 100 adults aged 5185 years living in Metro Vancouver
is presented here. During a 10-day period, participants used
iPad minis to capture photos representing prosocial behav-
iour (i.e. to give of themselves to others) opportunities they
encountered in their daily activities. They used the photos to
reflect on their experiences by making voice recordings and
completing questionnaires at the end of each day. Each partic-
ipant captured, on average, 14 photos (range 4 - 55). Findings
reveal that the majority (87 %) of photos captured times
when participants chose to engage, rather than refrain, from
behaving prosocially. Photo descriptions revealed a range of
prosocial behaviours, e.g., support with instrumental activi-
ties of daily living (IADL), volunteer activities for organi-
zations, symbiotic (reciprocal) social support, small acts of
kindness, teaching activities, and support with activities of
Innovation in Aging, 2017, Vol. 1, No. S1
daily living (ADL). Prosocial behaviour were typically with
friends and family or those in a formal caregiving arrange-
ment, but also included service providers and strangers. The
findings demonstrate that a variety of volunteer pro-social
behaviour takes place in diverse formal and informal social
contexts. This finding will help develop community-based
intergenerational programs for diverse groups of older adults.
MEASURING QUALITY IN THE UNITED STATES
(U.S.) PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY (PACE)
M.Stewart1, K.McNealy2, N.Dunton3, 1. Econometrica,
Inc, Bethesda, Maryland, 2. Sundance Research Institute,
Sundance, Wyoming, 3. University of Kansas, Kansas City,
Kansas
PACE provides comprehensive medical and social services
to certain frail, community-dwelling elderly individuals in
the U.S., most of whom are dually-eligible for Medicare and
Medicaid benefits. An interdisciplinary team of health pro-
fessionals works with PACE participants to coordinate care;
the comprehensive service package enables them to remain
in the community rather than receive care in a nursing home.
Econometrica, under contract to the Centers for Medicare
and Medicaid Service (CMS), is developing quality measures
for PACE nationwide. This late-breaker will summarize
efforts to date to develop, specify, and test the following
performance measures relevant to PACE Organizations and
their participants:
Fall Rate
Falls With Injury Rate
Pressure Ulcer Prevalence Rate
Pressure Ulcer Prevention Set for Participants With
Pressure Ulcers
30-Day All-Cause Readmission Rate
Percent of Participants with Advance Directive/Surrogate
Decision Maker
Percent of Participants with Annual Review of Advance
Directive/Surrogate Decision Maker
Percent of Participants Not in Nursing Homes
Percent of Participants with Depression Receiving
Treatment
Influenza Immunization
Staff Influenza Immunization
Pneumococcal Immunization
Emergency Department Utilization
All of the above measures are at different phases of devel-
opment, which will be detailed in the poster along with the
high level steps of endorsement by the National Quality
Forum (NQF) in the U.S. Given the increasing interest inter-
nationally in the PACE model, the authors believe attend-
ees will be curious about both the model and the intent to
develop measures that are meaningful given the uniqueness
of PACE.
REMOTE MONITORING TECHNOLOGIES IN LONG-
TERM CARE, CARE TEAM ORGANIZATION, AND
TRAINING
J.Spetz, A.Kottek, University of California, San Francisco,
San Francisco, California
Remote monitoring programs aim to enhance the
patients and providers surveillance of chronic conditions to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
anticipate and identify exacerbations, thus avoiding unnec-
essary emergency room visits, re-hospitalizations, surgeries,
premature death, and excess costs. This study, which reports
newly-completed qualitative data analysis, examines how
remote monitoring programs are preparing and leveraging
the health care workforce to manage patients with chronic
illness and long-term care needs who are living at home. We
conducted 20 semi-structured interviews with health care
providers, managers/administrators, and technicians who are
part of care teams that utilize remote monitoring technolo-
gies, and with authors of research trials investigating remote
monitoring technologies. Amultidisciplinary team approach
was associated with more positive biometric and health
care system outcomes. Because registered nurses experi-
ence allows them the independence to perform assessments
while simultaneously communicating and acting upon data,
they are the primary health professionals involved in remote
monitoring programs in the United States, with lower-skill
health workers providing support. Arange of clinical experi-
ence and skills are critical for successful telemonitoring pro-
grams. Nurses must rely on critical thinking skills and their
ability to verbally assess patients, ask the right questions, and
make clinical judgments. Protocols that include customizing
parameters to the patient, close monitoring, and case man-
agement with input from the whole care team appear to be
the best approach. To fully achieve the potential of remote
monitoring, programs should invest robustly in training. An
expanded effort to share information across remote monitor-
ing programs would accelerate learning and enhance success.
FACTORS OF BURNOUT AND ITS SOCIO-
DEMOGRAPHIC CHARACTERISTICS AMONG STAFF
IN LOCAL CENTERS IN JAPAN
M.Ohwa, H.Ishikawa, School of Human Welfare Studies,
Kwansei Gakuin University, Nishinomiya, Hyogo, Japan
Comprehensive Community Support Centers (CCSC) in
Japan were established when LTCI Law was revised in 2006.
The number of CCSC has been increasing and it is neces-
sary to improve the quality of professional staff in CCSC
because they have to work with various and complicated
cases. This study aims to clarify factor structures of burnout
and describe its socio-demographic characteristics among
professional staff in CCSC in Japan.
Subjects were selected randomly and the survey was con-
ducted by mail in February, 2011. There were 1145 respond-
ents from social workers, care managers, and nurses who
were working in CCSC. The revised Japanese version of the
Maslach Burnout Inventory (MBI) was used as a dependent
variable. Organizational factors such as social support, locus
of control and so forth, were independent variables.
As a result of principal factor analysis, three factors such
as emotional exhaustion, depersonalization, and per- living, care, nutritional, and social needs of older adults. We
sonal accomplishment were extracted with 15 items. The
reliability (cronbachs alpha) was 0.794 for EE, 0.810 for
DP, and 0.811 for PA. The results of one-way ANOVA using
burnout scores by socio-demographic variables showed that
there was a significant difference of their ages and years of
experience.
The result indicated that three factors of burnout were
extracted in this study. There was no significant difference
among three professionals such as social workers, senior care
IAGG 2017 World Congress
449
managers, and nurses. There was a significant difference of
ages and years of experience. This result suggested that it
has been necessary for local authorities to put experienced
professionals in position in CCSC.
DETERMINANTS OF JOB-SEEKING STATUS AMONG
THE ELDERLY IN TOKYO
S.Watanabe1, Y.Fujiwara2, K.Nonaka2, M.Kuraoka2,
E.Kobayashi2, U.Minami2, 1. Graduate School of
Gerontology, J.F. Oberlin University, Shiki, Saitama, Japan,
2. Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan
In Japan, the labor force participation rate between ages
65 to 69 are 52.2% for males and 31.6% for females in 2015.
National survey showed that furthermore 32% of males and
24% of females can work depending on conditions for this
age group. Promotion of employment for the elderly has
become a major issue in Japan. To identify the job-seeking
status among the elderly in Japan, we conducted a mail sur-
vey with questions about demographics, personal status,
social activities, economic status, WHO-5, self-rated health,
instrumental activities of daily living (IADL score of TMIG
Index of Competence), and job-seeking status to 3261 people
randomly extracted from 6584years old residents in Tokyo
in 2016. We used data of 920 non-working people (338 male
and 582 female) with a mean age of 74.3 (SD=5.6), exclud-
ing 400 working people out of 1320 who responded in all
items. Only 53 people (5.8%) out of 920 were in job seeking.
Binominal logistic analysis was conducted with job-seeking
status as the dependent variable, with gender, age, educational
status, economic status, number of chronic diseases, WHO-5,
self-rated health and IADL score as independent variables.
Only gender (male/female, RR=1.94), age (RR=0.842), and
economic status (borderline/secure, RR=2.77, be in difficul-
ties/secure, RR=9.97) were significantly related to job seek-
ing status. It was thought that the working motivation of the
elderly in Japan was very high, but job-seeking behavior rate
was not so high. The study findings suggested that economic
poverty was more important factor than functional capacity
for job-seeking behavior.
ADULT DAY CENTRES AND THEIR OUTCOMES ON
CLIENTS, CAREGIVERS, AND THE HEALTH SYSTEM:
ASCOPING REVIEW
M.Ellen1,2,3, P.Demaio3, A.Lang4, M.G.Wilson3, 1.
Jerusalem College of Technology, Jerusalem, Israel, 2.
University of Toronto, Toronto, Ontario, Canada, 3.
McMaster University, Hamilton, Ontario, Canada, 4.
McGill University, Montreal, Quebec, Canada
Purpose of the study: Adult day centers (ADCs) offer a
heterogeneous group of services that provide for the daily
sought to conceptually map and identify key gaps and find-
ings from literature focused on ADCs, including the types
of programs that exist and their associated outcomes on
improving health and strengthening health systems.
Design and Methods: We conducted a scoping review by
searching five databases for studies evaluating the outcomes
of ADCs specifically for community-dwelling older adults.
Included studies were conceptually mapped according to the
methods used, type of outcome(s) assessed, study population,
450
disease focus, service focus, and health system considera-
tions. The mapping was used to derive descriptive analyses
to profile the available literature in the area.
Results: ADC use has positive health-related, social, psy-
chological and behavioral outcomes for care recipients and
caregivers. There is a substantial amount of literature avail-
able on some ADC use outcomes, such as health-related,
satisfaction-related and psychological and behavioral out-
comes, while less research exists on issues of accessibility and
cost-effectiveness.
Implications: As the population ages, policymakers must
carefully consider how ADCs can best serve each user and
their caregivers with their unique circumstances. ADCs have
the potential to help shape health system interventions, espe-
cially those targeting caregivers and people requiring long-
term care support. Due to the variation among types of ADC
programs, future research on ADCs should consider different
characteristics of ADC programs to better contextualize their
results.
COMMUNITY-LEVEL SOCIAL CAPITAL AND SOCIAL
ISOLATION IN JAPAN: AMULTILEVEL PANEL STUDY
M.Saito1,2, K.Kondo3,4,2, J.Aida5, N.Kondo6, T.Ojima7, 1. rural United States, a multi-ethnic urban community in the
Faculty of social welfare, Nihon Fukushi University, Chita-
gun, Aichi, Japan, 2. Center for well-being and society,
Nihon Fukushi University, Nagoya-shi, Aichi, Japan, 3.
Center for Preventive Medical Sciences, Chiba University,
Chiba-shi, Chiba, Japan, 4. Center for Gerontology
and Social Science, National Center for Geriatrics and
Gerontology, Obu-shi, Aichi, Japan, 5. Department of
International and Community Oral Health, Tohoku
University Graduate School of Dentistry, Sendai-shi, Miyagi,
Japan, 6. Department of Health and Social Behavior, School
of Public Health, The University of Tokyo, Bunkyo-ku,
Tokyo, Japan, 7. Department of Community Health and
Preventive Medicine, Hamamatsu University School of
Medicine, Hamamatsu-shi, Shizuoka, Japan
Social isolation, which can result in solitary death, is one
of major problem in Japan. Although individual character-
istics among isolated individuals have been revealed, com-
munity-level factors remain unclear. Therefore, we examine
the association between social isolation and community-level
social capital. We used longitudinal panel data from 2010
and 2013 from the Japan Gerontological Evaluation Study,
a nationwide survey involving 58,683 functionally inde-
pendent older people nested within 381 communities. We
defined social isolation as contact with friends less than a
few times a year. Respondents were categorized to con-
tinuous non-isolation, change to isolation, continuous
isolation, and change to non-isolation. Social capital was
measured by community-level health related social capital
scale including civic participation, social cohesion, and reci-
procity (Saito etal. 2017)from the 2010 survey. Multi-level
Poisson regression analysis was adopted, controlling for indi-
vidual-level social capital, age, sex, educational attainment,
marital status, IADL, household income, and population
density. A marked difference was observed in the propor-
tion of change to isolation at the community level (3.1%
to 40.4%; mean: 14.8%). In addition, each individual-level
social capital dimension showed protective associations
with change to isolation and change to non-isolation.
Innovation in Aging, 2017, Vol. 1, No. S1
Furthermore, even after controlling for the above variables,
protective associations were observed between community-
level reciprocity scores and change to isolation (prevalence
ratio: 0.95, 95% confidence interval: 0.880.97). On the
other hand, no association was found between community-
level social capital and change to non-isolation. These
results suggest the potential of a population approach for the
prevention of social isolation among older people.
CROSS-NATIONAL COMMUNITY CASE STUDIES OF
RESILIENCE AND AGING
L.Skemp, Niehoff School of Nursing, Loyola University
Chicago, Chicago, Illinois
Resilience, the ability to recover from difficult or challeng-
ing situations is inherent to healthy aging. Contextual and
social determinants of health influence the cultural capital
that communities can access and resources that individuals
might use to respond to aging challenges. This is particularly
important in communities that are managing the double bur-
den of disease, outmigration of the young and environmental
uncertainty. Three ethnographic community case studies are
described and compared; an immigrant community in the
United States, and a rural Caribbean village. A description
of the contextual background, life experiences and social
networks of typical elders within these communities high-
light the importance of neighbors, friends, family, and social
organizations (both formal and informal) to resilience and
aging. Contextual factors of social, political and economic
uncertainty are highlighted. Conversely, inflexible social
structures and rigid rules, impact on resilience of communi-
ties and individuals. Discussion and comparison of evidence-
based community capacity building programs provides
insight into how local community capacity emerges within
diverse cultural contexts. Recommendations for culturally
informed research, policy, and practice are highlighted.
FURTHER EDUCATION ON ABUSE OF PATIENTS IN
NEED OF LONG-TERM CARE: DEMAND AMONG
GERMAN FAMILY DOCTORS
P.Schnapp1, A.Berzlanovich2, S.Eggert1, R.Suhr1, 1. Center
for Quality in Care, Berlin, Berlin, Germany, 2. Medical
University of Vienna, Vienna, Austria
Previous surveys have asked local and regional samples of
physicians about their demand for further education about
elder abuse, and found majorities of respondents indicat-
ing such demand. We present results from the first nation-
ally representative study of this topic. We focus on education
about physical restraint and neglect of patients in need of
long-term care. A postal survey of a probability sample of
German family physicians was conducted. Respondents
were randomly assigned to receive a questionnaire on either
restraint or neglect, with analogous content in both ques-
tionnaires. Questionnaires had been pretested and their psy-
chometric properties optimized. Response rates are 17%
(n=253) for restraint and 19% (n=284) for neglect. About
half of the respondents express an interest in education, with
the share significantly higher for neglect than for restraint.
Relative interest in specific topics is similar across conditions,
with the topic distinguishing signs of abuse from symptoms
due to other causes the most popular. In logistic regressions,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
significant predictors of interest are attitudes towards pre-
venting abuse of patients in need of long-term care as the
family physicians responsibility, lack of confidence in ones
abilities to tackle such abuse (both conditions), the propor-
tion of the respondents patients who are in need of long-
term care, and the respondents knowledge about patients
previous victimization (neglect condition only). We conclude
that there is high interest in education about these topics and
call for research that examines whether relatively positive
attitudes towards restraint are due to a lack of knowledge
about alternatives.
THE STRUCTURE OF PROFESSIONAL ADVICE
NETWORKS IN LONG-TERM CARE: INFLUENCES
AND IMPLICATIONS
J.Keefe1, J.Meng2, J.E.Squires3,4, M.Doupe5, C.Reid6, viduals who were informal sources of advice about quality
G.Cummings7, J.A.Knopp-Sihota8, C.A.Estabrooks7, 1.
Mount Saint Vincent University, Halifax, Nova Scotia,
Canada, 2. Michigan State University, East Lansing,
Michigan, 3. University of Ottawa, Ottawa, Ontario,
Canada, 4. Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada, 5. University of Manitoba, Winnipeg,
Manitoba, Canada, 6. University of British Columbia,
Okanagan, Kelowna, British Columbia, Canada, 7.
University of Alberta, Edmonton, Alberta, Canada, 8.
Athabasca University, Athabasca, Alberta, Canada
The Advice Seeking Networks in Long Term Care Study
used social network analysis to understand the informal
advice networks of senior leaders in Canadian long term care
(LTC), with the goal of using this knowledge to inform future
efforts to more effectively disseminate quality improvement
innovations. In this abstract we describe one main compo-
nent of the study, a quantitative analysis of the structure and
determinants of interpersonal advice networks in the sector.
At each of the 958 LTC facilities spanning 11 of Canadas
13 provinces and territories, we asked one senior leader to
complete a survey identifying individuals who were informal
sources of advice about quality improvement. Using expo-
nential random graph modeling to analyze data from 482
respondents (RR, 52%), we found that a single advice-seek-
ing network appears to span the nation, with opinion lead-
ers and boundary spanners who act as key sources of advice
located in each province and territory. Geographic proximity
exerted a strong effect on network structure, with only 3%
of advice seeking relationships crossing provincial bounda-
ries. The effect of facility owner-operator model was more
modest and varied across regions. Amajority of individuals
(61%) identified as sources of advice in the network were
professionals who were outside our original sample and not
employed in LTC facilities, such as regional and provincial
health administrators.
USING INTER-ORGANIZATIONAL NETWORK
ANALYSIS FOR QUALITY IMPROVEMENT IN LONG-
TERM CARE
A.M.Beacom1, J.Meng2, S.A.Chamberlain1, J.W.Dearing2,
W.B.Berta3, J.Keefe4, J.E.Squires5,6, C.A.Estabrooks1,
1. Faculty of Nursing, University of Alberta, Boston,
Massachusetts, 2. Michigan State University, East Lansing,
Michigan, 3. University of Toronto, Toronto, Ontario,
Canada, 4. Mount Saint Vincent University, Halifax, Nova
IAGG 2017 World Congress
451
Scotia, Canada, 5. University of Ottawa, Ottawa, Ontario,
Canada, 6. Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada
The Advice Seeking Networks in Long Term Care Study
used social network analysis to understand the informal
advice networks of senior leaders in Canadian long term care
(LTC), with the goal of using this knowledge to inform future
efforts to more effectively disseminate quality improvement
innovations. In this abstract we describe one main compo-
nent of the study, a quantitative analysis of the structure
and determinants of inter-organizational advice networks in
the sector, and of how these networks compare with inter-
personal advice networks. At each of the 958 LTC facilities
spanning 11 of Canadas 13 provinces and territories, we
asked one senior leader to complete a survey identifying indi-
improvement, and LTC facilities that were seen as models for
quality care. We used exponential random graph modeling
and quadratic assignment procedure correlation analysis to
analyze data from 482 respondents (RR, 52%). Compared
with interpersonal advice networks, the inter-organizational
networks were more dense and interconnected and featured
more relationships that spanned provincial boundaries. As in
the interpersonal networks, opinion leading and boundary
spanning LTC facilities were identified in all provinces and
regions, but opinion leadership in the inter-organizational
networks was more centralized around a smaller number of
facilities recognized as exemplars of quality residential care.
These differences between the two types of advice networks
suggest the value of understanding and utilizing both to dis-
seminate best practices throughout the sector.
POPULATION AGING AND THE GLOBAL ECONOMY:
WEAKENING DEMOGRAPHIC TAILWINDS REDUCE
ECONOMIC GROWTH
D.Baxter2, G.Donehower1, W.H.Dow1, R.D.Lee1, 1.
School of Public Health, University of California at
Berkeley, Berkeley, California, 2. Baxter Consulting,
Berkeley, California
Expansion of the working age population has been a
powerful engine of the global economy in recent decades,
with the resulting demographic tailwinds accounting for
48% of annual economic growth from 19902015. These
tailwinds will slow, however, with rapid global aging in
upcoming decades. Building on detailed country-specific
economic models and data on age profiles of labor, con-
sumption and savings from the National Transfer Accounts
project, we estimate how population changes will affect
national incomes to 2040 under likely future demographic
scenarios. We predict that global demographic tailwinds
will be only 31% as strong in the 20152040 period as
compared to 19902015. Tailwinds that added 1.3% per
year to global economic growth during 19902015 will
drop to only 0.4% per year from 20152040. Cumulatively,
this projection implies that the global economy in 2040
will be 20% smaller under projected 20152040 popu-
lation trends than it would have been if the population
trends of 19902015 had continued. In the United States,
tailwinds will drop by 0.8% per year, only slightly better
than the 0.9% drop in other high income countries. Many
low and middle income countries will experience similar
452
slowdowns to economic growth, although countries earlier
in the demographic transition will see rising demographi-
cally-driven economic growth, such as a 0.4% increase in
Nigerias tailwind. Amajor exception is China, which we
project will transition from a 1.5% annual tailwind to a
0.6% headwind as Chinas working age population actu-
ally began to shrink in 2016.
SESSION 915 (POSTER)
ARTHRITIS
PREDICTORS OF KNEE OSTEOARTHRITIS IN
COMMUNITY-DWELLING OLDER WOMEN:
A4-YEAR LONGITUDINAL STUDY
N.Kojima1, M.Kim1, K.Saito3, H.Yoshida1, H.Hirano1, ber of medication, smoking, drinking, and degree of exercise.
S.Obuchi1, T.Suzuki2, H.Kim1, 1. Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan, 2. National Center
for Geriatrics and Gerontology, Obu, Japan, 3. Yokohama
City University, Yokohama, Japan
The present longitudinal cohort study was conducted
to identify predictors of knee osteoarthritis in commu-
nity-dwelling elderly Japanese women. Baseline data were
collected in the autumn of 2008 and follow-up data were col-
lected in 2012, both at the Tokyo Metropolitan Institute of
Gerontology. One thousand two hundred eighty-nine women
aged 7585years living in Itabashi Ward, Tokyo, participated
in the baseline assessment; subsequently, 992 participants
with no history of knee osteoarthritis at baseline were reex-
amined after 4years. The follow-up assessment included 952
participants, 867 of whom provided information about knee
osteoarthritis. Baseline assessment included measurements
of anthropometry, physical fitness, blood components, life-
style, and past history of diseases. Alogistic regression analy-
sis incorporating age and history of diseases as moderator
variables (forced entry method) revealed that a higher body
mass index (22.25kg/m2), slower walking speed (78.94 m/
min), lower serum albumin level (<4.1g/dL), higher serum
creatinine level (>0.56mg/dL), higher HbA1C (5.4 %), and
low frequency of soy product consumption (once/2days) at
baseline were independent predictive factors of knee osteo-
arthritis incidence during the 4-year follow-up period. This
prospective cohort study suggested that parameters related
to obesity, decline of motor, hepatic, and renal functions, and
westernized dietary culture compose the causes of knee OA
incidence in Japanese elderly women. These results could
contribute to the design of knee OA prevention programs for
elderly women.
COMPARISON OF PHYSICAL FUNCTION BETWEEN
FALLERS AND NON-FALLERS AMONG OLDER
ADULTS WITH ARTHRITIS
J.Kim, M.Lee, J.Song, Korea University, Seoul, Korea (the
Republic of)
Falls are the second leading cause of accidental death
worldwide and are major cause of personal injury, espe-
cially for older people. Although arthritis has been iden-
tified as one of the risk factors of falls and its prevalence
increases with age, there has been little information about
Innovation in Aging, 2017, Vol. 1, No. S1
risk factors of falls for this group of population. The pur-
pose of this study was to identify risk factors of falls, par-
ticularly physical function aspects, among older adults with
arthritis. Using a sample of 3491 community-dwelling older
adults with arthritis from the 2014 Korean National Older
Adults Life Survey, this study investigated level of physical
function of the subjects by comparing fallers (n=1174) from
non-fallers (n=2317) group. Physical function of the subjects
was evaluated by the Korean versions of Activity of Daily
Living (K-ADL) and Instrument of Activity of Daily Living
(K-IADL). Independent sample t-tests, ANOVAs, and Chi-
square tests were mainly used. Significant differences (p<.01)
between fallers and non-fallers were found for demographic
and general characteristics such as age, sex, living with
spouse, number of generations with living, education, work-
ing status, economic status, diagnosis with dementia, num-
Fallers had significantly (p<.0001) more ADL and IADL
limitation (13.54% and 31.91%, respectively) compared to
non-fallers (7.18% and 21.37%, respectively). The findings
of this study suggest that interventions to promote physical
function would be beneficial to prevent falls of older adults
with arthritis. Correspondence to Jun-Ah Song (jasong@
korea.ac.kr).
PSYCHOLOGICAL STATUS MEDIATES THE BIPHASIC
RELATIONSHIP BETWEEN OSTEOARTHRITIS AND
FALLS
S.Mat3, C.Ng2,1, M.Tan 4, 1. Department of Rheumatology
& Immunology, Singapore General Hospital, Singapore,
Singapore, 2. Duke-NUS Medical School, Singapore,
Singapore, 3. Ageing and Age-Associated Disorders
Research Group, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia, 4. Division of Geriatric
Department, Faculty of Medicine, University of Malayad,
Kuala Lumpur, Malaysia
Several barriers have prevented adequate evaluation of
falls in OA: the lack of homogeneity in OA diagnostic tools
used and the heterogeneous nature of OA itself. Therefore,
a holistic evaluation of OA and falls using analogous OA
definitions to clinical practice is important. This was a case-
control study involving 389 individuals aged 65years (229
fallers, 160 non-fallers). Cases were fallers with 2 falls or
one injurious fall over the past 12 months. Osteoarthritis
was defined using three difference criteria: radiological
(Kellgren-Lawrence (KL)), cinical and self-reported physi-
cian-diagnosed. Severity of symptoms were assessed using
the Western Ontario and McMaster Universities Arthritis
Index (WOMAC) questionnaire. The total WOMAC score
was categorized to asymptomatic, mild, moderate and severe
symptoms. Fear of falling (FoF) and psychological status
were measured with the short falls efficacy scale-interna-
tional (FES-I) and the Depression, Anxiety and Stress Scale
(DASS-21) respectively. Individuals with radiological OA
and mild symptoms had reduced risk of falls compared
to those with no reported symptoms [OR: 0.402 (0.172
0.940), p=0.042]. Individuals with clinical OA and severe
symptoms had increased risk of falls compared to those with
mild OA [OR: 4.487 (1.88310.693), p=0.005]. The rela-
tionship between mild symptoms and reduced risk of falls
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
was attenuated after controlling for increased anxiety, while
the association between severe symptoms among elderly with
clinical OA and falls was no longer statistically significant
when adjusted for increased FoF. Our findings suggest the
previous conflicting evidence on OA and falls is explained
by the apparent biphasic relationship based of different diag-
nostic criteria. The mediating effect of psychological factors
for this relationship emphasize the urgent need to develop
effective treatment strategies for psychological factors associ-
ated with falls.
CULTURAL ADAPTATION OF FIT & STRONG! FOR
PORTUGUESE OLDER ADULTSFIRST STEPS
N.Duarte1,2, S.L.Hughes3, M.Paul1,2, 1. UNIFAI (ICBAS- its impact when associated morbidities and walking disabil-
University of Porto), Porto, Portugal, 2. CINTESIS, Porto,
Portugal, 3. University of Illinois Chicago, Chicago, Illinois
Osteoarthritis (OA) is a major cause of disability in
older adults world-wide. Fit & Strong! (F&S) is an 8-week
evidence-based physical activity program for older adults
with OA that has significantly improved strength and
mobility out to 18 months (Hughes et al., 2010). We are
currently translating the program in Portugal. We have
translated the program manual and materials and are
examining acceptability using focus groups with partici-
pants, providers and experts, followed by a randomized
pilot of the adapted program. The participant focus group
examined opinions about group exercise, characteris-
tics of F&S, knowledge of arthritis, barriers to exercise,
and the advantages of translating the program name into
Portuguese. Participants were a convenience sample from
a Day Care Center with lower extremity joint pain (n=11;
54.5% female), a mean age of 79.5 (SD=8.0), 54.5% of
whom attended school for 4years. Results indicated good
receptivity to the program with schedule being the main
concern identified. Participants reinforced the importance
of having music during the sessions, and suggested changes
in the program name. These results and those forthcom-
ing from focus groups with providers and experts, and the
pilot, will help to inform the cultural adaptation of the
program, its implementation and evaluation.
ENVIRONMENTAL FACTORS AND ONSET OF
RESTRICTED MOBILITY OUTDOORS IN OLDER
ADULTS WITH OSTEOARTHRITIS
M.Rantakokko1, R.Wilkie2, 1. Gerontology Research
Centre, University of Jyvaskyla, Jyvaskyla, Finland, 2.
Research Institute for Primary Care Sciences, Keele
University, Staffordshire, United Kingdom
The study examines how environmental factors con-
tribute to the onset of restricted mobility outside the home
among older adults with osteoarthritis. This was a prospec-
tive cohort study of adults aged 50years and over with osteo-
arthritis (N=1802). Logistic regression tested the association
between the onset of restricted mobility outside the home
and health, sociodemographic and perceived environmental
barriers (hills and steep slopes, inaccessible public buildings,
poor pavement condition, lack of access to public parks
or sport facilities, heavy traffic or speeding cars, and poor
weather). The potential moderating role of environmental
IAGG 2017 World Congress
453
barriers on the association between health factors and onset
was examined using interaction terms and stratified analysis.
Of 1802 participants, 13.5% (n=243) reported the onset of
restricted mobility outside the home at three-year follow-up.
Walking disability, anxiety, depression, cognitive impairment
and obesity, and all environmental barriers were associated
with onset after adjustment for confounders. There were
significant but less than multiplicative interactions between
hills and steep slopes that make it difficult to move outdoors
with walking disability (p=.030), anxiety (p=.037), depres-
sion (p=.002) and cognitive impairment (p=.029); poor pave-
ment conditions and anxiety (p=.036), and heavy traffic or
speeding cars and depression (p=.036). For older adults with
osteoarthritis, environmental barriers have a greater role on
ity exist. Awareness of environmental barriers is important
when aiming to maintain mobility and activities outside the
home despite health conditions in older adults.
ALTERATIONS IN STEPPING KINETICS AND
LEG STRENGTH ARE ASSOCIATED WITH KNEE
ARTHRITIS ASYMMETRIES
T.Gonzales1, H.J.Hernandez1, B.A.Seamon1,
D.Pennington1, V.McIntosh1, M.R.Blackman1,2,3,
M.Harris-Love1, 1. Clinical Research Center, Washington
DC VA Medical Center, Washington, District of Columbia,
2. School of Medicine and Health Sciences, George
Washington University, Washington, District of Columbia,
3. School of Medicine, Georgetown University, Washington,
District of Columbia
Knee osteoarthritis (OA) is a chronic disease charac-
terized by articular cartilage damage, pain, and weakness.
Ambulating stairs is a leading source of pain in people with
OA, and disease progression may be marked by asymmetrical
gait abnormalities. The purpose of this study was to assess
relative peak knee extension torque and Step-Up-and-Over
(SUO) test performance asymmetries in individuals with
knee OA. Forty-six male Veterans with knee OA (age=61.6
yrs. 5.6) enrolled in the study. Functional performance was
assessed via the SUO test, which involves ascending/descend-
ing an 8-inch box on a force plate. SUO test outcomes
included force-time parameters representing step-up force,
step-down force, and force-time curve smoothness. Peak
torque was measured using isokinetic dynamometry (180
deg/s). Self-reported symptoms and physical function were
evaluated using the Knee injury and Osteoarthritis Outcome
Score (KOOS). Force-time curve smoothness was the only
SUO test outcome significantly different in the less involved
leg (mean=-8.27.55) compared to the more involved leg
(mean = -8.48 .57, p<.001), and was not associated with
KOOS subscale scores. Relative peak torque was greater
in the less involved leg (mean = .27 .12) versus the more
involved leg (mean = .23 .11, p=.019) and was directly
associated with the pain (r=.53, p<.001) and function (r=.41,
p=.006) KOOS subscale scores. While leg strength is an
important component of physical status in those with knee
OA, force-time curve smoothness may reflect an important
aspect of lower-limb motor coordination that affects gait
asymmetries during stair ambulation.
454
SESSION 920 (POSTER)
AVENUES FOR AGING IN PLACE II
ROLE AWARENESS OF HOME-VISIT NURSES IN
MULTIDISCIPLINARY COLLABORATION
M.Kimata, Institute of Gerontology, The University of
Tokyo, Tokyo, Bunkyo-ku, Japan
To elucidate role awareness of home-visit nurses in multi-
disciplinary collaboration to enhance coordination between
home medical and nursing care, self-administered question-
naires were mailed to 145 home visiting nursing station
administrators and home-visit nurses in six municipal dis-
tricts working to enhance coordination between home medi-
cal and nursing care. Survey items included home-visit nurses
characteristics and their reasons for participating in multidis-
ciplinary collaboration. Analysis involved grouping subjects
by years of experience at home visiting nursing stations (<10
or 10years), and using SPSS Statistics Ver. 22 to compare
reasons home-visit nurses participated in multidisciplinary
collaboration. Sixty valid survey responses (41.4%) were
analyzed. Home-visit nurses participated in five multidiscipli-
nary collaboration situations (home medical care promoting
councils, face-to-face meetings, multidisciplinary case confer-
ences, community care conferences, public awareness-raising
events) for six different reasons (resolving multidisciplinary
collaboration problems, acquiring new users, sharing home
medical and nursing care community problems, expanding
home-visit nursing use, improving user care quality, educat-
ing ones own workplace staff). Comparing the results of the
two groups regarding multidisciplinary collaboration situa-
tions and home-visit nurses reasons for participating, those
with 10 years of working experience gave significantly
higher ratings (P<0.05) for: community care conferences in
resolving multidisciplinary collaboration problems; mul-
tidisciplinary case conferences, community care conferences
and public awareness-raising events in sharing home medi-
cal and nursing care community problems; and home medi-
cal care promoting councils and public awareness-raising
events in expanding home-visit nursing use. Home-visit
nurses with longer working experience were found to par-
ticipate in multidisciplinary collaboration with an awareness
of their different roles.
PROMOTING COMMUNITY-BASED ELDER CARE IN
CHONGQING, CHINA
N.R.Hooyman1, B.B.Cochrane1, T.Luo2, L.Prueher1, less than $30,000/year (p=0.02) were significantly less likely
1. University of Washington, Seattle, Washington, 2.
First Affiliated Hospital Chongqing Medical University,
Chongqing, China
This poster describes an ongoing, community-based, elder
care project involving the University of Washington and the
Seattle-Chongqing Sister City Association in partnership with
the First Affiliated Hospital of Chongqing Medical University
and the Qinggang Senior Care Center in Chongqing, China.
While the number of quality skilled nursing and assisted liv-
ing facilities is growing in Chongqings greater metropolitan
area of around 30 million residents, there are relatively few
community-based services to support older adults aging in
the community near their families and friends. The purpose
Innovation in Aging, 2017, Vol. 1, No. S1
of this partnership is to introduce community-based care
policy and program initiatives -- such as care transition mod-
els, aging friendly and dementia friendly communities, and
evidence-based wellness programs to staff from the hos-
pital and senior care facility and to learn from them about
both the barriers to the implementation of such models and
the strengths offered by other care models in their city. This
multiphase project involves a multidisciplinary group of UW
faculty visiting Chongqing to understand their elder care ser-
vices and introduce current community-based care models;
a Chongqing delegation visiting Seattle to attend a regional
conference on Elder Friendly Futures and visit community-
based services and facilities; a pilot testing of new care mod-
els in Chongqing; and sharing geriatric education programs
and tools for enhancing low-cost elder care networks. This
poster identifies the opportunities and challenges with such
collaborations, lessons learned and strategies relevant to
other groups seeking to develop similar partnerships that
have policy-level implications.
PERCEPTIONS OF AGING IN PLACE: AFOCUS ON
LOW INCOME AND OLDER ADULTS
C.R.Bolkan1, B.Mandal2, E.Kim1, 1. Washington State
University, Vancouver, Washington, 2. Washington State
University, Pullman, Washington
Many initiatives to support aging in place are based
primarily on the views of policy makers, healthcare profes-
sionals, and researchers, rather than on the perspectives of
representative samples of older adults, particularly those
with low incomes who may have limited resources to age
in place. Guided by community-based participatory research
(CBPR) principles, in partnership with local aging services
organizations, we surveyed a representative sample of adults
aged 60+ and family caregivers (N = 363, mean age = 73)
via computer-assisted-telephone interviews (CATI) that
addressed health, caregiving, transportation, access to and
utilization of a variety of community and health services/
resources, community strengths/weaknesses, and other needs
regarding aging in place. We found that most respondents
indicated good/excellent health (67%), despite almost 50%
also reporting at least one chronic condition or serious ill-
ness. This may indicate a future need for expanded support
in remaining at home, yet only 44% of respondents were cur-
rently aware of aging support services in the region. Further,
we found disparities in awareness of aging support services
by education and income: specifically, those with high school
or less education (p=0.04) and with household incomes of
to identify support that could help them to age in place. In
order to develop more effective interventions to support
aging in place for a diverse population of older adults, their
perspectives, experiences, and input must be incorporated
into practice and policy, especially for underserved and hard-
to-reach populations.
MUTUAL SUPPORT HAPPINESS HOMES: AN
ALTERNATIVE FORM OF AGING IN PLACE IN RURAL
CHINA
C.Zhang2, N.Muramatsu1,3, 1. Division of Community
Health Sciences, School of Public Health, University of
Illinois at Chicago, Chicago, Illinois, 2. Division of Social
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Security, College of Humanities and Development Studies,
China Agricultural University, Beijing, China, 3. Institute
for Health Research and Policy, Chicago, Illinois
In 2007 a Mutual Support Happiness Home (MSHH)
emerged as a grass-root movement in a rural village whose
population was rapidly aging. By 2014, 79,521 MSHHs
were established throughout rural China. Despite this rapid
growth, little is known about MSHHs. This study describes
MSHHs history and key features and identifies their cur-
rent challenges and future directions based on a two-month
field research and a literature review. The first MSHH was
born in a building with 12 rooms and 24 beds, converted
from an abandoned primary school. The mission was to have
older empty nesters live together and support each other
to remain in their community as long as possible. This model
appealed to rural governments looking for cost-effective
ways to address rural seniors needs, adult children with filial
responsibilities, and older adults wishing to remain in their
community. MSHHs quickly evolved into a governmental
policy. Funds are provided by central and local governments
for construction, by Village Collectives for daily operation,
and by older residents and families for living and health care
expenses. MSHHs have no paid staff. Older residents serve
as administrators and staff. The agreement co-signed with
the Village Committee facilitates adult children to fulfill their
filial obligation through financial support and regular visits.
MSHHs constitute an innovative and acceptable, yet transi-
tional model for rural communities. To develop MSHHs into
a sustainable model, they should be formally integrated into
a rural old support system to serve as old-care resource cent-
ers for all villagers and informal caregivers.
EXPLORING COMMUNITY LIVING FROM
ALIFECOURSE PERSPECTIVE: TOWARD LIFECOURSE
POLICY OPTIONS
E.Loughlin, National University of Ireland, Galway,
Galway, Ireland
Ageing and disability are part of the lifecourse trajec-
tory, with disability adding another dimension to the ageing
process. Older people and persons with disabilities share a
common vulnerability in respect of community living and in
relation to maintaining autonomy and independence. Further,
the ability of people belonging to each group to connect
and interact is often stifled through inadequate policies that
leave them susceptible to heightened risks of institutionaliza-
tion. The ageing-disability nexus provides the rationale for
greater cooperation between actors in each sector in order to
achieve common goals such as inclusive, accessible and age-
friendly communities. This paper presents the results from
an emerging conceptual framework that has arisen from a
documentary analysis of key Irish and international commu-
nity living law and policy as well as evidence relating to inde-
pendent living, ageing-in-place and the lifecourse. Evidence
from the international literature suggests that older people
and persons with disabilities express a common desire to live
and age in their communities. However, in many countries,
policies have often developed from silo-specific perspectives
that do not necessarily support the aspirations of those for
whom they are enacted. Understanding the conceptualiza-
tion of community living is therefore important for policy
innovation that seeks to support older people and persons
IAGG 2017 World Congress
455
with disabilities to realize, enhance and maintain meaningful
community living. Exploring community living as refracted
through the lens of the lifecourse perspective adds valuable
depth of understanding to the interpretation of the intent
and purpose of policy and how it may be better translated
into practice.
ENVIRONMENTAL DESIGN, ACTIVITY AND
INTERACTION IN CARE FACILITIES FOR OLDER
PEOPLE
S.Nordin1,2, K.McKee1, M.Wallinder1, L.von Koch2,
H.Wijk3, M.Elf1, 1. Department of Education, Health and
Society, Dalarna University, Falun, Sweden, 2. Karolinska
Institutet, Stockholm, Sweden, 3. Gothenburg University,
Gothenburg, Sweden
Older people living in residential care facilities spend
most of their time within the home due to high levels of frail
health and are depending on the physical environment for
their daily life activities and interactions. There is a need for a
deeper understanding on the complex relationships between
older people and the quality of the physical environment in
long-term care. The aim of this study was to explore how
environmental factors influence resident activities and inter-
actions at two care facilities. Amixed-method approach was
applied. The quality of the physical environment was assessed
by the Swedish version of the Sheffield Care Environment
Assessment Matrix (S-SCEAM). Activities and interactions
of older people were assessed through an adapted version of
the Dementia Care Mapping (DCM), and data on residents
emotional states were collected via the Observed Emotion
Rating Scale (OERS). Walk-along interviews with older peo-
ple, care staff and relatives were conducted and field notes
were taken. The results indicate that the environmental
design influenced activities and interactions among older
people. Private apartments and dining areas had high envi-
ronmental quality scores at both care facilities, and safety
aspects was highly supported while the overall layout had
lower quality. Despite high environmental quality in general,
several factors were found to limit residents activities and
interactions. These findings stress the importance of opti-
mising long-term care by focusing on environments that are
accessible and can offer possibilities for residents to use the
facility independently.
BUILDING AN AGING IN PLACE COMMUNITY
IN URBAN SHANGHAI: AN ETHNOGRAPHIC
ASSESMENT OF CCHC MODEL
G.Shen, The Institute of Anthropological and Ethnological
Studies, Fudan University, Shanghai, China
Under the auspices of the Shanghai Municipal
Government, server programs aimed at building ageing in
place communities have been piloted since 2014 for the
purpose of providing community based services for home-
bound elders. In actual practices, however, these well-inten-
tioned programs failed to match the real needs of the ageing
population owing to its lack of service options and narrow
coverage. To address this problem, a Continuing Care
Home-based Community (CCHC) model was piloted in a
designated community in Yangpu District in March 2016.
The CCHC model is essentially a joint venture between the
government and social organizations. With its promises to
456
offer a comprehensive eldercare service package, the CCHC
model is welcomed by the recipients at present. This paper
offers an ethnographic assessment of the likely impact of the
CCHC model on the everyday life of the elders in the com-
munity under study as well as a tentative discussion of its
applicability in the near future.
TRENDS AND PATTERNS OF SELF-REPORTED
ELDERLY MORBIDITY IN KERALA: FUTURE
PROBLEMS AND POLICY PROSPECTS
K.Paul1, R.Sengupta2, 1. Tata Institute of Social Sciences,
Mumbai, Mumbai, Maharashtra, India, 2. Jawaharlal Nehru
University, Delhi, Delhi, India
Kerala has achieved highest rank on literacy rate, life
expectancy, emigration, HDI index and wage rates in India.
The state is currently undergoing an epidemiological transi-
tion with a swift change in the disease profile of its popula-
tion. We analyzed the trend and pattern of the burden of
self-reported elderly morbidity (ICD classification) in the
states of Kerala using three rounds of (52nd, 60th, and 71st)
NSSO data. Descriptive analysis is carried out to understand
the prevalence of self-reported morbidity variation over
a period of two decades while the multivariate analysis is
performed to identify the determinants of various types of
ailments. The major concern is the considerable increase the
trends of CVDs and NCDs. The results are quite alarming
as there has been an eight fold increase in the prevalence of
CVDs in the last two decades while the prevalence NCDs
has risen by three times within last two decades. The rising
incidence of CVDs and NCDs has been observed among the
elderly and urban women in the state. Therefore, a huge pres-
sure on the public health system is very likely shortly with the
double burden of both communicable and non-communica-
ble disease. Hence, an effective and responsive public health
system is called for to make health care services available
for NCDs and CVDs at the primary level. Health promotion
measures may be taken to inform elderly people inculcate
healthy habits. To ameliorate caregiving, the involvement of
family will be most critical. So, Government needs to imple-
ment an elderly oriented policy to the betterment of their
condition.
DEVELOPING A RESIDENCY PROGRAM FOR
NOVICE THERAPISTS IN HOMECARE PRACTICE:
THERAPY GATEWAY PROGRAM
S.Rushanan1, E.C.Wang-Hsu1,2, 1. Penn Medicine, Bala
Cynwyd, Pennsylvania, 2. Drexel University, Philadelphia,
Pennsylvania
Background: The demand for homecare services has
increased rapidly as the populations in the U.S.ages. Acom-
mon perception is that homecare is not a suitable first job for
new graduates, due to their lack of experience. We developed
the Therapy Gateway Program (TWP) in 2012 as a pilot resi-
dency program to recruit young therapist to meet the grow-
ing need of workforce.
Aims:1. To provide supportive structures to novice thera-
pists to build upon their clinical experience and professional-
ism in the home health practice. 2.To promote home health
as a meaningful and rewarding career to novice therapists.
Method: Eleven new-hired novice therapists went through
the TWP homecare residency program from 2012 to 2016.
Innovation in Aging, 2017, Vol. 1, No. S1
The program uses the ICF model, self-reflection journals,
evidence-based practice, and ongoing mentorship. Novice
therapists spent from 12 to up to 18months of their employ-
ment engaged in various activities to help their transition to
the home care environment.
Results: After four years, ten of the eleven novice thera-
pists (91%) are successfully employed at this home health
agency. All ten therapists have become independent and pro-
ductive in their clinical positions. Eight therapists were pro-
moted to higher clinical levels based upon their performance.
One therapist left the program after one month to pursue a
different job.
Discussion and implications: The TWP model provided
the resources needed to assist new graduates in their transi-
tion from academics to homecare practice. This model may
be further expanded and structured into a formal and widely
accepted homecare residency program for novice therapists.
REDESIGNING AND RETROFITTING
EXISTING COMMUNITIES TOWARD LIFETIME
NEIGHBOURHOODS
B.Chen1,2, Y.Liu1,2, 1. Department of Urban Planning
and Design, Xian Jiaotong-Liverpool University, Suzhou,
Jiangsu Province, China, 2. Research Institute on Ageing
and Society, Xian Jiaotong-Liverpool University, Suzhou,
China
China has the largest number of the elderly among all
ageing countries. However, little attempt has been made
to accommodate the growing need for the elderly. This
research aims to provide an insight into this phenom-
enon, focusing on issues relating to the built environ-
ment. Following the current trend of ageing-in-place, it
intends to provide a critical view on the re-design and
retrofits of existing communities, using projects located
in Suzhou as examples, where the elderly (i.e. age over
60)has accounted for more than 24% of the local popula-
tion by 2014. Based on literature review and case studies
worldwide, a series of issues have been summarized as
benchmark criteria for age-friendly communities. Then
local communities (e.g. Zhuhui New Village, Living Bank
Community, Olive Bay Community, etc.) are studied
through such lens by comparing the target communities
against the benchmark criteria, it is found that several
important issues (including necessary facilities and ser-
vices) have not been well addressed in the existing com-
munities, though they tend to be taken into account in the
design processes more often from a longitudinal perspec-
tive. Onsite semi-structured interviews and focus groups
have also been conducted to explore the relative impor-
tance of these issues in the given context, in line with the
changing needs (e.g. physical and psychological needs) of
different families over time. Some early findings (e.g. evi-
dence on age-friendly communities) will be incorporated
into the redesign/retrofit guidance for existing communi-
ties and thereby inform the transformation of local neigh-
bourhoods towards lifetime standards.
ENVIRONMENTAL BARRIERS AND DISABILITY IN
ELDERLY LIVING IN AN APARTMENT COMPLEX
WITHOUT AN ELEVATOR
E.Duim1, M.L.Ferrer1,2, E.S.Sartor2, T.Dahy2,
A.L.Gonalves2, M.C.Silva2, C.M.Buchalla1, 1.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Epidemiology, University of So Paulo, So Paulo, So
Paulo, Brazil, 2. So Francisco University, So Paulo, So
Paulo, Brazil
The diversity and heterogeneity in aging is a challenge to
public policy makers and services in order to provide aging
in place, especially to developing countries such as Brazil.
Objective: To identify and to analyze the association between
disabilities and environmental barriers in older adults liv-
ing in a multi-storey apartament complex with no elevator.
Methods: a cross-sectional study with older adults living in
a apartment building for lower-income families subsidized
by the government in a neighborhood in a medium-sized
town in Brazil. Semi-structured interview was conducted
using environmental factors such as those proposed by the
International Classification of Functioning, Disability and
Health. To assess disability the WHODAS 2.0 (12 item) was
applied. Results: 96 older adults were interviewed with mean
age 69.9 (7.3) years, 68.8% were female, living in the same
place for 14.1 (6.2) years. 35% of all of them were liv-
ing on the first floor. The mean score of WHODAS 2.0 was
20.7 (17.7) points and the major disability identified was
to walk long distances (32%). Environmental barriers were
appointed by few people: 20% of them recognized stairs as a
major problem, followed by the lack of accessibility in pub-
lic transportation (25%) and sidewalk hazards (22.9%). The
association between perceived barriers and disability was
moderate (r=0.41). The need of an elevator was indicated by
one person only. Conclusion: There is association between
disability and environmental barriers. However it suggests
that older people in Brazil have difficulties to detect the role
of environmental barriers in their functioning.
THE IMPACT OF THE LOCAL ASSOCIATIONS FOR
THE ELDERLY IN ISRAEL TO THE QUALITY OF LIFE
OF OLD ADULTS
Y.Brick, Gerontology, University of Haifa, Jerusalem, Israel
This paper deals with the special contribution of the
Local Associations for the Elderly in Israel. There are 124
such associations, who develop and operate a variety of ser-
vices for the elderly people in the community, in cooperation
with the local municipalities and the government.
The purpose of this paper is to present the special con-
tribution of the associations by looking into the structure,
their financial stability, the operation, their cooperation with
the local municipalities and the unique contribution to the
network of services for the elderly and cosencuently on the
quality of life of the elderly.
The paper is based on a study which was not published
yet. The data was collected from the year 2013 and was
based on a questionnaire which was sent to the chair peo-
ple and the CEOs of the associations, 84 where received. In
addition, a different questionnaire was sent to the directors
of the services for the elderly in the local municipalities.
The findings of the study show that that most of the asso-
ciations are balanced financially with no deficit (64%). Most
of the associations are providing a wide range of services
for the elderly, 86%- day care centers, with the average of
130 participants, 81% - supportive communities, with the
average of 312 participants, 67% - social clubs with 212
beneficiaries, and 66% physical activities programs with
the average of 148 participants. The average number of
IAGG 2017 World Congress
457
volunteers in these associations was 47 who contributed 424
hours per month, 82% of them of 65+. More than half of the
associations employed professional volunteers.
Both, the leaders of the associations and the directors of
services in the municipality indicated that the relationships
are good. The directors of the associations indicated that the
cooperation with the municipalities is average or high and
66% of the directors of the municipal services answered that
the relationships are good.
The main conclusions from the study are that the asso-
ciations are financially stable, administer a large spectrum
of services, employ many volunteers and make a signifi-
cant contribution to the quality of life of the elderly in the
community.
USING APOLICY APPROACH TO FACILITATE
EVOLVING NEEDS OF ACTIVE AGEING
K.Wong1, S.Kwok2, 1. The Open University of Hong Kong,
Hong Kong, Hong Kong, 2. Vocational Training Council,
Hong Kong, Hong Kong
The continuously growing ageing population is both an
opportunity and a threat on the quantity and quality of
healthcare professionals and novice workers concerned. This
comes along with an increasing demand on informal carers
who could help facilitate elderly to age at their community.
This study conducted in Hong Kong described healthcare
issues that were associated with ageing in place. It also
examined obstacles for the youths to join the elderly care
workforce, and the crucial role of governments involvement.
Targeting at allied health professionals, elderly and their rela-
tives, and youths, both quantitative questionnaire survey and
qualitative focus group were employed. Results revealed a
high demand of paraprofessional care providers with appro-
priate therapeutic and soft skills. Since majority of the young
old in Hong Kong was well-aware of their health conditions,
community healthcare training programmes that are offered
by nurses and allied health professionals were urgently
required to facilitate self-care. Almost all youths participated
in this study realised the challenges resulting from the ageing
population and were eager to pursue t studies and careers
in clinical healthcare. However, they had hesitation in join-
ing the workforce as non-professional community healthcare
workers with poor reputation and social status. Lack of pro-
fessional recognition, clear career ladder and a transparent
master pay scale were other key obstacles that avert youths
from joining the field. Such information provided valuable
insights to the Government and a comprehensive policy
approach involving different level of governance was pro-
posed to cater the needs of ageing population.
THE EFFECT OF INCREASE IN GERMAN LONG-
TERM CARE INSURANCE SUBSIDIES FOR SENIOR-
FRIENDLY HOUSING
B.Joo, TU Dortmund University, Dortmund, North Rhine-
Westphalia, Germany
The market of home modifications for older adults is
expanding, which is especially supported by German long-
term care insurance. Based on 40 of Book XI of Social
Code (SGB XI), this insurance system, which aims at
improvement of the home environment, promotes home-
based long-term care for older adults rather than nursing
458
home care. This research intends to examine the effect of
the increase in German long-term care insurance subsidies
for senior-friendly modification of older adults living space.
Aqualitative research (semi-structured interview and partic-
ipant observation) was conducted to investigate the impact
of the subsidies for senior-friendly home modification,
which has increased from 2,557 to 4,000 since January
2015. For data collection, two groups were included as
study targets: eight experts working in the industry and
public services and 12 insured older adults. With the eight
experts, face-to-face interviews were conducted. The inter-
views were recorded, transcribed, and analyzed using the
qualitative content analysis method developed by Kuckartz
(2016). Participant observation was added to retrace the
decision-making process of the insured people. This study
found that after the increase in subsidies, the demand for
senior-friendly home adaptations increased substantially.
Following the increase in the requests for subsidies, the long-
term care insurance funds began to examine applications
more strictly to prevent abuse of subsidies. Furthermore,
the price of home modification increased partially after the
policy change; thus older adults have not received benefit
from the increase in subsidies to the extent it was initially
expected. The results of this study suggest the importance
of improving market transparency in home modifications
and reinforcing on-site assessment of housing environments
of grant applicants so as to meet their actual needs and to
achieve expected policy outcomes.
SESSION 925 (POSTER)
BIOLOGY OF AGING
EFFECT OF ZINC SUPPLEMENTATION ON SERUM
ALBUMIN LEVEL IN ELDERLY
D.Ngestiningsih, Geriatric Subdivision of Internal
Medicine, Biochemistry Departement, Diponegoro
University, Semarang, Jawa Tengah/ Central Java, Indonesia
Background: Aging has been associated with increased
oxidative stress, physiological-biochemical changes and
impaired organs function. Those changes, might alter albu-
min homeostatic level in elder population due to nutrient
intake insufficiency, organs degeneration, and oxidation of
pre-formed albumin. Zinc was an essential trace element
which functioned as co-factor of enzymes, liver protector
and present antioxidant activity inside human body. We sus-
pected zinc supplementation would enhance elders serum
albumin level.
Aim: This study was to determine the effect of zinc sup-
plementation on serum albumin level in elder populations.
Methods: In this randomized control trial, with pre and
post-test control group design, we included 31 elder peo-
ple who lived in Unit Rehabilitasi Sosial Pucang Gading
Semarang. Samples were randomly divided into two groups.
Treatment group (16 people) were daily supplemented with
40mg, whereas control group (15 people) were placebo sup-
plemented. Both treatment last for 8 weeks. Albumin level
analysis was performed before and after the trial. The data
was then evaluated with Wilcoxon and Paired t-test.
Innovation in Aging, 2017, Vol. 1, No. S1
Results: The result showed that the average level of serum
albumin improved in both groups. Treatment group resulted
in significant increase of mean albumin level by 0,5 0,23g/
dl, p<0.001 while the changes observed in placebo group
were not significant (0,2 0,61g/dl, p=0,175).
Conclusions: Zinc supplementation could improve serum
albumin level on elder subject.
SESAMIN AND SESAMIN COMBINED WITH
ALPHA-TOCOPHEROL IMPROVE AGE-RELATED
KIDNEY DYSFUNCTION
S.Shimoyoshi1, D.Takamoto1, H.Masutomi2,
Y.Kishimoto2, A.Amano2, Y.Ono1, H.Shibata1,
A.Ishigami2, 1. Institute for Health Care Science, Suntory
Wellness Limited, Soraku-gun, Kyoto, Japan, 2. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan
Background/objectives: Oxidative stress is closely asso-
ciated with aging. Sesamin, a natural ingredient contained
in sesame (Sesamum indicum) seed and oil, has potent anti-
oxidative activities in mice and humans, and could increases
the bioavailability of -tocopherol (VE). Kidney is an organ
susceptible to aging, and often results in the age-related dys-
function. However, the effect of sesamin on aging kidney is
unclear. The aim of this study is to clarify the effects of sesa-
min or sesamin+VE on age-related kidney dysfunction.
Methods: Twenty-months-old male C57BL/6N were
divided into three groups. They were fed CRF-1 diet (old
control; OC), CRF-1 containing 0.2% sesamin (SE) or 0.2%
sesamin plus 0.2% VE (SE+VE) for five months. Six-months-
old mice were fed CRF-1 (young control; YC). Blood and
kidney samples were collected and blood urea nitrogen
(BUN), histopathological changes and lipofuscin deposition
were evaluated. Differential expression of genes related to
oxidative stress and inflammation was examined.
Results: BUN level was significantly higher in OC
(29.43.65mg/dL) compared to YC (19.11.08mg/dL,
p<0.01). SE+VE decreased BUN level compared to OC
(p<0.05). Lipofuscin deposition, an age-related change of
kidney, was significantly reduced in SE or SE+VE. The gene
expressions of NAD(P)H oxidase, chemokine and adhesion
molecules were significantly elevated in OC and suppressed
in SE or SE+VE compared to OC.
Conclusion: These results suggest that sesamin or sesamin
combined with -tocopherol are protective to age-related
kidney dysfunction through its anti-oxidative and anti-
inflammatory effects.
ASSOCIATION BETWEEN SERUM TESTOSTERONE
AND BRAIN VOLUME AMONG COMMUNITY
MIDDLE-AGED AND OLDER ADULTS
C.Liang1,2,3, M.Chou1,2, Y.Lin1,3, L.Chen4,2, 1. Center
for Geriatrics and Gerontology, Kaohsiung Veterans
General Hospital, Kaohsiung City, Taiwan, 2. Aging
and Health Research Center, Institute of Environmental
and Occupational Health Sciences, National Yang-Ming
University, Taipei, Taiwan, 3. Division of Neurology,
Department of Internal Medicine, kaohsiung Veterans
General Hospital, Kaohsiung, Taiwan, 4. Center for
Geriatrics and Gerontology, Taipei Veterans General
Hospital, Taipei City, Taipei City, Taiwan
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Studies showed that testosterone is associated with cogni-
tive function; However, few evidence proved the association
between serum testosterone levels and brain volume of differ-
ent area. The I-Lan Longitudinal Aging Study (ILAS), which
randomly invited community-dwelling people aged 50years
and older for study, were retrieved for study. Free Testosterone
(FT) levels were obtained from total testosterone, SHBG, and
albumin by the Vermeulen method, and free androgen index
(FAI) was defined as serum total testosterone (nM/L) divided
by serum SHBG (nM/L). The total brain volume (TBV),
gray and white matter volume, cerebrospinal fluid volume
(CSF), and total intracranial volume (TIV) evaluated by
MRI. Among 456 subjects (239 males, mean age: 64.08.5),
we found that serum testosterone, FT and FAI were lower
in women than in men (30.118.0 vs 491.6176.2ng/dL, Medicine, Seoul, Korea (the Republic of), 3. Department
p < 0.01; 0.3980.284 vs 7.7842.269ng/dL, p < 0.01; of Family Medicine, Gangnam Severane Hospital, Yonsei
2.2422.103 vs 37.01513.325, p < 0.01). Multiple linear University College of Medicine, Seoul, Korea (the
regression showed that TBV/TIV ratio, FT and FAI were sig-
nificantly correlated in men, but not in women, after adjust-
ment for age, educational levels, type 2 diabetes, hypertension
and dyslipidemia, smoking, alcohol drinking, skeletal muscle
mass, physical activities, cognitive function, depressive symp-
toms, and serum levels of homocysteine. Analysis of different
parts of brain volume showed that FT and FAI were posi-
tively correlated with gray matter/TIV ratio and negatively
correlated with CSF/TIV ratio. However, There was no cor-
relation between serum testosterone levels and WMV/TIV
ratio. Moreover, the FAI, compared with serum testosterone
and FT, is more significantly association with multiple cogni-
tive domain.
VITAMIN D INSUFFICIENCY AND MUSCULAR
FATIGABILITY AMONG OLDER WOMEN
G.Duval1, A.Schott2, Y.Rolland3, H.Blain4, O.Beauchet5, diol, thyroid-stimulating hormone, and estimated GFR
C.Annweiler1, 1. Geriatric Medicine, Angers University
Hospital, Angers, France, 2. Lyon University Hospital,
Lyon, France, 3. Grontople, Toulouse, France, 4.
Montpellier University Hospital, Montpellier, France, 5.
McGill University, Montreal, Quebec, Canada
Background: Vitamin D affects physical performance in
older adults. Effects on muscles, notably on muscle strength,
remain yet unclear. The objective of this cross-sectional study
was to determine whether vitamin D insufficiency was asso-
ciated with triceps brachii muscle fatigability in community-
dwelling older women.
Methods: A randomized subset of 744 women aged
75years from the French EPIDOS cohort was categorized
into two groups according to vitamin D insufficiency (i.e.,
serum 25-hydroxyvitamin D concentration30ng/mL).
Triceps brachii muscle fatigability was defined as the loss of
strength between two consecutive maximal isometric volun-
tary contractions. Age, body mass index, comorbidities, use
psychoactive drugs, physical activity, first triceps strength
measure, hyperparathyroidism, serum concentrations of cal-
cium, albumin and creatinine, season and study centers were
used as potential confounders.
Results: Triceps fatigability was more prevalent among
women with vitamin D insufficiency (n=671) compared
to the others (27.3% versus 12.3%, P=0.006). The serum
concentration of 25OHD was inversely associated with the
between-test change of triceps strength (adjusted =-0.09,
IAGG 2017 World Congress
459
P=0.044). Vitamin D insufficiency was positively associated
with triceps fatigability (adjusted OR=2.65, P=0.009).
Conclusions: Vitamin D insufficiency was associated with
muscle fatigability in this cohort of community-dwelling
older women. This is a relevant new orientation of research
toward understanding the involvement of vitamin D in mus-
cle function.
HDL-C AND LDL-C ARE ASSOCIATED WITH BMD
IN PREMENOPAUSAL AND ELDERLY WOMEN
RESPECTIVELY
Y.Choi1,2, J.Shin3, J.Jee1, S.Cho1, 1. Center for Health
Promotion, Samsung Medical Center, Seoul, Korea (the
Republic of), 2. Sungkyunkwan University School of
Republic of)
Recent studies have explored the association between
serum lipids and bone mineral density (BMD). However,
the results are inconsistent and studies for premenopausal
women are very sparse. For the investigation without con-
founding effects of menopause, we analyzed the data col-
lected from premenopausal women in early 40s and elderly
women aged 70 and older, and comprehensive physiologic
markers were included. Our Korean study population
was consisted of 3,953 premenopausal women (age range
40~44, mean age 42.31.3) and 986 elderly women (70~92,
73.83.5). BMDs were measured by dual X-ray absorptiom-
etry at lumbar spine (LS), femoral neck (FN), and total hip
(TH). Height, percent body fat, and fasting serum measures of
total cholesterol (TC), HDL-C, LDL-C, triglyceride, hsCRP,
albumin, glucose, gamma-glutamyltransferase (GGT), estra-
were included in the analyses. Multivariate linear regression
models were used to examine relationships between BMD
(dependent variable) and other variables. After adjusting for
covariates, HDL-C was negatively associated with BMD at
LS (=-0.052, p=0.004), FN (=-0.064, p=0.000), and
TH ( = -0.073, p = 0.000) in premenopausal women. In
elderly women, LDL-C was negatively associated with BMD
at LS (=-0.104, p=0.001), FN (=-0.057, p=0.068), and
TH (=-0.064, p=0.042). Our results suggest that serum
lipids are inversely correlated with BMD and the pattern is
different among young and old women.
AGING-DEPENDENT CG HYPERMETHYLATION D
GENE EXPRESSION OF GSTM1 INVOLVED IN T CELL
DIFFERENTIATION
S.Yeh1, K.Yang1,2,3, L.Lin4, M.Lee5, C.Hsieh6, C.Lin6,
1. Institute of Long-Term Care, Mackay Medical College,
New Taipei City, Taiwan, 2. Institute of Biomedical Science,
Mackay Medical College, New Taipei City, Taiwan, 3.
Department of Medical Research, Department of Pediatrics,
Mackay Memorial Hospital, Taipei, Taiwan, 4. Department
of Nursing, HungKuang University, Taipei, Taiwan, 5.
Department of Medical Research and Development,
Show Chwan Memorial Hospital, Changhua, Taiwan,
6. Department of Medical Research, Mackay Memorial
Hospital, New Taipei City, New Taipei City, Taiwan
460
This study investigated whether aging was associated
with epigenetic changes of DNA hypermethylation on
immune gene expression and lymphocyte differentiation.
We screened CG sites of methylation in blood leukocytes
from different age populations, picked up genes with age-
related increase of CG methylation content more than
15%, and validated immune related genes with CG hyper-
methylation involved in lymphocyte differentiation in the
aged population. We found that 12 genes were associated
with promoter or exon one DNA hypermethylation in the
aged group. Two genes, GSTM1 and LMO2, were chosen
to validate its aging-related CG hypermethylation in dif-
ferent leukocytes. Modulation of aging-associated GSTM1
methylation may be able to promote Th1 immunity in the
elders.
HIGHER FREQUENCY OF MICRONUCLEUS IS
ASSOCIATED WITH SARCOPENIA IN AN ELDERLY
FREE-LIVING COMMUNITY
G.M.SilvaTavares1,2, V.Manfredini1, J.Mezzomo1,
A.A.Gllich1, I.da Cruz3, M.G.Gottlieb2, 1. physiotherapy,
Federal University of Pampa, Uruguaiana, Rio Grande
do Sul, Brazil, 2. Pontifcia Universidade Catlica do Rio
Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil,
3. Universidade Federal de Santa Maria, Santa Maria, Rio
Grande do Sul, Brazil
Micronuclei is considered an important biomarker to
monitor the health of individuals or populations exposed to
different biological and environmental stressors. The aim of
this present study was to verify the frequency of micronuclei
lesions and the association with, muscle mass, lifestyle and
health status in elderly residents in a free-living community.
Across-sectional observational investigation was performed
on a sample of 168 elderly (60 males, 108 females) residents
of a free-living community were included in this study. The
blood sample was collected for a micronuclei assay. Social
demographics, muscle mass, lifestyle and health status were
also evaluated. The sample was categorized in two groups:
lower micronucleus frequency (LM, < 5 micronuclei/1000
nuclei) and higher micronucleus frequency (HM, 5 micro-
nuclei/1000 nuclei). In the percentile distribution, 50% of
the sample presented 5 micronuclei/1000 nuclei (the HM
group). The mean age of sample was 68.416.13. The
mean micronucleus frequency was 5.872.75 micronu-
clei/1000 nuclei. Only smoking habit (p0.002) and sarco-
penia (p0.021) were significantly associated with higher
micronucleus frequency. Higher frequency of micronucleus
is associated with sarcopenia, independent of sex, age and
smoking habit in an elderly sample.
SESSION 930 (POSTER)
CANCER
EFFECTIVENESS OF ADJUVANT CHEMOTHERAPY
FOR OLD PATIENT (70 YEARS OR OLDER) IN STAGE
III COLON CANCER
K.Yi-Hung, Y.Yu-Wen, H.Jui-Chu, Chang Gung Memorial
Hospital, Chiayi, Taiwan, Chiayi, Taiwan
Innovation in Aging, 2017, Vol. 1, No. S1
Background Surgery and postoperative adjuvant chemo-
therapy has been recommended for stage III colon cancer,
especially in younger patients. In old patients (aged 70years
or older), the benefit is not so clear.
Methods This study was a retrospective observation of
patients with stage III colon cancer who underwent cura-
tive surgery between January 1995 and December 2004 at
the Chang Gung Memory Hospital. The disease-free (DFS)
and cancer-specific survivals (CSS) of the old patients were
calculated using univariate analysis with the KaplanMeier
method and compared using the log-rank test. The Cox
regression model was used for multivariate analysis for the
confounding factors.
Results Atotal of 645 patients with stage III colon can-
cer were initially enrolled and stratified by age ( 70, 70>
and 50, younger than 50). The 50.5, 80.6 and 85.0 percent
of three groups received adjuvant chemotherapy after cura-
tive surgery. No significant difference existed in 5-year CSS
between old patients receiving adjuvant chemotherapy (n=
108) and those who had surgery along (n= 106) (72.2 vs.
65.2%, P= 0.323, Fig.1A), whereas adjuvant chemotherapy
improved 5-year DFS (54 vs. 48.8%, P= 0.039, Fig. 1B).
However, multivariate analysis for 5-year DFS and CSS
found an independent benefit for adjuvant chemotherapy in
old patients with stage III colon cancer (in DFS, hazard ratio,
0.582, 95% confidence interval, 0.3940.860, P= 0.007; in
CSS, hazard ratio, 0.035, 95% confidence interval, 0.335
0.960, P= 0.035).
Conclusions Amultimodal approach in old patients with
stage III colon cancer improved oncological outcomes.
OUTCOMES AFTER BREAST CANCER SURGERY IN
NURSING HOME RESIDENTS: ANATIONAL STUDY
V.L.Tang1,2, R.Sudore1,2, K.E.Covinsky1,2, C.S.Ritchie1,2,
S.Zhao1, E.Finlayson1, 1. Medicine/Division of Geriatric
Medicine; Division of Hospital Medicine, University of
California San Francisco, San Francisco, California, 2. San
Francisco VA Medical Center, San Francisco, California
Background: Over 60% of cancer-related operations in
nursing-home residents occur for breast cancer. We studied
functional and mortality outcomes after breast cancer sur-
gery in nursing-home women.
Methods: We identified long-term stay nursing-home
residents age 65 who underwent inpatient breast cancer
surgery in 20032009 using Medicare and Minimum Data-
Set (MDS). We examined 30-day mortality and hospital
re-admission rates, stratified by procedure (lumpectomy,
mastectomy, lymph node dissection with lumpectomy or
mastectomy [LND]). In multivariate analysis, we examined
factors associated with 1-year mortality. Functional status
was measured by assessing the degree of dependence in seven
activities of daily living (ADL): MDS-ADL scale with a 2
point difference as clinically significant.
Results: We identified 4,180 subjects (age: 827, 48%
dementia). Residents experienced significant functional
decline that persisted 1year after surgery (MDS-ADL score:
lumpectomy: -3.4, mastectomy: -2.9, and LND: -2.5). Thirty-
day readmission and mortality were high after surgery:
lumpectomy: 26% and 9%, mastectomy: 14% and 4%, and
LND: 15% and 2%, respectively. Oneyear all-cause mor-
tality was high: lumpectomy: 42%, mastectomy: 31%, and
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
LND: 26%. In a multivariate analysis, poor baseline MDS-
ADL score before surgery was strongly associated with
1-year mortality-- lumpectomy: HR 2.6 (95%CI:1.54.4),
mastectomy: HR 2.1 (95%CI:1.52.9), and LND: HR 1.9
(95%CI:1.52.5).
Conclusions: Among nursing-home women residents who
undergo breast cancer surgery, 30-day hospital readmission
and mortality are high, as is 1-year all-cause mortality. Poor
baseline function prior to surgery was strongly associated
with 1-year mortality. Individualized goal-oriented care (i.e.,
hormonal therapy or symptom management only) should be
considered.
ASSOCIATION BETWEEN FRAILTY AND
READMISSION AFTER GASTRECTOMY IN OLDER
PATIENTS WITH GASTRIC CANCER
Y.Choe, J.Joh, Y.Kim, Chonnam National University
Hwasun Hospital, Hwasun, Chonnam, Korea (the Republic
of)
Background: The incidence of gastric cancer in older peo-
ple has been increased. Because older patients are at increased
risk of postoperative complications and mortality, preopera-
tive risk assessment in this population is important. In this
study, we want to know if preoperative assessment of frailty
could be useful for predicting the postoperative outcome in
gastric cancer patients
Methods: We investigated 223 patients (136 men and
87 women) over 65years old underwent gastric cancer sur-
gery from April 2012 to March 2015. We used the Study
of Osteoporotic Fractures (SOF) frailty index to assess the
frailty. In order to find the predicting factors for readmission
within 1-year of discharge after gastrectomy, we used logistic
regression model.
Results: Total 26 (11.7%) patients readmitted within
1-year after gastrectomy. Patients in robust group had a
readmission rate of 4.4% and 19.1% in pre-frail and frail
group. After adjusting age, gender, Eastern Cooperative
Oncology Group (ECOG) performance statue (score 1),
histological type and stage (III, IV), the frailty (pre-frail and
frail) was revealed predicting factor for readmission within
1-year of discharge after gastrectomy (Odds Ratio (OR)
5.74, 95% Confidence Interval (CI) 1.7818.48, p=0.003).
Conclusion: Preoperative risk assessment including frailty
evaluation can predict the readmission within 1-year of dis-
charge after gastrectomy. Thus, frailty assessment can help
physicians to identify the risk and inform patients and their
families of the risk for better decision making process in gas-
tric cancer treatment
FACTORS CONTRIBUTING TO FALLS IN OLDER
BREAST CANCER SURVIVORS
J.Blackwood, M.Huang, E.Neuman, M.Godoshian,
L.Pfalzer, Physical Therapy, University of Michigan--Flint,
Linden, Michigan
INTRODUCTION: In older adults, cancer and its treat-
ment affect multiple body systems, leading to functional
impairments, limited balance and impairments in walking,
and thus contributing to an increased falls risk. The purpose
of this study was to examine the health-related factors (phys-
ical, cognitive) contributing to falls in breast cancer survi-
vors who were actively being treated (Active) versus those
IAGG 2017 World Congress
461
who were not receiving active treatment for their cancer
(Non-Active).
METHODS: This cross-sectional study used data from
the Surveillance, Epidemiology and End Results national
cancer registry and Medicare Health Outcomes Survey link-
age. Forward stepwise logistic regression analyses were com-
pleted to assess the contribution of health-related variables
(difficulty walking or getting out of a chair, balance prob-
lems, and cognitive function) to falls in older breast cancer
survivors.
RESULTS: Sample included 8187 cases. In the Active
group (n=4045), 27% reported falling and 40% had balance/
walking difficulties while those numbers were 35% and 24%
respectively in the Non-Active group (n=4142). Impaired
cognitive function (difficulty with memory/concentration)
was present in 18% (Active) and in 13% (Non-Active).
Logistic regression modeling indicated that difficulties with
memory/concentration and balance problems were signifi-
cantly associated with falls in the Active group. In the Non-
Active group the presence of balance problems was the only
significant variable contributing to falls (p<0.01).
CONCLUSIONS: In older breast cancer survivors under
active treatment for cancer, cognitive function and balance/
walking problems were both significantly associated with
falls. Future research needs to delineate the impact of cancer-
specific factors on functional mobility.
HEALTH CARE PROFESSIONALS PERSPECTIVES OF
CARING FOR PATIENTS WITH HEPATOCELLULAR
CARCINOMA
L.Hansen, S.Rosenkranz, A.Schroeder, W.Naugler,
Oregon Health & Science University, Portland, Oregon
Background: Hepatocellular carcinoma (HCC) is the sec-
ond leading cause of cancer related mortality in the world. It
is often diagnosed at an advantaged stage. Due to the numer-
ous physical and psychological symptoms and the number
of treatments patients receive, management is extremely
complex and may best be done by a multi-disciplinary liver
tumor board. Research is lacking on these tumor boards and
on health care professionals (HCPs) perspectives on the
challenges they face in caring for patients with HCC.
Aim: To examine challenges in symptom management,
treatment therapies, and care of patients with HCC from the
perspectives of urban and rural HCPs.
Methods: The study used a prospective, descriptive design.
Semi-structured interview data were obtained from 10 HCPs
employed at an urban hospital, and 8 at urban and 8 at rural
primary health care clinics. Data were analyzed using con-
ventional content analysis.
Results: Tumor boards are a trustworthy and valuable
resource but high number of referrals, access to treatment,
and lines of communication are barriers to care. Lack of
knowledge, expertise, and specialties make it difficult for
rural HCPs to manage and coordinate the care for patients.
Lack of follow-up care with primary care providers, inability
by specialists to manage non-cancerous issues, and lack of
continuity of care jeopardize symptom management.
Conclusions: Focus should be on improving communica-
tion between referring providers, patients, and multi-discipli-
nary care groups. Referral to palliative care should happen
early in the treatment process. Early screening and regular
462
surveillance should be implemented for patients with liver
cirrhosis.
PARTITIONING OF TIME TRENDS IN MORTALITY
OF LUNG CANCER AMONG OLDER U.S. ADULTS
I.Akushevich, A.P.Yashkin, J.Kravchenko, F.Fang, provide an evidence base from which targeted interventions
A.I.Yashin, Duke, Durham, North Carolina
Direct evaluation of lung cancer mortality from SEER
data is challenging because of uncertainties in evaluating
the population at risk at the time of death We overcome this
problem by proposing a new approach for the calculation of
cancer-specific mortality rates through the evaluation of mul-
tiple components contributing to total mortality and apply-
ing it to lung cancer patients. Specifically, the time-trend of
lung cancer mortality is the result of three competing pro-
cesses: changes in incidence rate, stage-specific survival, and
ascertainment at early stages. Our approach estimates the
contribution of each of the above components to the overall
mortality trend. Using SEER data, we found that lung cancer
mortality increases in females and decreases in males over
the study period (19882012). The main contributions to
the change in mortality trends for both genders are incidence
rates (increasing in females and decreasing in males). Trends
in incidence explain more than 50% of total lung cancer
mortality trend. The remaining percentages are explained by
increased ascertainment at early stages, improved survival,
and prevailing trends in mortality for the general population.
These patterns held for analysis of histotype-specific groups
(adenocarcinoma, squamous-cell carcinoma, and small-
cell carcinoma) with the exception of the increased role of
incidence in adenocarcinoma in males and ascertainment at
early stages for squamous-cell and small-cell carcinoma. The
methodology developed in this study increases the range of
analysis that can be accomplished with SEER data and can
serve as an additional tool for improvement in the quality of
health outcomes research.
DEFINING LUNG CANCER DIAGNOSTIC PATHWAYS
IN THE PRIMARY CARE SETTING IN MONTRAL,
QUBEC
S.Khare, I.Vedel, G.Bartlett, Family Medicine, McGill OF MAMMOGRAPHY SCREENING DECISION FOR
University, Montreal, Quebec, Canada
Lung cancer is the leading cause of cancer-specific mor-
tality in Canada, with the highest mortality observed in
Qubec. Incidence rates for lung cancer peak at 8084years of Texas Medical Branch, Galveston, Texas, 2. The Ohio
of age with a median age at diagnosis of 71. Thus, the death
toll due to lung cancer is concentrated among the elderly. The
five-year survival rate for lung cancer is a dismal 17%. This
is because lung cancers are often diagnosed at a late stage of
disease when treatment options are limited. Interventions to
reduce delays in diagnosis require an examination of diag-
nostic pathways and an understanding of the factors that
influence these pathways. As patients in Canada must pre-
sent in primary care before being referred to specialist care,
the primary care interval within the larger diagnostic interval
is a fundamental component of the diagnostic pathway. This
study aims to examine lung cancer diagnostic trajectories in
the primary care setting, and explore patient, disease, and
health-care system factors that contribute to the diagnostic
process. An explanatory sequential mixed-methods design
will be employed in two phases. Phase one will involve the
Innovation in Aging, 2017, Vol. 1, No. S1
identification of diagnostic pathways through latent profile
analysis using clinical and administrative databases along
with structured patient interviews, while phase two will use
semi-structured patient interviews to explore contributing
factors to late diagnosis. The findings from this study will
can be formed to reduce or eliminate unnecessary and avoid-
able delays in lung cancer diagnosis.
THERAPEUTIC PATIENT EDUCATION AND
COUNSELLING IN GERIATRIC ONCOLOGY
H.Villars1, M.Champarnaud1, L.Balardy1,
F.Nourhashemi1,2, 1. Geriatric Department, Toulouse
University Hospital, Toulouse, France, 2. U558 Inserm,
Toulouse, France
Therapeutic patient education (TPE) has largely dem-
onstrated its efficiency in the care of patients suffering
from chronic conditions, as defined by the World Health
Organization (WHO). At the same time TPE has been imple-
mented in Oncology, particularly in the field of pain manage-
ment but not only, considering cancer as a chronic condition.
Moreover, in the early 2000s, Geriatric Oncology has begun
to emerge as a discipline. Indeed, as the incidence of cancer
regularly increases during the life, cancerous pathologies are
prevalent in subjects over 65years, and the care of these sub-
jects is raising very different issues and challenges from those
of younger patients (polypathology and co-morbidity, iatro-
genesis, cognitive disorders and dementia, sensory deficits,
role of caregivers...).TPE has secondary followed this devel-
opment in getting adjusted to the specific needs of this popu-
lation. Because of its global, multidimensional and holistic
character, TPE now appears as an interesting tool in Geriatric
Oncology. Some educational programs have been created,
implemented and evaluated but only a few are specifically
addressed to the geriatric population. This communication is
a brief review of Therapeutic Education Programs designed
for geriatric patients suffering from cancer and hematologi-
cal conditions.
CONTINUE OR STOP: AQUALITATIVE ANALYSIS
OLDER WOMEN
M.R.Pappadis1, S.Krishnan1, S.Weller1, A.Tan2,
E.Jaramillo1, K.M.Sheffield1, J.S.Goodwin1, 1. University
State University, Colombus, Ohio
There is insufficient evidence to determine the benefits
and harms of screening mammography for women aged 75
and older. Therefore, guidelines emphasize on shared deci-
sion-making. This study aimed to understand older womens
mammography screening decision, physicians role in their
decision, and their willingness to discontinue screening.
Using stratified sampling based on age (7074 vs. 75+), race/
ethnicity (Non-Hispanic Blacks, Hispanics, Non-Hispanic
Whites) and education (high school vs. >high school),
fifty-six older women with no breast cancer history partici-
pated in semi-structured interviews to discuss their decision-
making process and preferences for screening. Iterative,
comparative thematic analyses revealed that the majority
of the older women desired to continue screening. Women
aged 75+ tended to discontinue, whereas those aged 7074
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
tended to continue screening. Seventy-seven percent of the
older women stated that their physician initiated the discus-
sion regarding continuing/discontinuing screening, whereas
18% initiated the discussion, 1% were influenced by a rela-
tive and only 4% stated involvement in shared decision-mak-
ing, describing the process as a mutual thing between us or
both [of us]. Most women followed their physicians recom-
mendations for screening. Nearly 80% of those continuing
mammography had no personal desire to stop, even for those
aged 75+ (38%). Some of the reasons why a continuer may
discontinue mammography screening were health, physician
recommendation, harms, evidence or beyond the age of 80.
This study suggests a need for improved communication
between physicians and older women regarding the benefits
and harms associated with mammography screening.
SESSION 935 (POSTER)
CAREGIVING III
KINSHIP CAREGIVER STRESS, BURDEN, HEALTH,
SOCIAL SUPPORT, AND NEEDS
M.Trail Ross, D.Kang, S.Cron, The University of Texas
Health Science Center at Houston, Houston, Texas
Background: Kinship caregivers including grandparents,
other relatives, and friends increasingly assume greater
responsibility of raising their kin children. These caregivers
experience increased stress, depression, and poorer health.
Because of limited legal relationship, kinship caregivers are
often denied from obtaining services, information, and finan-
cial assistance.
Aims: 1.Assess the needs of primary kinship caregivers.
2.Compare levels of stress, caregiver burden, health status,
and social support between grandparent and non-grandpar-
ent caregivers.
Methods: Two hundred fifty-five kinship caregivers com-
pleted mailed standardized questionnaires.
Results: Over half of the sample were responsible for
caring for other kins living with them. Forty-eight percent
expressed need for financial resources, followed by 36%
being interested in information about foster care and adop-
tion. Thirty-two percent were interested in learning about
stress management. Preferred method for receiving informa-
tion varied, including email, websites, workshops, newslet-
ters, and video. The majority had access to a computer and
internet service.
Although the majority of the caregivers were employed
fulltime, grandparent caregivers were less likely to be
employed, more likely to be widowed or divorced, were car-
ing for more children, and had a lower level of education
compared with non-grandparent caregivers.
Grandparent caregivers were significantly older, more
stressed, and scored lower on physical and social function-
ing, role participation, and bodily pain. They also had signifi-
cantly lower social support and social interaction, and more
burden impact on health.
Conclusion: The needs assessment and comparison of
kinship caregivers shed light on future studies, interventions,
and services for these caregivers.
IAGG 2017 World Congress
463
IN THEIR OWN WORDS: HOW FAMILY CAREGIVERS
OF PEOPLE WITH DEMENTIA DEFINE RESILIENCE
S.ODwyer1,2, W.Moyle2, T.Taylor2, J.Creese2, M.Zimmer-
Gembeck2, 1. Medical School, University of Exeter,
Exeter, United Kingdom, 2. Griffith University, Brisbane,
Queensland, Australia
There is a growing body of research on resilience in fam-
ily caregivers of people with dementia, but caregivers voices
are noticeably absent from it. The aims of this study were
to explore: (1) caregivers definitions of resilience; (2) the
factors caregivers consider to be associated with resilience.
Twenty-one in-depth interviews were conducted in Australia
with people who were currently, or had previously been, car-
ing for a family member with dementia. Transcripts were
analysed thematically and three themes emerged: Being
Resilient, Becoming Resilient, and Characteristics of the
Resilient Caregiver. Although caregivers struggled to define
resilience, the vast majority considered themselves resilient.
Caregivers identified a range of traits, values, environments,
resources, and behaviours associated with resilience, but
there was no consensus on the relative importance or causal
nature of these factors. Caregivers also considered resilience
to be domain- and context-specific, but did not agree on
whether resilience was a trait or a process. These findings
highlight both the importance of including caregivers voices
in resilience research and the limitations of the extant lit-
erature. Future research on resilience in family caregivers of
people with dementia must be theoretically sound, methodo-
logically rigorous, and reflect the lived experience of caregiv-
ers. After this session, participants will be able to discuss the
challenges of conducting research on resilience in family car-
egivers and identify directions for future research.
FINDING MEANING IN DEMENTIA FAMILY
CAREGIVING: APILOT STUDY
R.Pang, D.Lee, The Nethersole School of Nursing, The
Chinese University of Hong Kong, Hong Kong, Hong Kong
Although there is a body of knowledge indicating that
finding meaning has a positive impact on the caregivers
wellbeing, little is known about the actual process of how
caregivers of persons with dementia find meaning in their
caregiving experience. This pilot study has provided insights
into how Chinese family caregivers of persons with demen-
tia find meaning in their caregiving experience and adapt to
their caregiving role. Grounded theory methodology was
employed in this study. Unstructured, in-depth interviews
were conducted with seven primary caregivers who were
taking care of a family member with dementia at home.
Data were analyzed using constant comparative method.
The results showed that the process of finding meaning con-
sists of four stages: questioning, exploring, accepting, and
transforming. Caregivers went through these four stages as
they struggled to regain a sense of control over the chang-
ing caregiving situation. Caregivers who could successfully
go through the four stages have demonstrated a higher moti-
vation to care and a better wellbeing. For those caregivers
who could not progress through the four stages, they were
trapped in the stages of questioning and exploring. They
were struggling to find ways to manage the situation and
felt hard to accept the situation. These caregivers were more
depressed and had a higher level of caregiving burden. These
464
findings suggest that interventions can aim at assisting car-
egivers to regain a sense of control over the changing caregiv-
ing situation, in order to help caregivers find meaning in their
experience and adapt to their caregiving role.
CAREGIVING TRANSITIONS AND LIFE
SATISFACTION OF INFORMAL CAREGIVERS
R.Keller, APOLLON University of Applied Sciences,
Bermen, Germany
In the Western world, about two third of care recipients
are in home care. This fact holds also for Germany: 70 per-
cent of care recipients are cared for at home. Most of the
caregivers are family members without any professional
background in caregiving. To date, little is known about how
caring for a close relative influences life satisfaction of car-
egivers in the long run. This study seeks to fill the gap by
focusing on the process of transitions into and out of their
caregiver role. Further, Iexamine how the caregivers life sat-
isfaction develops after these incisive life events.
The analyses are based on the data of the German Socio-
Economic Panel, which provides annual information about
caregiving situations in German households and life satisfac-
tion since 1997. Using panel data allows to capture intrain-
dividual changes by controlling time constant unobserved
heterogeneity. The longitudinal research design also enables
to identify effects of adjustment processes in terms of life sat-
isfaction with respect to transitions into and out of caregiv-
ing situations.
As expected, life satisfaction decreases after transitioning
into the caregiving status andin contrast to the findings of
the vast majority of cross-sectional studiesremains stable
over the time of caregiving. When analyzing the period that
marks the transition out of caregiving, the picture is rather
heterogeneous. It seems that women recover more quickly
than men from this strenuous event that is often associated
with the death of the care recipient. After recovery, life satis-
faction increases constantly for both genders.
FINANCIAL COSTS OF CAREGIVING OVER THE
LIFECOURSE
S.L.Porterfield, H.Shen, Social Work & Gerontology,
University of Missouri - Saint Louis, St. Louis, Missouri
Many research studies have documented the balancing
of work and family life among adults who have caregiving
responsibilities. This balance is more tenuous when the care
recipient has significant disabilities or special needs. While
many parents reduce work hours while their children are
young, the work force ties of those whose children have dis-
abilities that affect functioning into adulthood remain weak
for a longer period of time, moderated by lower health sta-
tus among these caregivers.In the US, 70% of working-age
adults with disabilities live with relatives; 55% with a parent
who is age 60 or older. This paper examines the health and
pension costs of caregiving, specifically whether women who
are or have been caregivers are more or less likely to hold
a pension in their own name, whether there is a significant
difference in the value of private pension holdings, given age
and health status, and whether these differences persist when
total household pension values are compared among women
Innovation in Aging, 2017, Vol. 1, No. S1
who are, or are not caregivers. Data for women aged 4069,
who have not yet retired, are drawn from the combined
2001, 2004 and 2008 panels of the US Survey of Income and
Program Participation (n=40,552). Women caring for disa-
bled or elderly relatives are significantly more likely to report
fair/poor health status (28%) and more sick days (13 on aver-
age), and are less likely to have pension savings (23.6% &
32.2% respectively) than those caring for children or no one
(15% report fair/poor health; 49.5% have pension savings).
In addition, the odds of owning and value of pensions held
by those caring for non-elderly, disabled family members are
significantly lower than those of other caregiver types, con-
trolling for socio-demographic characteristics. Additional
testing shows health status is a significant mediating fac-
tor, accounting for just over 26% of the effect of caregiving
on individual pension value if caring for an adult with dis-
abilities. Caregiving for a working-age adult with disabilities
is associated with poorer health status and lower pension
savings at both the individual and household levels. Newly
adopted policies such as the ABLE Act in the US may pro-
vide some support for these families. Additionally, caregiving
could be rewarded through the Social Security system, as it is
in several European countries, improving the financial strain
on these households in their retirement years.
LONG-TERM EFFECTS OF DIFFERENT TYPES OF
CAREGIVING ON DEPRESSION IN OLDER ADULTS
S.C.Hu, National Cheng Kung University, Tainan City,
Taiwan
Caring family member is a matter of stress and may
increase depressive symptoms in elderly. This study aimed to
examine the long-term effects of caregiving on depression of
older adults and compared whether elder caregivers felt more
depression than child caregivers, and whether child caregiv-
ing can ease depressive symptoms among dual caregivers. We
used the dataset of nationally representative samples from
Taiwan Longitudinal Study of Aging, and four waves of sur-
vey were analyzed, including 1996, 1999, 2003, and 2007.
After excluding institutional older adults and poor physical
functions (ADL>0), a total of 2250 sample was recruited.
Caregivers were divided into 4 types: non-caregivers, elder
caregivers, child caregivers, and dual caregivers (who care
elder and children at the same time). Depression was meas-
ured by CESD scale. The generalized estimation equation
(GEE) was used to analyze the long-term effects of repeated
measured data.
Comparing with non-caregivers, elder caregivers had sig-
nificantly higher score of depression (95%C.I.=0.25~1.89),
child caregivers had lower score of depression (95%C.I.=-
0.59~0.00), and dual caregivers appeared nonsignificant
impact on depression. Regarding caregiving times, the
child caregivers who provided 2 waves of caregiving had
significantly lower depressive score (95%C.I.=-1.06~-
0.24), whereas the elder caregivers who provided 1 wave
of caregiving had significantly higher depression score
(95%C.I.=0.18~1.95). Taking care of older adults is more
stressful than taking care of children. Child caregiving can
significantly reduce depression in older adults; however, it is
not enough to relief depressive symptoms for dual caregivers.
Future policy should pay more attention on elder caregivers.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
FINDING NEW MEANINGS AND CONNECTION IN
FAMILY DEMENTIA CAREGIVING BY ENHANCING
INTERNAL COPING
J.Wang, L.Yong, W.Chan, E.Ho, Y.Wong, K.Peh, Tsao congruent evidence-based programs to assist Hispanic car-
Foundation, 298 Tiong Bahru Road #15-01 Central Plaza
Singapore 168730, Singapore, Singapore
Background: Caregiving for People with Dementia (PwD)
is often a psycho-emotional challenge to family members.
However, caregiver support addresses usually, if not entirely,
only resource coping for family caregivers. This paper pre-
sents an approach focus on psycho-emotional coping as
applied by a gero-counselling team based in Singapore. The
team is part of a community based health and psychosocial
care services specially for older persons and their family
caregivers.
Method and result: Over a three year period, the team
working with more than 70 family caregivers through indi-
vidual counselling and support groups, we identified and
intervened common issues affecting emotional well-being of
caregivers. Two issues were the most challenging to family
caregivers: communication breakdown with the PwD and
the loss of meaningful family activities. As a result, family
caregivers often experienced emotional distress including
sadness, frustration and helplessness. Counselling focused
on internal coping enabled acceptance and adjustment of
expectations. The outcomes of counselling were usually posi-
tive. Many were able to find new possibilities and hopes in
connecting with their loved ones, and were able to resume
caregiving with more positive outlook.
CAREGIVING FOR GRANDCHILDREN AND
DEMENTIA CAREGIVING: NOT THAT DIFFERENT
AMONG HISPANICS
L.C.Arevalo-Flechas1,2, M.Martinez1,2, B.Flores2, 1.
GRECC, South Texas Veterans Health Care System, San
Antonio, Texas, 2. The University of TX HSC at San
Antonio, San Antonio, Texas
Hispanic older adults assuming caregiving roles continue
to increase in unprecedented numbers. Development of pro-
grams to assist these caregivers to manage their stress and the
demands placed on them has also increased. However, the
vast majority of these programs are developed focusing more
on the specific needs and characteristics of the care-recipients
than on caregiver commonalities determined by cultural val-
ues. At the core of Hispanic culture are: Familismo, collectiv-
ism, personalismo, marianismo, and respeto.
We aimed to compare the experience of older Hispanic
family caregivers of relatives living with Alzheimers disease
or related dementias (ADRD), and Hispanic grandparents
caring for their grandchildren as a result of parental sub-
stance abuse disorders. We conducted a content analysis of
qualitative ethnographic interviews of these two populations
of caregivers. While the realities of daily caregiving duties
were of different nature (dementia vs. childrearing), regard-
less of care-recipient, caregivers provided narratives sup-
porting the themes: duty to family first, sense of satisfaction,
willingly sacrificing, sense of purpose, physically exhausting,
emotionally draining, financially straining, role challenges,
role captivity, legal stressors, fear, and major stressor. More
commonalities than differences were found. Caregivers dif-
fered in the root cause of fear (institutionalization vs. children
IAGG 2017 World Congress
465
placement in foster care), and the major stressor in their lives.
For grandparents the stressor was the perceived or actual
continued parental substance abuse. In addition to culturally
egivers to manage their levels of stress, urgent policy changes
are needed to support Hispanic family caregivers regardless
of age /type of care-recipient.
VOLUNTEER CARE FOR AN AGING POPULATION:
HIGHER QUALITY OF LIFE FOR CARING AND CARE
RECEIVING PEOPLE?
Y.Rubin, University of Applied Sciences, Fulda, Germany
Aging is increasingly accompanied by themes of care.
While younger and fitter elderly are invited to participate in
the context of voluntary activities the older take advantage
of this offers.
The debate on the organization of care and treatment of
an aging population follows two main lines of discussion:
One is on the context of social change and political neces-
sities. While the number of aging people is increasing, wel-
fare state security systems do not seem suitable to cope with
the associated (expected) challenges. The other main line to
these developments is that family support systems are pre-
carious as less and less resources are available for the acquisi-
tion of necessary care due to an increasing focus on gainful
employment.
From a feminist point of view care is understood as a
social practice that involves the whole of the paid and unpaid
care work. It has to be equipped with identifiable structural
conditions such as material and time resources, in both the
private as well as in public spaces.
This paper presents results of a qualitative research with
people who are engaged as volunteers for support services
for elderly in rural areas. The main question is how volunteer
care manifests in and for an aging population and in which
kind gender differences continue.
DEVELOPING ACARER IDENTITY AND
NEGOTIATING EVERYDAY LIFE THROUGH SOCIAL
NETWORKING SITES
F.Andrasson, J.Andreasson, E.J.Hanson, Faculty of Health
and Life Sciences, Linnaeus University, Kalmar, Sweden
Research highlights that a key overarching reason why
family carers do not utilize support services is that many peo-
ple who perform the duties of caregiving do not necessarily
self-identify as a carer. Understanding the development of
carer identities may thus be understood as crucial for the uti-
lization of different health services directed towards carers.
Based on the EU funded Innovage project, this project aims to
describe and analyse how older carers supporting and caring
for an older person understand and socially negotiate their
life situation and identity as carers on a Swedish online social
forum. Theoretically the project departs from a construction-
ist approach and methodologically it has been inspired by a
specifically designed method for studying the cultures and
communities that emerge from online computer-mediated
or Internet-based communications, called netnography. The
results indicate that in the process through which a carer role
is acquired, a significant change in self-perception occurs.
The presence or absence of recognition for the older carers
capacity, is understood as filtered through the needs of the
466
cared for person, making the carer identity into an invisible
self. At the same time, the opportunity for online communi-
cation may help to create a virtual space of social recognition
through which negative and positive experiences attached to
caring can be discussed. The significance of online communi-
cation is here understood as the possibility to be recognized,
and feel empowered by other carers.
FRIEND CAREGIVERS OF OLDER ADULTS IN THE
UNITED STATES: HOW DO THEY COMPARE TO
OTHER INFORMAL CARERS?
T.A.LaPierre, University of Kansas, Lawrence, Kansas
This study increases our understanding of the character-
istics and contributions of friend caregivers of older adults,
as well as the positive and negative consequences they
experience as the result of providing care and the different
supports they utilize in providing care. Similarities and dif-
ferences between friend caregivers and various types of kin
caregivers (e.g. adult children, siblings, grandchildren) and
other non-kin caregivers were investigated using bivariate
and multivariate statistical analyses. Data come from 928
unpaid, non-co-resident caregivers in the United States 2011
National Study of Caregiving. Friend caregivers were sig-
nificantly different than certain types of kin caregivers on
many, but not all characteristics, contributions, and conse-
quences examined. For example, friend caregivers were more
likely than certain types of kin caregivers to be female, to
be single, to live alone, to receive emotional support, and to
participate in caregiver support groups. They were less likely
to be sole caregivers, to use respite, and to experience nega-
tive caregiving consequences. Multivariate analyses reveal
potential explanations for differences in contributions and
consequences. Implications for policy and practice related
to informal caregivers are discussed, as well as the implica-
tions of study design on the population of caregivers being
examined.
CAREGIVER FAMILY THERAPY: APILOT STUDY
OF TREATMENT FIDELITY, ACCEPTABILITY, AND
EFFICACY
K.OMalley, 1. Psychology, VA Puget Sound American
Lake Division, Puyallup, Washington, 2. University of
Colorado Colorado Springs, Colorado Springs, Colorado
Physical and psychological health problems associated
with caregiving for a chronically ill family member are well
documented (Connell et al., 2001; Magliano et al., 2005),
and caregiver interventions are effective in reducing feelings
of burden and increasing feelings of competence (Pinquart
& Srensen, 2006). Tailored interventions incorporating
family systems are among the most effective treatments
for family caregivers (Belle et al., 2006; Mittleman et al.,
2004; Zarit, 2009). Caregiver Family Therapy (CFT) was
developed over a 10-year period; however, it has not been
evaluated for treatment fidelity or efficacy, the gold stand-
ard for assessing evidence-based practices. This study aimed
to assess treatment fidelity, acceptability, and efficacy in a
help-seeking population. 11 caregivers seeking services at
the UCCS Aging Center between September 1, 2015 and
May 1, 2016 were asked for their voluntary participation
in this study. Treatment fidelity was assessed by therapists,
clients, and expert raters throughout the intervention period.
Innovation in Aging, 2017, Vol. 1, No. S1
Therapists adhered to and skillfully implemented CFT in
weekly sessions with caregivers, Wilks Lambda=.81, F (1,
148)=35.75, p < .01, 2p=.20, and more time was spent
in session on targeted than non-targeted goals. CFT was
found to be highly acceptable (M=10.91, range 018) and
satisfying to caregivers (M=3.96, range 04) in this study.
Outcome data was positive, and improvement was found in
positive aspects of caregiving, t(9)=3.44, p=.01, 2=.56.
CFT appears to be a promising approach to reducing burden
and increasing competence in caregivers.
SESSION 940 (POSTER)
COGNITION
EFFECT OF SSRIS ON COGNITIVE FUNCTION
OF GERIATRIC PATIENTS WITH OBSESSIVE
COMPULSIVE DISORDER
L.Kouti1, H.Ansari2, A.Torbati3, 1. Clinical Pharmacy,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran (the Islamic Republic of), 2. Headache Clinic at
University of California, San Diego (UCSD), San Diego,
California, 3. Northshore University Hospital at Northwell
Health, Brooklyn, New York
SSRIs are the most chosen treatment for obsessive com-
pulsive disorder (OCD). Some studies have reported the
effects of SSRIs on cognitive function, but the results are
conflicting. Geriatric patients are usually more vulnerable to
drugs that affect memory and cognitive function. The pur-
pose of this study is the assessment of SSRI effect on cogni-
tion of geriatric patients with OCD.
Patients aged 65years and above, diagnosed with OCD
and nave to therapy, with no complaints or history of mem-
ory loss, were eligible for entering this study. Cognitive func-
tions of those who were willing to participate and an SSRI
drug was prescribed for, were assessed by Mini-mental state
examination (MMSE) test. MMSE scores of patients were
recorded at four points, before taking the drug, after 3, 5 and
8 weeks of drug therapy.
25 patients with the mean age of 671.8 years (68%
male and 32% female) entered our study. Their mean MMSE
score prior to medication was 24.3. At 3, 5 and 8 weeks
of treatment, the mean scores were 22.9, 21.04 and 20.66
respectively. With a p-value of <0.0001, the gradual decline
was significant. Gender, level of education, onset of disease,
patients response to the treatment, or drug agent did not
have a relationship with this decline.
The MMSE scores of our patients over the consecutive
weeks of taking SSRI drugs lowered significantly. It seems
that the use of SSRIs in geriatric patients with OCD, can
cause cognitive dysfunction in the acute phase of treatment.
USE OF THE GOLDSMITHS MUSICAL
SOPHISTICATION INDEX IN OLDER AMERICAN
ADULTS: AFEASIBILITY STUDY
D.Petrovsky, R.H.Hamilton, P.Z.Cacchione, University of
Pennsylvania, Philadelphia, Pennsylvania
The purpose of this feasibility study was to determine
older American adults ability to understand the terminol-
ogy used in the Goldsmiths Musical Sophistication Index
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
(Gold-MSI). The Gold-MSI was designed in the United
Kingdom to measure musical sophistication on a broad
range of musical expertise, skills, achievements and related
behaviors. The Gold-MSI is different from its predecessors
in that it assesses musical behaviors outside of instrumental
practice and years of formal music training. We administered
the Gold-MSI to 32 community-dwelling older adults (age
55 and older) living in the Northeast. The sample consisted
of older adults from a Program of All-inclusive Care (PACE)
(n=8), five participants from the Alzheimers Disease and
Research Centers choral group and nineteen were recruited
using snowball sampling. The sample consisted of 25 females
and 7 males with an average age of 68.3 and mean 15.5years
of formal education. The majority of adults were White
(n=15), or Black (n=14), with one Hispanic, one American
Indian and one who chose not to answer. Participants varied
in their musical background. On average, participants scored
lower (70.43) compared to the average scores reported in
the norms (81.58) established in the original reliability and
validity study in the UK. Three PACE participants identi-
fied minor difficulties in answering questions with double
negative statements. The participants did not indicate any
difficulty understanding the meaning of the questions when
filling out the index. This feasibility study supports the use of
the Gold-MSI with older adults living in the US.
CHRONIC PAIN PREDICTS ACCELERATED MEMORY
DECLINE AND DEMENTIA
E.L.Whitlock1, L.Diaz-Ramirez2, M.Glymour2,
J.Boscardin2, K.E.Covinsky2, A.K.Smith2, 1. Anesthesia &
Perioperative Care, University of California, San Francisco,
San Francisco, California, 2. University of California, San
Francisco, San Francisco, California
Chronic pain is highly prevalent among the elderly and
in cross sectional studies is associated with cognitive deficits
upon detailed neuropsychiatric testing. Using a nationally-
representative population-based study, we investigated the
association between pain at cohort inception and longitudi-
nal measures of memory and dementia probability over the
following 12years.
We studied Health and Retirement Study (HRS) par-
ticipants who were interviewed in both 1998 and 2000.
Chronic pain was defined as being often troubled by mod-
erate or severe pain in both the 1998 and 2000 interviews.
Based on data from each biennial telephone-based HRS eval-
uation through 2012, memory z-score and dementia prob-
ability were calculated from the validated HRS cognitive
battery using published methodology. Linear mixed effects
models were used to estimate the effect of chronic pain on
the slope of an individual longitudinal cognitive trajectory,
adjusted for baseline demographic, economic and health
factors.
The 10,065 subjects (mean age 73 in 2000, 60% female)
underwent a median of 5 biennial cognitive evaluations. Of
these, 1,120 (11%) reported chronic pain. After controlling
for other predictors in the model, chronic pain was associ-
ated with 7.5% (95% CI 2.812.2%) more rapid relative
increase in dementia probability, and 10.3% (95% CI 3.9
16.8%) faster memory z-score decline, compared to those
with no pain.
IAGG 2017 World Congress
467
We conclude that, at a population level, there is a mod-
est but significant independent association between chronic
pain and subsequent accelerated cognitive decline. Chronic
pain may place elders at risk of accelerated memory loss and
dementia.
BENEFICIAL EFFECTS OF PERILLA OIL AND BRAIN
TRAINING INTERVENTION ON COGNITION IN
ELDERLY JAPANESE
M.Hashimoto1, K.Yamashita2, K.Matsuzaki1, S.Kato3,
O.Shido1, 1. Shimane University Faculty of Medicine,
Izumo, Japan, 2. Department of Nursing, Faculty of
Nursing, The University of Shimane, Izumo, Japan, 3. Kato
Hospital, Jinjukai Healthcare Corporation, Izumo, Japan
Perilla oil contains 60% -linolenic acid and exhibits the
function of -3 fatty acids. It is utilized as an energy source
in the brain. In this 6-month randomized, placebo-controlled
trial, we verified the effects of perilla oil and brain train-
ing on the cognitive function and mental health of healthy
elderly Japanese individuals.
Independent elderly individuals aged 65years (n=158,
71.40.4years) were randomized to four groups (placebo,
perilla oil, brain training, and brain training with perilla
oil). Perilla oil (7 [Editor1] g) was administered every day
for 6 months. Brain training was performed according to
Shichida brain training. Cognitive function was assessed at
baseline and after 6months of intervention using the Mini-
Mental State Examination and Frontal Assessment Battery
(FAB). Mental health was assessed using the apathy and
Zung self-rating depression scales; biochemical factors were
measured in the participants blood.
The plasma and erythrocyte plasma membrane -linolenic
acid levels significantly increased in the perilla oil and brain
training with perilla oil groups. The mean changes in FAB
intellectual flexibility scores from baseline to month 6
were significantly greater in the brain training with perilla
oil group.
These results suggest that a combination of brain train-
ing and perilla oil improves age-related cognitive decline in
elderly people with very mild cognitive impairment.
EFFECTS OF COGNITIVE LEISURE ACTIVITY
PROGRAMS ON COGNITION IN MCI:
ARANDOMIZED CONTROLLED TRIAL
T.Doi1, J.Verghese2, H.Makizako1, K.Tsutsumimoto1,3,
R.Hotta1, S.Nakakubo1, T.Suzuki4,1, H.Shimada1,
1. Department of Preventive Gerontology, Center for
Gerontology and Social Science, National Center for
Geriatrics and Gerontology, Obu, Japan, 2. Albert Einstein
College of Medicine, Bronx, New York, 3. Japan Society
for the Promotion of Science, Tokyo, Japan, 4. J.F. Oberlin
University Graduate School, Tokyo, Japan
Participation in cognitive leisure activities is reported to
be associated with reduced risk of dementia in older adults in
observational studies; however, there are no definitive clinical
trials examining whether cognitive leisure activities reduce
the risk of cognitive decline. To test the hypothesis that a
long-term, structured cognitive leisure activity program is
effective on cognition in older adults with mild cognitive
impairment (MCI), a high risk for dementia. The study was
designed a 3-arm, single-blind randomized controlled trial.
468
Participants were 201 Japanese adults with MCI (mean age:
76.0, 52% women). Participants were randomized into 1 of
2 cognitive leisure activity programs (60 minutes weekly for
40 weeks): dance (n=67) and playing musical instruments
(n = 67), or a health education control group (n = 67). At
40 weeks, the dance group showed improved story memory
recall scores compared with controls (mean change dance
group 0.73 vs. controls 0.01; P=.011), whereas the music
group did not show an improvement compared with controls
(mean change music group 0.35; P=.123). Both dance (mean
change 0.29; P=.026) and music groups (mean change 0.46;
P=.008) showed improved Mini-Mental State Examination
scores compared with controls (mean change 0.36). Long-
term cognitive leisure activity programs involving dance or
playing musical instruments resulted in improvements in
memory and general cognitive function compared with a
health education program in older adults with MCI.
MONTREAL COGNITIVE ASSESSMENT VS.
ROWLAND UNIVERSAL DEMENTIA ASSESSMENT
SCALE FOR COGNITIVE SCREENING
C.Brymer, C.Sider, A.Evans, B.Y.Lee, K.Taneja, a previous literature report comparing EOAD (mean age
J.Morgenstern, R.Naqvi, medicine, western university,
London, Ontario, Canada
Our study involved 208 consecutive patients seen in an
outpatient memory clinic in London, Ontario, Canada (63
with diagnosis of mild dementia, 86 with diagnosis of mild
cognitive impairment, 59 with normal cognition) for whom
both a MoCA (Montreal Cognitive Assessment) and RUDAS
(Rowland Universal Dementia Assessment Scale) could be
completed. The sensitivity and specificity of both measures
were assessed for detection of mild cognitive impairment and
dementia. Using a cutoff score of 25 or less for both, the
MoCA had a sensitivity of 97 % to detect dementia, with
only 31% specificity, while the RUDAS had a 94% sensitiv-
ity to detect dementia, with 54% specificity. The MoCA at
25 or less had a sensitivity of 95% and a specificity of 69%
to detect mild cognitive impairment, while the RUDAS at 25
had a sensitivity of 81% and a specificity of 88% to detect
mild cognitive impairment. RUDAS score variation with edu-
cational attainment is significantly smaller than MoCA score
variation (P<0.01). The RUDAS is significantly briefer than
the MoCA as a cognitive screening tool, and demonstrated
similar sensitivity for dementia, with much better specificity
for dementia and mild cognitive impairment, in an outpa-
tient memory clinic.
COGNITIVE PATTERN ACCORDING TO AGE
Z.Barrou1, L.Dourthe1, S.Greffard1, B.Dieudonn1, for promoting recovery and maintaining life functions in the
L.Zerah1, J.Cohen-Bittan1, H.Vallet1, M.Verny1,2, 1.
Centre de griatrie Hpital Piti salptrire (APHP), Paris, after approximately 60years of age, following even a slight
France, 2. Universit Pierre et Marie Curie et UMR8256
(CNRS), Paris, France
Introduction: when comparing patients with early-onset
Alzheimers disease (EOAD) (before 65years) and late-onset
Alzheimers disease (LOAD), there have been conflicting
results. In general, EOAD patients have more difficulties in
non-memory domains including language, visuospatial skills
and executive functions. We tested the effect of age on cog-
nitive patterns among our geriatric population of AD, with
higher ages than in the literature.
Innovation in Aging, 2017, Vol. 1, No. S1
Method: prospective data collection on consecutive
patients with mild AD (MMSE>20). Individualization of two
groups: young patients (YP) 75years, elderly patients (EP)
85years. All patients underwent clinical examination, neu-
ropsychological assessment, laboratory workup and brain
imaging.
Results: 22 YP and 52 EP (72.82 and 87.62 years)
were included. Groups were comparable for socio educative
level, ADL and IADL scores, geriatric depression scores, neu-
ropsychiatric inventory scores and MMSE scores (24.12
and 24.02). We mainly observed that EP had poorer results
for semantic fluencies (Isaac set test, animals) and recall of
social events. There were no differences for phonetic flu-
encies and executive functioning. We also observed that
EP were slower on the TMT A, had worse performance in
abstract praxis and Rey figure copy. There was no significant
difference in episodic memory.
Conclusion: In patients with mild AD, cognitive patterns
differ between patients younger than 75 years and those
older than 85years. The main finding is a more pronounced
semantic impairment in older patients, in accordance with
60.6years) and LOAD (mean age 77.9years).
THE CONSTRUCT OF RESILIENCE IN THE FACE
OF HEALTH-RELATED ADVERSITY AMONG
COMMUNITY-LIVING ELDERLY
Y.Kobayashi2,5, H.Sugisawa3, R.Kariya4, H.Osada3, 2.
University of Human Arts and Sciences, Saitama, Saitama,
Japan, 3. J.F.Oberlin University Graduate School of
Gerontology, Machida, Tokyo, Japan, 4. Doctoral Course of
Gerontology, J.F.Oberlin University, Machida, Tokyo, Japan,
5. Institute for Gerontology, J.F.Oberlin University, Tokyo,
Japan
Decline of physical, psychological, and life functions is
an inevitable consequence of aging. Interestingly, it has been
reported that psychological factors, such as the purpose in
life, has an effect on physiolosical aspects of aging, such as
cognitive decline. This study, based on previous research, the
purpose in life was considered as one construct of resilience.
Resilience, defined as a psychological treat that promotes
recovery and maintains life functions in the face of health-
related adversities including illnesses, was investigated among
community-living elderly people in Japan. Participants (N=20,
mean age 81.45years, Age range 7292years, 80% women)
were recruited for the study by community care managers
and volunteer workers. Episodic interviews were conducted
with the participants about their thoughts, efforts and ideas
face of health-related adversity that they had experienced
recovery. Responses from transcripts revealed four themes:
Activation (acceptance of novelty, resolute will, natural pose,
and trust of intuitions), Purpose in life (affirmative accept-
ance, meaning, past feelings in overcoming difficulties, and
goals in life), Relationship preferences (enjoyment of contact
with others, support seeking, and willingness to serve), and
Health consciousness (health for life, industrious attitude,
assessment, and sensitivity to information). It is suggested
that these four constructs are linked in a chain reaction. The
results of this study will contribute to the development of
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Innovation in Aging, 2017, Vol. 1, No. S1
preventive psychological interventions for dementia among
the aging population in Japan.
VITAMIN D INSUFFICIENCY AND COGNITIVE
TRAJECTORIES IN OLDER ADULTS: THE RANCHO
BERNARDO STUDY
G.A.Laughlin, D.Kritz-Silverstein, J.Bergstrom, E.Reas,
S.Jassal, E.Barrett-Connor, L.K.McEvoy, University of
California San Diego, La Jolla, California
Evidence of a role for vitamin D in cognitive aging is
mixed and based primarily on extreme vitamin D deficiency.
We evaluated the association of vitamin D with patterns of
change in cognitive function in community-dwelling adults
living in a temperate climate with year-round sunshine.
This is a longitudinal study of 1058 older adults (median
age 75)who had cognitive function assessed and serum vita-
min D (25(OH)D) measured in 199799 and were followed
with up to three repeat cognitive function assessments over a
12-year period. Overall, 13.5% (n=145) of participants had
vitamin D insufficiency (<30ng/ml); only 3% had vitamin D
deficiency (<20ng/ml). Adjusting for age, sex, education, and
season of blood draw, vitamin D insufficiency was associated
with poorer baseline performance on Mini-Mental Status
Exam (MMSE) (P=0.013), Trails Making Test B (Trails B)
(P=0.018), Category Fluency (P=0.006) and Long Term
Retrieval (P=0.016), but was not related to the 12-year rate
of decline for any test. For those with vitamin D insufficiency,
odds of poor cognitive function at baseline were 63% higher
(P=0.033) for MMSE, 78% higher (P=0.013) for Trails B,
and 2-fold higher (P<0.001) for Category Fluency and Long
Term Retrieval, and the risk of developing impaired Trails B
performance during follow-up was 67% (P=0.013) higher.
Although the possibility of confounding by concomitant
poor health cannot be excluded, these results suggest that
even moderate vitamin D insufficiency may contribute to
reduced cognitive function in older adults.
MOTOR IMAGERY OF GAIT WITH AGING: MENTAL
IMAGERY STRATEGY AND BODY POSITION
MATTER
O.Beauchet1, G.Allali2, 1. Medicine, McGill University,
Montreal, Quebec, Canada, 2. Geneva University, Geneva,
Switzerland
The imagined version of Timed Up and Go test (iTUG)
is an efficient clinical way to assess age-related changes in
highest levels of gait control. This study aims 1)to examine
the effects of the MI strategy (i.e.; egocentric versus allocen-
tric representation) and the body positions (standing, sitting,
lying down) for the time needed to complete the iTUG, and
2)to compare TUG performances under different MI strate-
gies and body positions in healthy young and older adults.
A total of 60 healthy individuals (30 young participants
26.67.4years with 48.3% women, and 30 old participants
75.04.4 with 40.0% women) were recruited in this cross-
sectional study. Times of the pTUG and iTUG and the TUG
delta time, used as outcomes. The strategies of gait MI (i.e.;
ego versus allocentric representation) were recorded. Older
participants used more frequently the allocentric representa-
tion compared to young adults, regardless the body position
(P0.001). Multiple linear regressions showed a significant
increase of iTUG time with age (P0.008), except in model
IAGG 2017 World Congress
469
non-adjusted on MI strategy. Allocentric MI strategy was
associated with significant decrease in iTUG (P0.015),
whereas lying down position was associated with increase
in iTUG (P0.04). The results showed an aging effect while
imagining gait characterized by a change in representation
from ego to allocentric representation. Furthermore, lying
down position represents the more accurate position of the
real performance in comparison to other positions.
THE RIGHT KIND OF SMART? EMOTIONAL
INTELLIGENCE AND COGNITIVE IMPAIRMENT IN
OLDER ADULTS
O.Saad1,4, L.Zysberg3, J.Heinik2, R.Ben-Itshak2,
A.Zisberg1, 1. The Cheryl Spencer Department of Nursing
Faculty of Social Welfare and Health Science, University of
Haifa, Israel, Haifa, Israel, 2. The Psycho-Geriatric Institute,
Sorasky Medical Center, Tel Aviv, Tel-Aviv, Tel-Aviv, Israel,
3. Gordon College of Education, Haifa, Israel, Haifa, Haifa,
Israel, 4. JCT - Jerusalem College of Technology - Lev
Academic Center, Jerusalem, Israel
Background: Health psychology, emphasizes the potential
of individual resources in effectively adapting to health chal-
lenges. Older adults with cognitive impairment (CI) suffer
depletion of individual resources (e.g.: intelligence, certain
personality traits, etc.) that jeopardizes their ability to adapt
and function. Emotional intelligence (EI), a relatively new
concept, holds promise as a pivotal resource for health chal-
lenges that until recently went unnoticed. In this pilot study
we examined the distribution and inter-correlations among
individual resource measures against a cognitive impairment
measure to test EIs potential role as a resource for older
adults coping with CI.
Methods: Applying a correlational study design, 66 older
adults (mean age 77.926.83), 60% of whom were women,
were recruited from a memory clinic in central Israel. The
participants showed a broad spectrum of cognitive function
on Montreal Cognitive Assessment (MoCA scores 1530),
ranging intact through Mild Cognitive Impairment to demen-
tia. General intelligence (GI), EI, Instrumental ADL (IADL),
social support and comorbidities were assessed.
Results: EI positively associated with IADL (r=.37; p<.01)
GI (r=.26; p<.05) and social support (r=.27; p<.05). In a
regression analysis controlling for intervening factors EI did
not correlate with MoCA while showing associations with
GI (=.26; p<.05), IADL (=.21; p<.05) and education level
(=.42; p<.01).
Conclusions: As GI decreases with CI, EI remains rela-
tively intact as an individual resource. This first of its kind
evidence supports the possibility that EI may serve as a resil-
ient resource in older adults with CI that may facilitate cop-
ing with the challenges of this condition.
COGNITIVE FUNCTIONING IN LATER LIFE:
BENEFITS OF SPIRITUAL RESOURCES
N.Lekhak, T.Bhatta, J.Zauszniewski, Nursing, Case
Western Reserve University, Cleveland, Ohio
Spiritual resources have been used by human beings from
time immemorial to reduce psychological distress and in heal-
ing. Primarily based on racially homogenous smaller clinical
studies, previous research have suggested positive influence
of meditation and prayers on memory and brain functioning
470
associated with cognition. Despite extensive research on its
role in enhancing mental health, there has been relatively
little attention paid to its significance in mitigating cogni-
tive decline in later life. This study synthesizes Proactive
Adaptation Model and Resourcefulness Theory to explore
whether spiritual resources can be proactively utilized to
reduce the later life risk of cognitive decline. Drawing from
a racially heterogeneous subsample (n=1159) from Health
and Retirement survey, this study investigated the effect of
meditation and prayers on changes in cognitive functioning
among older adults. Results based on generalized estimat-
ing models suggest statistically significant positive effect of
prayers (0.50, p<0.05) on cognitive functioning at baseline.
While positive, the effect of meditation on cognition at base-
line was not statistically significant (0.15, p=0.4). We also
observed slight gain in cognitive functioning among older
adults practicing meditation (0.03, p<0.05) and prayers
(0.03, p=0.08). Furthermore, we documented significantly
higher cognition among older adults with higher level of
education and lower cognitive functioning among African
American. Consistent with prior literature, our study high-
lights positive cognitive health benefits of spiritual resources
and provides much needed research evidence to design effec-
tive community level interventions to reduce the risk of cog-
nitive decline in later life.
OLDER VETERANS WITH TYPE 2 DIABETES: A1C
AND COGNITIVE FUNCTION
P.Lee1,2, E.Guerrero-Berroa3,4, J.Schmeidler4, M.Schnaider-
Beeri3,4, R.West3,4, M.Sano3,4, N.Alexander1,2,
J.M.Silverman3,4, 1. University of Michigan, Ann Arbor,
Michigan, 2. Veterans Affairs Ann Arbor Healthcare System,
Ann Arbor, Michigan, 3. James J.Peters Veterans Affairs
Medical Center, Bronx, New York, 4. Icahn School of
Medicine at Mount Sinai, New York, New York
Poor glycemic control (i.e., high A1c) among older adults
with type 2 diabetes (DM) is associated with high risk of
cognitive impairment across various domains of cognitive
assessments. Older Veterans with DM have not been well
studied. We hypothesized that high A1c is associated with
worse executive function among older Veterans with DM.
We performed preliminary analysis of the baseline data
from 61 Veterans with DM (aged 60years or older) recruited
from 2 VA health systems for a computerized cognitive train-
ing study. None had dementia diagnosis or Clinical Dementia
Rating scale 1. A finger-stick blood sample was analyzed
using a point-of-care A1c analyzer to obtain A1c results.
Five cognitive domains were assessed - Episodic Memory,
Executive Function, Attention/Working Memory, Language/
Semantic Categorization, and Psychomotor Speed. The asso-
ciation between A1c and cognition was examined using mul-
tiple linear regressions, adjusting for age and education.
For 61 Veterans (2 females), means were age 70 years,
14 years education, and 7.4% A1c. A1c was significantly
associated with cognition only for Executive Function at
one VA center (n=31, mean 7.9% SD 1.4, range 611%).
Higher A1c was associated with better executive performance
(=0.40, t=3.61, p=0.001, partial r=0.59), explaining had the participants to walk a 9m walking way, of 5m meas-
0.31 of the variability in performance (R2=0.41).
This preliminary result of unexpected positive association
of executive function with higher A1c may reflect recruit-
ment of Veterans with high and variable A1c at that center.
Innovation in Aging, 2017, Vol. 1, No. S1
Ongoing recruitment and increased sample size will be
needed to verify this result.
BRAIN GAMING EFFECTS ON MILD COGNITIVE
IMPAIRMENT: ASYSTEMATIC REVIEW
P.Sood1, S.Kletzel2, C.Ciro3, J.Machtinger4, D.R.Dawson5,
P.C.Heyn4, 1. University of Florida, Gainesville, Florida,
2. VA, Chicago, Illinois, 3. The University of Oklahoma
Health Sciences Center, Oklahoma City, Oklahoma, 4.
University of Colorado, Denver, Colorado, 5. University of
Toronto, Toronto, Ontario, Canada
Objective: To systematically review and synthesize the
research findings regarding the effects of brain gaming inter-
ventions on cognitive function of older adults with cognitive
impairments (CI).
Methods: A systematic search was conducted using
PRISMA guidelines. Acombination of key terms (i.e. brain
gaming, older adult, dementia, cognition) were used to
search for relevant literature on common electronic data-
bases (MEDLINE, PubMed, EMBASE, CINAHL, PsycInfo,
Cochrane Library Databases). Two level eligibility criteria
were used to identify potential peer-reviewed manuscripts:
1) titles and abstracts were carefully reviewed by review-
ers; and 2)full manuscripts that passed Level 1 review were
retrieved for inclusion consideration. Frequencies, ranges,
means and standard deviations were used to evaluate the
studies characteristics and quality.
Results: 766 studies were identified as potential for inclu-
sion. 215 studies were excluded as duplicates. 515 abstracts
were screened for Level 1 review accordingly to a priori cri-
teria. 51 abstracts passed level 1 review and underwent full
manuscript review (Level 2). Seven articles met full eligibility
criteria for data extraction. Total sample of 396 older adults
(77 yrs 6) with CIs including dementia were analyzed.
Studies treatment ranged from 20 minutes session to 100
minute session. Primary outcomes were memory, learning,
executing function, and visuospatial attention and depres-
sion as secondary. Five out of seven studies showed positive
cognitive effects from the brain gaming interventions.
Conclusion: Our results suggest that brain gaming has an
overall positive effect on the cognitive function of older adults
with CI. Although, high level of evidence-based research
studies are recommended to reach conclusive results.
IS GAIT USING DUAL TASK POSSIBLE TO DETECT
COMMUNITY DWELLING ELDERLY WITH
COGNITIVE DECLINE?
Y.Shiba1, T.Yamagami2, T.Ueda3, S.Tanaka4, S.Anzai5,
1. Kitasato Univerity, Sagamihara-shi, Kanagawa-ken,
Japan, 2. Gunma University, Maebashi-shi, Japan, 3. Sanno
Rehabilitation Clinic, Tokyo, Japan, 4. Takasaki University
of Health and Welfare, Takasaki-shi, Japan, 5. Tokyo
Metropolitan Institute of Gerontology, Tokyo, Japan
In Japan, due to the increase of old-old, Aging-Associated
Cognitive Decline (AACD; Levy, 1994) qualifiers are rap-
idly increasing. The number of AACD group was 13 (age
74.72.8), and the healthy group was 6 (age 71.83.7). We
uring distance made by connecting 2Walk Way (ANIMA
Corp.), plus 2m acceleration distance and 2m deceleration
distance, 2 trials each of fastest possible gait (Speed up walk-
ing; S) and dual task gait of calculating while walking (Dual
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
task walking; DT) in the respective order. Further, inter-
vention task for the DT group was, to chant the answer of
calculation starting from 70 minus 7 for the first trial and
50 minus 7 for the second trial, and continue to take away
7.We carried out Five Cog for detection of AACD elderly
(Yatomi, 2006). The significant differences in gait character-
istics between the two groups within the DT task were, gait
speed (P=0.037), cadence (P=0.058), stride (P=0.149). On the
other hand, there were no differences seen in the S task (n.s.).
The S task (Shinkai, 2000), said to be beneficial as a good
predictor of vital functions, could not detect AACD elderly.
Within the DT task, since there was a gait speed decrease, it
is possible to be beneficial as one of screening tasks to detect
AACD elderly. It could be possible even for non-specialists,
in a short time to detect AACD elderly, by adding a DT task
to widely popular gait test.
EFFECTS OF DUAL TASK SWITCHING WORKING
MEMORY TRAINING ON COGNITIVE FUNCTIONS
IN THE ELDERLY
N.Trushkova1, N.Ermolina2, G.Zelano1, 1. Rehabilitation
Research Center Armonia, Aprilia, Latina, Italy, 2.
Astrakhan State University, Astrakhan, Russian Federation
Objectives: Several studies suggest that the human abil-
ity to rapidly and accurately switch between tasks multi-
ple times and to focus attention on the currently relevant
response set employs working memory capacity. This ability
decreases with age and thats why older people have great
difficulty in dual-task performance and TMT part B tests.
Moreover, TMT-B has been proven to be a single predictor to
predict dementia. We hypothesized that Dual Task Switching
Working Memory Training (Dual Task-SWMT) where both
motor and cognitive task requires working memory might
improve not only task-switching ability but also the working
memory capacity in healthy older adults. The purpose of this
study was to examine the benefits Dual Task-SWMT on cog-
nitive functions specially in the working memory capacity in
healthy subjects
Methods: The study subjects were 50 healthy adults,
21 men and 29 women, aged 73 years, cognitive status
screened (MMSE>25). We proposed them to perform Dual
Task-Switching Working Memory Training that we have cre-
ated one hour twice a week for 24 weeks. At the beginning
and at the end of treatment, participants received a cognitive
assessment that included Mini-Mental State Examination
(MMSE), Forward and Backward Digit Span Test, Reys
Auditory Verbal Learning test, TMT-A, TMT-B.
Results: The cognitive assessment showed statistically
significant improvement in all the scores tested (t-test per-
formed), including the TMT-B (p<0.05).
Conclusions: These findings indicate that Dual Dual
Task-SWMT where both motor and cognitive task requires
working memory may serve as an efficient way to improve
cognitive performance on healthy adults.
MOTOR-COGNITIVE TRAINING IMPROVES
BALANCE AND COGNITION OF PATIENTS WITH
PARKINSONS DISEASE
J.R.Bacha, K.G.Silva, T.B.Freitas, G.Gomes, L.Viveiro, challenges and strategies associated with the CPT in practice.
E.Varise, C.Torriani-Pasin, J.Pompeu, Department of
Physical Therapy, Speech Therapy and Occupational
IAGG 2017 World Congress
471
Therapy, School of Medicine, University of Sao Paulo, So
Paulo, So Paulo, Brazil
Objective: To investigate the effects of motor-cognitive
training on individuals with Parkinson disease (PD) com-
pared with community dwelling elderly. Method: This is a
randomized clinical trial, in which participated five elderly
people [mean age 68.3 (2.03) years] and five patients with
idiopathic PD [mean age 67.7 (2.1) years, stages 13 in the
Hoehn and Yahr scale]. Participants underwent 14 training
sessions of one hour of duration each one, twice a week.
Training was conducted in groups with a maximum of five
elderlies. The program included challenging exercises for
balance and cognition, including warming up, strengthen-
ing, flexibility, aerobic training, gait, balance and transfer
training. Participants were assessed pre and post-test and
after 30days [follow-up (FU)]. Cognition and balance were
assessed by the Montreal Cognitive Assessment (MoCA)
and Mini-Balance Evaluation Systems Test (Mini-BESTest),
respectively. Study was registered in Brazilian Registry of
Clinical Trials (RBR-27kqv5). Results: Both groups showed
improvement on balance and cognition post-test with main-
tenance of its effects on the FU. However, this improvement
was substantial in the elderly group, but there was is not
difference between groups. The mean (SD) scores in scales
evaluated in the elderly were: Mini-BESTest were: 26.93.4
(pre-test), 29.43.7 (post-test) and 28.72.8 (FU); MoCA
were 24.05.2 (pre-test), 26.73.3 (post-test) and 26.94.4
(FU). The mean (SD) scores of PD patients on Mini-BESTest
were: 24.03.9 (pre-test), 24.44.1 (post-test) and 26.33.7
(FU); MoCA were 21.34.5 (pre-test), 23.65.5 (post-test)
and 23.44.5 (FU). Conclusion: The proposed intervention
promoted improvement on balance and cognition in PD
patients and community dwelling elderly.
ASSESSMENT, HOME SAFETY AND THE COGNITIVE
PERFORMANCE TEST: ADISCONNECT IN PRACTICE
OR PURPOSE?
S.Davidson1,2, R.Emonts2, M.Rotman2, 1. Occupational
Therapy, Baycrest Health Sciences, Toronto, Ontario,
Canada, 2. University of Toronto, Toronto, Ontario,
Canada
Home safety is crucial for older adults. Occupational
therapists use performance-based assessments (PBAs) to pre-
dict clients occupational capacity and provide recommen-
dations for needed supports to ensure safety. Occupational
therapists face barriers with using PBAs in practice due to
their complexity and variability. The Cognitive Performance
Test (CPT) is a widely sourced standardized PBA, regularly
utilized with the older adult population, and is reportedly
challenging to administer and score. Currently there is a
lack of knowledge about challenges associated with the use
of PBAs. This study will explore occupational therapists
perspectives on challenges they experience when using the
CPT, and aim to produce strategies to remediate the discon-
nect of the CPTs use in practice. Six occupational therapists,
from various clinical programs at a geriatric hospital, par-
ticipated in scoring of a recorded CPT administration and
an audio-recorded focus group. Participants discussed the
Using multiple analyst triangulation, the transcribed record-
ings underwent thematic analysis to uncover main themes.
472
Clinicians expressed personal qualities influencing their
practice of being an occupational therapist, influences of
the environment affecting their use of the CPT and identi-
fied patterns that they noticed while participating in the
occupation of doing the CPT. The knowledge gained from
this study can enhance clinician awareness of challenges
associated with using the CPT and provide opportunity for
occupational therapists to reflect upon their fit as clinicians
within their practice environment, while utilizing a standard-
ized assessment to help with the significant challenges that
often accompany discharge.
CESSATION OF WALKING DURING DIVIDED
ATTENTION TASK IN OLDER ADULTS WITH
COGNITIVE IMPAIRMENT
S.M.Borges1,2, M.Radanovic2, O.V.Forlenza2, 1. Santa
Ceclia University, Santos, Sao Paulo, Brazil, 2. Laboratory
of Neurosciences - LIM27; Department and Institute of
Psychiatry Faculty of Medicine, University of So Paulo, Sao
Paulo, Sao Paulo, Brazil
The aim of the present study was to evaluate if older
adults with Mild Cognitive Impairment (MCI) and mild
Alzheimers Disease (AD) patients stop walking during a
functional mobility test with or without divided attention
(dual task paradigm). We examined functional mobility in
104 older adults (42 with MCI, 26 with mild AD, and 36
cognitively healthy controls) using the Timed Up and Go
test (TUG) under four experimental conditions: TUG single
task, TUG plus a cognitive task (listing animals), TUG plus a
manual task (holding a full glass of water) and TUG plus a
cognitive and a manual task (performing the listing animals
while carrying a full cup of water). Statistically significant
differences between the mean time of execution were found
in all four experimental conditions when comparing MCI
and controls (p <.001), AD and controls (p <.001), and when
comparing MCI and AD patients (p <.05). However mem-
bers of all groups stopped walking while talking in TUG cog-
nitive dual task (controls: n=02; 5.6%, MCI: n=17; 40.5%
and AD: n=19; 73.1%; p <.001) and TUG plus a cognitive
and a manual task (controls: n=02; 5.6%, MCI: n=21; 50%
and AD: n=19; 73.1%; p <.001). These findings demonstrate
the influence of cognitive impairment in divided attention
task, especially cognitive dual task, during functional mobil-
ity. This data is relevant, because the termination of walking
during the TUG indicates a loss in executive function and,
consequently, increased risk of falls in older adults with cog-
nitive impairment.
IS COMBINED MOTOR LEARNING COGNITIVE
TRAINING THE EFFECTIVE TOOL TO IMPROVE
COGNITIVE FUNCTION?
N.Trushkova1, N.Ermolina2, G.Zelano1, 1. Rehabilitation incontinence, vision and hearing impairment are also signifi-
Research Center Armonia, Latina, Italy, 2. Astrakhan
State University, Astrakhan, Astrakhan, Russian Federation
Objectives: Several studies suggest that the brain main-
tains neuroplasticity even in older age and can benefit from
mental training. Asuccessful brain training program should
preferably include a range of different tasks, that should be
less automatic and more complex, in order to involve a mul-
titude of functions. Numerous studies have claimed evidence
that motor learning provides a great variety of exercises and
offers neuroplastic benefits to the brain. We hypothesized
Innovation in Aging, 2017, Vol. 1, No. S1
that combining cognitive exercises with motor learning
training might improve cognitive functions in healthy older
adults.
The purpose of this study is to examine the benefits of
combined motor learning and cognitive exercises training on
cognitive functions in healthy subjects.
Methods: The study subjects were 48 healthy adults,
17 men and 31 women, aged 74 years, cognitive status
screened (MMSE >25). We proposed them to perform one
hour of motor learning activity combined to cognitive stimu-
lation exercises based on novelty and variability twice a week
per 24 weeks. At the beginning and at the end of treatment,
participants received a cognitive assessment that included
Mini-Mental State Examination (MMSE), Digit Span Test,
Reys Auditory Verbal Learning test, TMT-A, TMT-B.
Results: The cognitive assessment showed statistically
significant improvement in all the scores tested (t-test per-
formed), the most significant was in MMSE (mean=1,6;
p<0.001).
Conclusions: These findings indicate that motor learning
combined to cognitive stimulation exercises may serve as an
efficient way to improve cognitive performance on healthy
adults. We also discussed several directions for future com-
bined training studies.
SUBJECTIVE COGNITIVE IMPAIRMENT IN INDIAN
OLDER ADULTS: CLINICAL AND SOCIAL PROFILE
V.Kumar1, G.R.Desai1, S.K.Yadav1, P.Chatterjee1,
A.Chakrawarty1, A.B.Dey1,2, 1. Geriatric Medicine, AIIMS,
New Delhi, New Delhi, Delhi, India, 2. AIIMS, New Delhi,
New Delhi, Delhi, India
Aims & objectives: To detect cognitive impairment among
older people with subjective memory complaints in a tertiary
hospital setting AIIMS.
Methods: In a cross-sectional study involving patients
attending the Memory Clinic of the Department of Geriatric
Medicine 200 patients, aged 60 and above, with subjective
memory complaints were included. A detailed evaluation of
the cognitive status, functional status and co-morbidities was
done as per various validated scales. Socioeconomic and other
demographic characteristics were obtained from the caregiv-
ers. The diagnosis, management and follow up of patients
were carried out in the memory clinic.
Results: Out of 200 patients, 158 were males and 42 were
females. Mean age was 67.5years and the number abruptly
declined after the age of 85years. Most of the patients were
living with their spouse and children, economically depend-
ent and were from middle income group. GDS score was sig-
nificantly associated with cognitive impairment. Cognitively
impaired patient were more depressed as compared to nor-
mal participants (p value -0.000). Polypharmacy, urinary
cantly associated with cognitive decline. Previous history of
falls and dental problems were also found to have significant
effect on cognitive performance of the patients. Alzheimers
disease (AD) (49%) and Vascular dementia (42%) were the
main causes of dementia in cases.The common co-morbid-
ities were hypertension, diabetes mellitus, cerebro-vascular
accidents, and COPD. The most interesting result was that
patients who themselves were concerned about cognitive
decline had better scores than those who were presented by
family members.
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Innovation in Aging, 2017, Vol. 1, No. S1
Conclusions: Subjective cognitive impairment is the
very serious evolving issue in elderly and it should not be
ignored as it may help to focus on future dementia cases.
Geriatricians should develop clinical protocol to manage
cognitive decline in old age without depending on neurolo-
gist and psychiatrists.
HIGH ANTICHOLINERGIC COGNITIVE BURDEN IS
ASSOCIATED WITH URGENCY INCONTINENCE IN
ELDERLY POPULATION
U.Cintosun, I.Naharci, T.Turker, E.Bozoglu, S.Oguz, tion, gender, mental status, driving status, study location, and
A.Ozturk, H.Doruk, Geriatrics, Gulhane Medical School,
Ankara, Turkey
Urgency urinary incontinence (UUI) is involuntary leak-
age of urine associated with urgency. Medications with
anticholinergic cognitive burden (ACB) are considered as
a risk factor for cognitive limitations and decreased physi-
cal functionality. Our aim was to investigate whether high
ACB will be an independent risk factor for UUI in elderly
or not.
The analysis was carried out on 1050 subjects aged
65years. Out of those, 189 were eligible to meet the study
criteria. They were divided into two groups: The study group
included subjects with UUI (n:82) and the control group
included those without UUI (n:107). ACB was calculated for
each subject by adding the score of each drug and classi-
fied as having absent (ACB=0), low(ACB=1 or 2), and high
(ACB3) anticholinergic properties based on ACB scale.
Age, gender and cognitive status did not differ between
groups. There was more subjects with definite and possi-
ble ACB in the study group compared to the control group
(17.3% and 29.6% vs. 1.9% and 25%; p<0.001. In multi-
variate regression analysis high ACB was found to be a risk
factor for UUI (OR: 11.2; CI: 2.33353.776; p=0.003) while
low ACB not (OR:1.652; CI: 0.8093.376; p=0.168).
We found that high ACB is an independent risk factor
for UUI. Central effects of medications with ACB and their
functionality-limiting effects are possible causes of UUI in
this population. Further randomized and controlled studies
are needed to enlighten the causal relationship between ACB
and UUI.
SESSION 945 (POSTER)
COGNITION III
THE IMPACT OF THREE COGNITIVE TRAINING
INTERVENTIONS ON OLDER ADULTS LIFESPACE
ACROSS FIVE YEARS
L.Ross1, A.Stanford1, C.Phillips1, M.L.OConnor2, Fluency, Executive Functioning, Visuospatial, and Memory).
J.Dodson3, F.Cortez2, 1. Human Development and Family
Studies, The Pennsylvania State University, University Park,
Pennsylvania, 2. North Dakota State University, Fargo,
North Dakota, 3. University of Alabama at Huntsville,
Huntsville, Alabama
Lifespace is the purposeful movement throughout ones
environment and is a central aspect of healthy aging. As fluid
cognitive abilities are strongly linked to lifespace, targeted
cognitive interventions may preserve lifepace in older adults.
The objective of this study was to assess the effects of three
IAGG 2017 World Congress
473
separate cognitive interventions (reasoning training, speed
of processing training, and memory training) on changes in
older adults lifespace across 5years. Participants (age range
6594, M=73.64) randomized to a no-contact control condi-
tion (n=698) were compared to those randomized to: rea-
soning (n=694), speed of processing (n=702), and memory
(n=703) training using multilevel modeling. Intention-to-
treat (ITT, randomization to training conditions) and dosage
(treatment-received via number of training sessions) analyses
were conducted. Models were adjusted for age, race, attri-
residential status (i.e. living alone or not). Results revealed no
significant group differences in the ITT analyses. However,
dosage models revealed that more sessions of speed of pro-
cessing [95% CI: .0002, .0098] and reasoning [95% CI:
.0002, .0100] training predicted greater lifespace across the
five years relative to the control group. Participants rand-
omized to memory training did not differ from the control
group in lifespace across five years [95% CI: -.0044, .0055].
This is the first study to show that two cognitive interven-
tions (reasoning and speed of processing training), but not
memory training, transferred to maintained lifespace across
five years. Future research should investigate the mechanisms
of these far transfer effects.
MODERATE ALCOHOL USE AND COGNITIVE
PERFORMANCE OVER TIME AMONG OLDER
ADULTS
D.Herring, D.Paulson, University of Central Florida,
Orlando, Florida
Individual trajectories of cognitive aging can vary widely
and are affected by numerous lifestyle factors 1. Moderate
alcohol use among older adults is known to confer protective
effects with regard to cognition and other health outcomes2-5.
However, less is known about how moderate drinking relates
to rate of change between cognitive domains and the timing
of emergence of moderate use-associated benefits.
The purpose of this study was to explore older adults self-
reported alcohol use over time in relation to their cognitive
performance over a period of eight years. Data for the 856
participants was obtained from the ADAMS sample of the
HRS, a longitudinal, cohort study on health, retirement, and
aging conducted by the University of Michigan. Participants
were predominantly female (58.6%) and Caucasian (76.9%).
The mean age at baseline was 81.56 years (SD=7.17) and
average years of education was 10.03years (SD=4.35).
A series of latent growth curve models examined the
effects of moderate use on rate of change in cognitive per-
formance over time for each measure (relating to domains of
After controlling for education, medical burden, and mari-
tal status, moderate drinking was consistently significantly
associated across cognitive measures with increased baseline
functioning (p .05), but did not have a significant effect on
rate of change over time.
These findings suggest that the effect of moderate alcohol
use on cognition emerges prior to the time period captured
by available data (age 73), and that these differences appear
to persist throughout later life.
474
ALCOHOL INTAKE AND COGNITIVELY HEALTHY
LONGEVITY: THE RANCHO BERNARDO STUDY
E.Richard1, D.Kritz-Silverstein1, G.A.Laughlin1, T.Fung2, average retired individuals had less cognitive impairment
E.Barrett-Connor1, L.K.McEvoy1, 1. Radiology, University
of California, San Diego, La Jolla, California, 2. Harvard
University, Boston, Massachusetts
Moderate alcohol consumption has been associated with
reduced mortality, but the association of alcohol with cogni-
tively healthy longevity has not been well characterized. Here
we explored the association between alcohol intake and cog-
nitively healthy longevity among 1353 community-dwelling
adults. Frequency and amount of alcohol intake was assessed
by questionnaire in 19841987. Cognitive function was
assessed at approximate 4year intervals beginning in 1988
1992 through 20072009. Multinomial logistic regression
was used to examine the association between alcohol intake
and a three level outcome: cognitively healthy longevity (liv-
ing to at least age 85 without cognitive impairment), survival
to age 85 with cognitive impairment (defined as an MMSE
score > 1.5 standard deviations below expectation for age,
sex, and education), or death before age 85, with adjustment
for numerous health and lifestyle factors. Only 17% of par-
ticipants reported no alcohol intake; 48% reported drinking
near-daily. Most drinkers (48% of the sample) consumed a
moderate amount of alcohol ( 1drink/day for women and
those over age 65; 2 drinks/day for men under age 65).
Relative to nondrinkers, those who drank near daily had
23 fold higher odds of cognitively healthy longevity versus
cognitive impairment (p< .05) or death before 85 (p<.001).
Compared to nondrinkers, moderate or heavy drinkers had
significantly higher odds of cognitively healthy longevity ver-
sus cognitive impairment or death before age 85 (ps < .05).
Although excessive drinking is associated with significant
mortality and morbidity, our results suggest that frequent,
moderate alcohol intake may play a role in promoting cogni-
tively healthy longevity.
UNDERSTANDING THE RELATIONSHIP BETWEEN
RETIREMENT AND COGNITIVE HEALTH
J.Godin1, O.Theou2, J.Armstrong2, M.Andrew1,2, 1. Nova with lower IL-6 for people with lower IQ. Although some
Scotia Health Authority, Halifax, Nova Scotia, Canada, 2.
Dalhousie University, Halifax, Nova Scotia, Canada
Researchers have examined the association between cog-
nition and retirement; however, results are inconsistent and
the direction of the relationship is unclear. Risks may be con-
text dependent. Retirement may be viewed by some as an
opportunity to pursue interests and hobbies, whereas oth-
ers may derive meaning and benefits from employment. Our
purpose was twofold: 1)examine whether cognitive impair-
ment predicts future employment status (i.e., retirement) and
whether employment status predicts future cognitive impair-
ment; and 2)explore predictors of cognitive impairment in
employed, retired, and not employed individuals over the age
of 50. We conducted secondary analyses of data from the
first five waves of the English Longitudinal Study on Aging.
In cross-lagged growth curve models (N=6492) adjusted for
age, sex, education, social vulnerability, frailty, and baseline
cognition or employment status, being retired was associated
with better future cognitive function (b=-.19, p<.001) and a
10% unit increase in cognitive impairment was associated
Innovation in Aging, 2017, Vol. 1, No. S1
with lower odds of being retired in the future (OR=0.93,
p<.05). In nonlagged growth curve models (N=10125), on
(b=-0.93, p<.01), but accumulated cognitive deficits more
quickly than employed individuals. In general, cognitive defi-
cits accumulated with age (b=0.64, p<.01); however, being
employed and having higher education offered some protec-
tion. Increasing frailty was associated with faster cognitive
decline. Retirement does not necessarily lead to decreasing
cognitive function. Understanding the link between retire-
ment and cognition can facilitate the development of appro-
priate interventions to help people maintain cognitive health
in retirement.
IQ, REPETITIVE THOUGHT, AND INFLAMMATION
IN OLDER ADULTS: REPETITIVE THINKING MAY
BENEFIT HEALTH
S.Segerstrom, A.Scott, R.G.Reed, Psychology, University
of Kentucky, Lexington, Kentucky
Higher IQ correlates with lower systemic inflammation,
which in turn reduces risk for disorders of aging. The pre-
sent study examined the role of repetitive thought (RT) in the
relationship between IQ and interleukin (IL)-6, an inflamma-
tory marker. RT is thinking attentively, repeatedly, and fre-
quently about oneself and ones world and is characterized by
Valence (positive-negative), Purpose (searching-solving), and
Total quantity (much-little). Estimated IQ and RT dimension
scores were assessed at baseline in a sample of older adults
(N=120, Mage=74 years), who had blood drawn up to 10
times semiannually (n=799). Models included IL-6 covari-
ates: BMI, chronological age, and statin medication. Higher
IQ was associated with lower IL-6 (t(120)=2.03, p=.045).
Of the RT dimensions, only more Total RT predicted lower
IL-6 (t(124)=3.26, p=.001), an effect that was not moderated
by Valence or Purpose. In a test of mediation, more Total
RT accounted for part of the effect of IQ on IL-6 (indirect
effect=-0.06 [CI=-0.14, -0002]). There was also a signifi-
cant interaction between IQ and Total RT (t(119) =2.64, p
.009), in which more Total RT was more strongly associated
forms of RT such as worry may have negative health cor-
relates for older adults, engaging in RT per se can be healthy
insofar as it also encompasses planning, cognitive processing,
and coping. Older adults with higher IQ were more likely to
engage in RT, but older adults with lower IQ benefitted the
most in terms of systemic inflammation.
LONGITUDINAL CHANGES IN PHYSICAL
FUNCTION-COGNITIVE FUNCTION RELATIONSHIPS
IN OLDER ADULTHOOD
B.Sprague1, C.B.Phillips2, L.Ross1, 1. The Pennsylvania
State University, University Park, Pennsylvania, 2. Arizona
State University, Phoenix, Arizona
Evidence suggests increasing interconnectedness of physi-
cal and cognitive functions in older adulthood, and possible
co-occurring terminal declines on approach to death. Newer
statistical techniques such as time-varying effects modeling
(TVEM) allow researchers to explore how the magnitudes
of these relationship differ across time without imposing
traditional assumptions like linearity. Using time-to-death
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
in years as the time-varying metric, we examined relation-
ships between physical function (Turn 360, grip strength)
and specific cognitive domains (processing speed, reasoning,
and memory) in a subsample of 429 healthy community-
dwelling older adults aged 65 91 (mean age=76.0, 62.7%
female, 82.3% Caucasian, mean MMSE=27.4). After con-
trolling for baseline age, sex, education, race, and general
health, associations between Turn 360 and processing speed
strengthened and then stabilized around 7.5 years prior to
death (estimate=-.1, p < .05). Increases in relationship mag-
nitudes followed by stabilization were also found between
grip strength and memory (estimate=.1, p < .05), processing
speed (estimate=.1, p < .05), and reasoning approximately
at 7.5, 10 and 12 years prior to death, respectively. These
results partially support prior findings that time-to-death
may be an important time metric to examine relationships
between physical and cognitive function in older adults.
Although the relationship magnitudes remained stable until
death, these results may not generalize to less healthy sam-
ples. These results also demonstrate the utility of TVEM as
an exploratory tool. Future work should replicate and extend
these findings to more diverse, at-risk samples.
APOE EFFECTS ON COGNITION FROM MIDDLE
CHILDHOOD TO THE CUSP OF MIDDLE
ADULTHOOD
C.A.Reynolds1, A.Smolen2, B.C.Haberstick2, J.C.DeFries2,
S.J.Wadsworth2, 1. University of California, Riverside,
Riverside, California, 2. Institute for Behavioral Genetics,
University of Colorado, Boulder, Colorado
APOE is a well-established genetic risk factor for cogni-
tive aging and dementia, but its influence on cognition in
childhood through early adulthood is inconclusive. We exam-
ine cross-sectional and longitudinal relationships of APOE
on cognitive performance in individuals now approaching
midlife (3045years) from the ongoing Colorado Adoption/
Twin Study of Lifespan behavioral development and cog-
nitive aging study (CATSLife), with over 30 years of fol-
low-up from parent studies (Colorado Adoption Project,
Longitudinal Twin Study). We conducted an analysis on a
subset of participants who participated in cognitive assess-
ments between middle childhood and early adulthood with
available APOE genotyping. Cross-sectional analyses of
WAIS subtests in adolescence (Mage = 16.42, SDage = .73;
N=401) accounting for sibling clustering, sex and age sug-
gested that APOE e4 carriers perform significantly more
poorly at age 16 on the WAIS Vocabulary, Digit Span, Picture
Completion and Object assembly subtests (p < .05; ds .27
- .34). Longitudinal growth analyses of specific memory, spa-
tial and speed abilities between middle childhood and early
adulthood (7 35years; N=436) suggested that APOE e4 healthy adults 50 to 87years of age (mean age=60.7years),
alleles were associated with poorer memory performance on
a paired associates task (Names and Faces delayed, p < .05),
and with dampened nonlinear gains on a spatial rotations
task across age (ETS Card Rotations, p < .02). These findings
suggest that APOE is associated with differential cognitive
performance earlier than midlife, particularly for memory
and spatial abilities. We will extend analyses to the entire
CATSLife sample (N=1600) and compare results to the inter-
national context.
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475
DO MULTIPLE CONSTRUCTS EXPLAIN
INCONGRUENT ASSOCIATIONS BETWEEN
SUBJECTIVE MEMORY AND COGNITION?
W.Haavisto, J.A.Blaskewicz Boron, J.Beadle, C.M.Kelly,
University of Nebraska at Omaha, Omaha, Nebraska
Many studies have demonstrated no (or weak) associa-
tions between self-evaluated and objective memory. The pur-
pose of this study is to investigate whether such incongruent
associations between the two constructs could be explained
by better or worse self-assessments in reporting subjec-
tive memory. Participants from the 2000 wave of the Long
Beach Longitudinal Study (N= 916; age range: 2998; mean
age=69.17) were utilized. The four factors (frequency of for-
getting, retrospective functioning, seriousness of forgetting,
mnemonics usage) of the Memory Function Questionnaire
(MFQ; Gilewski, Zelinski, & Schaie, 1990) were used for
subjective memory. Four groups were created based on quar-
tiles of scores across three cognitive domains (Immediate
recall, Vocabulary, and Recognition Vocabulary). ANOVAs
were used to analyze the data. Results indicated signifi-
cant mean differences in frequency of forgetting for the
groups based on immediate recall (p<0.001), vocabulary
test (p<0.05), and recognition vocabulary (p<0.001) per-
formance, suggesting that people with higher scores in the
various cognitive domains rated their subjective memory in
frequency of forgetting higher. Significant mean differences in
retrospective functioning emerged for the groups categorized
based on vocabulary (p<0.001), and recognition vocabulary
(p<0.001), suggesting that people with higher scores in these
cognitive domains rated their subjective memory in retro-
spective forgetting poorer. People with better cognitive abili-
ties appeared to be more optimistic about their frequency
of forgetting and more pessimistic about their retrospective
functioning. The findings support the work of Gilewski etal.
and others that subjective memory is not a single construct; it
comprises multiple factors that are highly distinctive.
FLUID COGNITIVE ABILITIES AND AUTONOMIC
AND AFFECTIVE RESPONSE TO ACUTE STRESSORS
IN OLDER ADULTS
K.L.Heffner, Nursing and Psychiatry, University of
Rochester Medical Center, Rochester, New York
There is a need for more integrative understanding of
the self-regulatory systems that promote older adults stress
adaptation. This study examined associations among three
domains hypothesized to support adaptive capacity in
response to challenge: fluid cognitive abilities, particularly
attention and processing speed; flexible parasympathetic nerv-
ous system activity, indexed by high frequency heart rate var-
iability (HF-HRV); and affect regulation. In a sample of 100
controlling for age and education, better attention ability
from the Repeated Battery for Neuropsychological Status
was associated with greater HF-HRV decline and lower
negative affect response to acute laboratory stressors, sug-
gesting greater adaptive capacity. Stratifying the sample as
more or less stressed based on Perceived Stress Scale scores,
less stressed older adults showed no significant associations
among fluid cognitive abilities and HF-HRV and negative
affect in response to stressors. By contrast, among the more
globally stressed participants, worse processing speed was
476
associated with smaller HF-HRV decline and larger increase
in negative affect response. These findings support the grow-
ing recognition that the capacity to adapt to stressors is a
function of multiple, overlapping regulatory systems. Further,
there may be stronger functional dependencies among regu-
latory domains in the context of stress. Aging affects multiple
regulatory domains, and can be accompanied by exposure
to chronic stressors known to affect health, such as spousal
dementia caregiving. As such, integrative models of stress
adaptation are needed to identify intervention targets that
promote adaptive capacity and well-being in older adults.
DTLA-A NEW SCREENING TEST FOR LANGUAGE
IMPAIRMENT IN AGING
J.Macoir1,2, M.Fossard3, L.Lefebvre4, L.Monetta1,2, old controls versus persons with AD.
A.Renard5, T.Tran6, M.A.Wilson1,2, 1. Laval University,
Quebec city, Quebec, Canada, 2. Centre de Recherche
de IInstitut Universitaire en Sant Mentale de Qubec, constructs of Mental Status, Memory, Language Expression,
Quebec City, Quebec, Canada, 3. Universit de Neuchtel,
Neuchtel, Switzerland, 4. Universit de Mons, Mons,
Belgium, 5. Centre Leenaards de la mmoire, Lausanne,
Switzerland, 6. Universit de Lille, Lille, France
Compared to cognitive functions such as working mem-
ory and executive functions, language appears to be mostly
resistant to age-related decline. However, language is affected
in the early stages of major forms of dementia and language
deficits are at the core of the clinical portrait of primary
progressive aphasias. Primary care providers are frequently
faced with patients whose main complaints concern lan-
guage problems in everyday and professional life. Up to now,
no brief, accurate, screening test, which could be applied
during routine office visits, was available for language defi-
cits in neurodegenerative diseases. The aim of this study is
to fill this important need by developing a handy, sensitive
and brief detection test for language impairments in adults
and aging. In this presentation, we describe the psychometric
properties of the DTLA (Detection Test for Language impair-
ments in Adults and Aging), a new screening test developed
in four French-speaking countries (Belgium, Canada, France
and Switzerland). We first present the development phase
of the DTLA, then we provide normative data for healthy,
community-dwelling, French-speaking people from the four
countries. Finally, we report data on the convergent and dis-
criminant validity of the DTLA as well as on its test-retest
and internal consistency reliability. The use of the DTLA
could improve the diagnosis of neurodegenerative diseases,
especially those in which language is primarily affected.
Ultimately, this will permit patients and their families to
receive adequate services at an earlier stage of the disease.
EFFECTS OF MILD COGNITIVE IMPAIRMENT ON
LINGUISTIC COMMUNICATION: APILOT STUDY
N.Mahendra1, M.Ifah2, 1. San Jose State University,
Fremont, California, 2. California State University East Bay,
Hayward, California
Mild cognitive impairment (MCI) is a nosological entity
increasingly recognized as a prodrome of dementia. As dis-
tinct types of MCI have been identified, it is well recognized
that other cognitive functions besides memory are frequently
affected. Linguistic communication measures are important
cognitive biomarkers and our objective was to study the
Innovation in Aging, 2017, Vol. 1, No. S1
effects of healthy older adults and persons with MCI on a
language battery. Our secondary objective was to identify
which language tasks might have greater clinical utility in
identifying and quantifying MCI.
Subsequent to obtaining informed consent, we assessed
10 persons with MCI and compared their performance
to healthy older adults and published norms for persons
with Alzheimers disease. Participants medical history was
obtained; hearing, vision and affect screened; cognitive func-
tion assessed, followed by administering a standardized
language battery - the Arizona Battery for Communication
Disorders of Dementia (ABCD; Bayles & Tomoeda, 1993).
This test has been especially validated for distinguishing
between the linguistic communication profile of young and
Performance of persons with MCI was documented on 14
subtests of linguistic communication, mapping onto 5 broad
Language Comprehension and Visuospatial Construction.
Our results demonstrated that linguistic communication
tasks that require episodic recollection (e.g. word learning,
story recall), and more generative, narrative responses on
discourse tasks (e.g. tasks requiring object description and
concept definition) were especially sensitive to language
changes accompanying MCI. Simpler tasks of linguistic com-
munication (e.g. word or sentence reading comprehension;
confrontation naming) did not reveal any differences from
healthy older controls. Implications of these results for clini-
cal assessment of persons with MCI will be discussed.
THE IMPACT OF NOISE AND WORKING MEMORY
ON ONLINE PROCESSING OF SPOKEN WORDS:
EYETRACKING EVIDENCE
B.M.Ben-David1,4, G.M.Nitsan1,3, A.Wingfield2, 1.
Interdisciplinary Center Herzliya, Herzliya, Israel, 2.
Brandeis University, Waltham, Massachusetts, 3. Haifa
University, Haifa, Israel, 4. University of Toronto, Toronto,
Ontario, Canada
Among the complaints of older adults is a difficulty in
speech recognition, especially in noisy backgrounds. This dif-
ficulty can interfere with maintenance of health and quality
of life and can potentially affect the rate of cognitive decline.
A central research question in speech recognition in older
adults is the extent to which difficulties stem from bottom-
up, sensory declines that degrade the speech input, and to
what extent they stem from an age-related reduction in
working memory.
We used eye-tracking as an on-line measure of spoken
word recognition. Listeners hear spoken instructions that
relate to an object presented in the visual display, while their
eye movements are recorded. For example, hearing touch
the candle, with four objects displayed: candle, candy, dog
and bicycle. As the speech signal unfolds, several alterna-
tives are activated in response to phonemic information, i.e.,
CAND leads to candy and candle. In order to successfully
achieve word identification, one has to inhibit phonological
alternatives. Using eye-tracking, we tracked, in real-time, as
the listener shifts his or her focus between candle and candy.
We manipulated working memory load by using the digit
pre-load task, where participants have to retain either one
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
(low-load) or four (high-load) spoken digits for the duration
of a spoken word recognition trial.
We will present three separate studies. The data show that
both noise and working memory can delay speech processing.
With younger adults, data suggest that the two effects may
interact. Preliminary data with older adults will be discussed.
THE SURVIVAL ADVANTAGE OF READING BOOKS
A.Bavishi, M.Slade, B.Levy, Yale University School of
Public Health, New Haven, Connecticut
Although books can expose people to new people and
places, whether books also have health benefits beyond other
types of reading materials is not known. This study exam-
ined whether those who read books have a survival advan-
tage over those who do not read books and over those who
read other types of materials, and if so, whether cognition
mediates this book reading effect. The cohort consisted of
3635 participants in the nationally representative Health
and Retirement Study who provided information about their
reading patterns at baseline. Cox proportional hazards mod-
els were based on survival information up to 12years after
baseline. Adose-response survival advantage was found for
book reading by tertile (HRT2=0.83, p<.0001, HRT3=0.77, between self-reported activity interests and talents with cog-
p<.0001), after adjusting for relevant covariates including age,
sex, race, education, comorbidities, self-rated health, wealth,
marital status, and depression. Book reading contributed to
a survival advantage that was significantly greater than that
observed for reading newspapers or magazines (tT2 = 98.8,
p<.0001; tT3=4956, p<.0001). Compared to non-book read-
ers, book readers had a 4-month survival advantage at the
point of 80% survival. Book readers also experienced a 20%
reduction in risk of mortality over the 12 years of follow
up compared to non-book readers. Cognitive score was a
complete mediator of the book reading survival advantage
(p=.04). These findings suggest that the benefits of reading
books include a longer life in which to read them.
IMPACT OF SOCIAL SUPPORT ON COGNITIVE
FUNCTION IN CHINESE ELDERLY: ONE-YEAR
FOLLOW-UP COHORT STUDY
S.L.Lin, Department of Social Work, Chinese University of
Hong Kong, Hong Kong, Hong Kong
Background: The maintenance of cognitive function is the
key dominant of older age wellbeing. Promoting successful
cognitive aging is a major public concern to individuals and
the field of public health. This study examines the association
between perceived social support and cognitive function in a
representative community sample of 82 Hong Kong Chinese
Elderly.
Methods: Baseline data collection was completed in 2005
and included a 180-min face-to-face interview covering
detailed assessments of physical and cognitive performance
(Chinese version of Dementia Rating Scale, CDRS), health
status, social support (from three types of network members
including their children, relatives, and friends), and other
life-style characteristics. The cohort was subsequently reeval-
uated in 2006, with reassessments of cognitive function.
Result: The mean age was 69years old for the participants,
of whom 78.05% were female. In the multiple linear regres-
sion, controlling for demographics variables, medical con-
ditions, pulmonary function, grip strength, blood pressure,
IAGG 2017 World Congress
477
Body Mass Index, and leisure activities, greater baseline
social support from children was a significant predictor of
better cognitive function (changes in adjusted CDRS for age
and education) at the 1-year follow-up. Among three types
of social support network, perceived childrens willingness to
offer help was strongest predictor.
Conclusion: Consistent with Western studies, social sup-
port from family is important for elderly Chinese people
in Hong Kong. Strengthening social support among family
members are highly recommended for preserving cognitive
function during aging.
ACTIVITY INTERESTS AND TALENTS IN RELATION
TO COGNITIVE PERFORMANCE: APROSPECTIVE
STUDY
B.P.Trubenstein1, B.C.Haberstick2, R.Corley2,
S.J.Wadsworth2, C.A.Reynolds1, 1. Psychology, University
of California - Riverside, Riverside, California, 2. University
of Colorado - Boulder, Boulder, Colorado
Past research shows lifespan activity engagement provides
multiple benefits to physical, emotional and cognitive health
into late life. We investigated the prospective relationships
nitive performance in a subset of participants taking part
in the ongoing Colorado Adoption/Twin Study of Lifespan
behavioral development and cognitive aging (CATSLife).
Initial analyses evaluated associations of interest/talents, and
cognitive performance beginning in late adolescence and
approaching midlife (16 to 36years; N=852). Individuals
rated 20 activities as to interests and talents (1=not at all
to 5=very much). Activity types were classified into artistic
(writing, music, visual arts), physical (team sports, swim-
ming, skiing), or practical (cooking, carpentry, mechanics),
and were correlated across assessments (rs = .230 - .767).
Cognitive performance was assessed from a battery of 14
tasks spanning verbal, spatial, memory and speed domains.
Interests and/or talents in arts were positively correlated with
better immediate and delayed performance on the Names
and Faces Memory Task at years 16, 21, and 30 (rs=.091
- .232). Interests and/or talents in physical and practical
activities correlated with performance on the Card Rotations
spatial task across assessments (rs = .123 - .204), and prac-
tical activities with the Paper Form Board spatial task (rs
=.109-.274). These initial findings hint at possible influences,
or environmental selection, of activity engagement and
maintenance of memory and spatial abilities. We will extend
analyses to the full CATSLife sample, consider activity and
cognitive performance trajectories in tandem, and compare
findings to the international literature.
SELECTIVE ATTENTION IN AGE-ASSOCIATED
MEMORY IMPAIRMENT: AN ERP STUDY IN VISUAL
SEARCH
A.Bujn1, L.Lorenzo-Lpez1, A.Maseda1, R.Lpez-Lpez1,
C.Diego-Diez1, V.Valdiglesias2, J.Milln-Calenti1, 1.
Gerontology Research Group, Instituto de Investigacin
Biomdica de ACorua (INIBIC), Complexo Hospitalario
Universitario de ACorua (CHUAC), SERGAS,
Universidade da Corua, A Corua, Spain, 2. DICOMOSA
Group, Department of Psychology, Area of Psychobiology,
Universidade da Corua, A Corua, Spain
478
Age-Associated memory impairment (AAMI) may be
related to a decline in selective attention. In this work, the
potential attentional capture by task-irrelevant stimuli was
examined in older adults with AAMI compared to healthy
older adults using event-related potentials (ERPs).
A visual search task was employed, in which the partici-
pants had to detect the presence of a target stimulus that
differed from distractors by orientation. To explore the auto-
matic attentional capture, an irrelevant distractor stimulus
defined by color was also presented without previous knowl-
edge of the subjects. The N2pc component of ERPs, an elec-
trophysiological indicator of the allocation of attentional
resources, was analysed.
The results indicated that in both groups the N2pc
component was present for target stimuli but not for task-
irrelevant color stimuli. In addition, the latency of N2pc for
targets was significantly delayed in AAMI patients compared
to controls, although no differences in the amplitude of the
component were found.
The delay in N2pc latency in AAMI subjects suggested
they require more time than healthy seniors to shift their
visuospatial attention onto the task-relevant information.
However, the lack of significant differences between the
groups in N2pc mean amplitude and scalp distribution sug-
gested that the amount of attentional resources allocated to
the target did not differ between older adult with and with-
out memory impairment. The lack of N2pc component for
irrelevant non-target stimuli indicated that the mechanism
of top-down suppression of task-irrelevant information is
preserved.
Funding: Xunta de Galicia (GPC2014/082)
THE IMPACT OF SELF-RELEVANCE AND TASK
COMPLEXITY ON INFORMATION SEARCH DURING
DECISION-MAKING
X.Liu, H.Peng, B.Pu, Beijing Normal University, Beijing, structions of older adults as merely dependent, and offers
Beijing, China
Cognitive declines may negatively impact older adults to
systematically search information, which might lead them
to make decisions more based on the presence or absence
of values on important dimensions (i.e., noncompensatory
strategies) rather than consider all the information associ-
ated with each alternative (i.e., compensatory strategies).
However, draw from selective engagement, self-relevance
would increase older adults motivation to engage in the
task, which might result in more search behaviors. To inves-
tigate the impact of self-relevance and task complexity on
information search during decision-making, the present
study adopted a 2 (age: young, old) 2 (self-relevance:
low, high) 2 (task complexity: simple, complexity) mixed
design. We examined information search behaviors in 60
younger and 60 older adults using a process-tracing proce-
dure with 6 decision matrices. Decision tasks varied in com-
plexity, and half of them were considered as relevant to older
than to younger adults, whereas the opposite would be true
for the others. Results showed that older adults were more
likely than younger adults to use compensatory strategies,
and spent more time and searched more information during
decision making. With self-relevance increasing, older adults
used less compensatory strategies, while younger adults
Innovation in Aging, 2017, Vol. 1, No. S1
changed strategies from noncompensatory to compensatory
strategies. Increased in task complexity result in more infor-
mation search, more time on decision-making, but adults of
all ages still tend to use compensatory strategies. The results
suggest that self-relevance may be more important than task
complexity to determine older adults information search
behaviors during decision-making.
SESSION 950 (POSTER)
CULTURAL AND CROSS-NATIONAL RESEARCH
GLOBAL AGING AS LIFE COURSE EXPERIENCE:
RESULTS FROM ETHNOGRAPHIC RESEARCH IN
GHANA AND THE U.S.
A.L.Crampton, Marquette University, Milwaukee,
Wisconsin
The discourse underlying population aging as a policy and
practice concern has long been dominated by modernization
and demographic transition theories. In this discourse, an
older adult is defined by chronological age and is constructed
as dependent (Aboderin 2004). For example, dependency
ratios drastically simplify intergenerational caregiving and
support. Anthropological research on aging helps document
the limitations of this discourse in understanding the full
range of experience people have as they grow older that is,
the culturally informed, locally specific, lived experience of
people as they age. This paper first reviews the construction
of older adulthood within dominant policy and practice dis-
course on population aging, and then contrasts this construc-
tion with results from sixteen months of ethnographic data
collection in Ghana and the United States during 20045.
Data analysis of how people experience the challenges of
growing older in local contexts challenges dominant con-
a more nuanced, culturally informed life course perspec-
tive. Implications for policy include steps towards reforming
global aging policy from addressing aging as a separate life
stage of old and dependent to a life course experience in
which growing older contributes to but does not define the
role of older adults in family support systems and society.
WHY DO OLDER TURKISH IMMIGRANTS LIVING IN
EUROPE USE HEALTH CARE SERVICES IN TURKEY?
N.Korkmaz Yaylagul, S.Yazici, Akdeniz University,
Antalya, Turkey
Background: Turkish labor immigrants that moved to
European countries around 1970s and have already reached
the old age. Health care needs increase with advanced age
as the number of chronic diseases increases. In the case of
migration, retirement enables more flexible use of the coun-
try for treatment. Research has shown that satisfaction from
health care services in host countries are among factors hin-
dering the immigrants to consider remigration. Cross border
health care practices of older Turkish immigrants have been
found to differ from other nationalities.
The aim of the research is to evaluate the effect of inter-
personal relations between health care providers and older
Turkish immigrants on cross border health care use, the
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Innovation in Aging, 2017, Vol. 1, No. S1
perceptions and practices of older Turkish immigrants about
the health care services in their host countries (Denmark
(DK), Germany (D) and England (UK)) and Turkey.
Methods: A multi centered, qualitative cross sectional
study was conducted with Turkish immigrants living in
Copenhagen (DK), Hildesheim (D) and London (UK). Semi
structured interviews were performed with 67 individuals
aged between 50 and 83. All interviews were audio recorded,
transcribed and submitted to thematic analysis.
Results: Using Glinos typology for cross border health
service use, availability and perceived quality have been
found to be push factors shaping cross border health care
use. Practices were mainly towards early and right diagno-
sis. Language barrier however has come up as a theme but
surprisingly did not affect the use and perceptions of cross
border health care.
PUBLIC OR PRIVATE SERVICE DELIVERY?
EMPLOYEES ATTITUDES TO END-OF-LIFE CARE IN
SIX EU COUNTRIES
M.Kylanen1, S.Peltola1, T.Smets2, S.Payne3, dataset. We evaluated the associations between 2 types of
K.Szczerbinska4, G.Gambassi5, R.Pasman6, L.Van den social services (community-based and public support) and
Block2, 1. The Department of Welfare, National Institute
for Health and Welfare (THL), Tampere, Finland, 2.
Department of Family Medicine and Chronic Care, End-of-
Life Care Research Group, Vrije Universiteit Brussel (VUB)
and Ghent University, Brussels, Belgium, 3. International
Observatory on End-of-Life Care, Lancaster University,
Lancaster, United Kingdom, 4. Unit for Research on
Aging Society, Department of Sociology of Medicine,
Epidemiology and Preventive Medicine Chair, Faculty of
Medicine, Jagiellonian University Medical College, Krakow,
Poland, 5. Universit Cattolica del Sacro Cuoro, Rome,
Italy, 6. EMGO Institute for Health and Care research,
Expertise Center for Palliative Care, VU University Medical
Center, Amsterdam, Netherlands
Why should there be a distinction between public or pri-
vate funded long term care for people at the end of their
life? The conventional wisdom and the study of public
administration is based on the belief that public and pri-
vate organizations differ significantly. This paper argues that
this statement is more a myth than a fact. Notwithstanding
the number of public-private comparisons, comparative
cross-country studies on employees behavior and attitudes
towards end-of-life care for older people are neglected in this
area. This paper aims to explore similarities and differences
between care staffs behavior and attitudes towards end-of-
life care for older people in public and private long term care
facilities (LTCF) in six European countries: Belgium, Finland,
Italy, the Netherlands, Poland and United Kingdom. As part
of PACE project (Comparing the Effectiveness of Palliative
Care for Elderly People in Long Term Care Facilities in
Europe funded by the EU 7th Framework Programme), the
survey data were collected in 2015 by recruiting a random
sample of LTCFs in six countries. The results indicate more
similarities than differences. Possible explanations between
the sectors are explored, and the strengths and limitations
of the study are discussed. Findings contribute in particular
to the literature on public service motivation and public val-
ues and our understanding of how both public and private
LTCFs serve public good. As a conclusion the paper suggests
IAGG 2017 World Congress
479
that service delivery as a public/private service issue should
be taken more seriously: care staff prefer to care older people
as human beings.
THE EFFECTS OF COMMUNITY AND PUBLIC
SUPPORT ON THE MENTAL HEALTH OF ELDERLY
CHINESE
K.A.Zurlo1, H.Hu2, 1. School of Social Work, Rutgers
University, New Brunswick, New Jersey, 2. North China
Electric Power University, Baoding, Hebei Province, China
Economic reforms in China are associated with migration
of young Chinese from rural to urban centers. This migration
as well as the one-child policy and increased longevity have
affected the well-being of the elderly, who largely remain in
rural residences. An erosion of the cultural tradition of fil-
ial piety is related to the mental health of a growing elderly
population, who is at-risk of increased depressive symptoms.
We analyzed data from the China Health and Retirement
Longitudinal Study that were collected in 2011. These data
were from a nationally representative and publicly available
depressive symptoms in the Chinese elderly ( 60 years)
with a focus on age differentials and type of residential reg-
istration (urban or rural hukou). The results indicated that
components of community and public support were signifi-
cantly and negatively associated with depressive symptoms.
These components included having a senior center in the
community, receiving a subsidy from the local agency, and
receiving a pension. Also, the elderly living in a rural hukou
had greater levels of depressive symptoms, and depressive
symptoms in this population were most significantly and
negatively affected by having a senior center in the com-
munity and receiving a local subsidy. These results suggest
that specific types of social support may negatively affect
depressive symptoms and provide opportunities for targeted
interventions from community leaders and policymakers
that improve mental health and well-being among a growing
elderly population in China.
COMPARING PUBLIC DISCOURSE ON ELDER CARE
IN FINLAND AND THE UNITED STATES
U.Koivula2, A.T.Woodward1, 1. Michigan State University,
East Lansing, Michigan, 2. Tampere University of Applied
Sciences, Tampere, Finland
Academic literature on elder care examines the quality
of care, the structure of services, and the role of non-pro-
fessional care. While fairly universal across developed coun-
tries, the cultural and social welfare contexts vary suggesting
cross-country differences in how these issues are understood
and addressed. The media both reflects and shapes what peo-
ple regard as significant and is, therefore, one place to exam-
ine cross-cultural differences in approaches to care; however,
studies that compare the discourse across countries with dif-
ferent social welfare structures are almost non-existent. In
this study, we analyze print media published in four major
newspapers in Finland and the United States. Using quality
of care, structure of services, and non-professional care as
our guiding framework, we conducted a thematic analysis of
news reports, feature stories, and editorials published during
May-June 2015 and March-April 2016. Quality of care was
480
the most common theme in Finnish media with a focus on:
1) harmful or dangerous care practices, 2) neglect or lack
of care, and 3)care falling behind set quality requirements.
Despite the differences in the welfare regime, cost of care to
the individual was a common theme in both countries as was
a focus on increasing home care and informal care. There are
weak signals in both countries of innovations that co-mingle
aspects of informal and formal care such as intergenerational
housing, employment opportunities for older adults, and co-
locating day care and adult day care centers. These tend to be
based on local initiative rather than strategic, governmental
planning.
BALIKBAYANS STORIES OF RETURN:THE LIFE
COURSE PERSPECTIVE AND INDIGENOUS
METHODOLOGIES
K.Kalaw, Dept. of SOCIO, GERO and SAS, University of
Central Oklahoma, Edmond, Oklahoma
This paper offers a rethinking of the life course perspec-
tive and contribution of a culturally sensitive approach in
doing qualitative research. The life course perspective had
proven its utility in the field of gerontology and invited sev-
eral levels of analyses across fields of knowledge. With its
key premises on human agency, linked lives, historical and
geographical context and timing of life events, this enables
an understanding of the present and emerging social realities
prevalent in society. In this paper, the life course perspective
is substantiated and informed through the use of indigenous
methodologies. With the focus on labor migration as a sali-
ent feature of Philippine society, the paper offers a unique
opportunity to investigate the potential discourse of the life
course perspective, migration and aging. Through qualitative
narratives, life stories and use of Filipino indigenous meth-
odologies (FIM) among 6 male overseas Filipino workers
from the gulf areas, their later life experiences as refracted by
age is presented. More so, the family members of the return-
ees were interviewed to stress the role of culture and family
dynamics throughout the migration process and foremost
upon their return. Further, the paper suggests that migration
is a collective understanding among family members and not
solely a function of human agency in making choices. The
paper ends with a reconsideration of inclusion of indigenous
methodologies to enhance and maximize the efficacy of the
life course framework useful for discussing implications for
instruction and practice in educational research.
GERONTOGROWTH AND POPULATION AGING
IN AFRICA: WHY DOES THIS DIFFERENTIATION
MATTER?
A.Francisco, 1. Institute of Social and Economic Studies,
Maputo, Maputo, Mozambique, 2. Eduardo Mondlane
University (UEM), Maputo, Maputo, Mozambique
Population aging is a major achievement of human devel-
opment enjoyed by an increasing number of people around
the world. In Africa, despite the remarkable increase in abso-
lute terms, the proportion of African elderly is only 5% of
the African population, against over 12% of the elderly pop-
ulation worldwide. No less important than the increase in
the numbers is the remarkable global progress in quality of
life and satisfaction of the elderly. At this level, most African
Innovation in Aging, 2017, Vol. 1, No. S1
low-income countries are overrepresented as the worst
countries for the elderly to live in, as shown by the Global
AgeWatch Index 2015. According to HelpAge International
the countries with the worst performance lack a comprehen-
sive approach to policy framework to address the challenges
posed by the aging of their populations. Although this con-
clusion is not entirely wrong, it needs careful attention and
qualification: What does it mean to have a comprehensive
approach to population aging in countries where increasing
numbers of elderly, here designated gerontogrowth, is over-
shadowed by the rejuvenation of the younger population?
Why people would worry in advance with a phenomenon
that they still do not live or feel? Without questioning the
new Indexs potential this article shows that its explanatory
power and reach can and should be substantially improved
with a really more comprehensive analytical and methodo-
logical framework. Aframework that articulates the concept
of capabilities with crucial structural concepts of population
dynamics, in the context of the different stages of global
demographic transition, where the worlds elderly popula-
tion is integrated.
A COMPARATIVE ANALYSIS: DEPRESSIVE SYMPTOM
AMONG KOREAN IMMIGRANT ELDERS IN TWO U.S.
STATES
S.Kang1, I.Kim2, W.Kim2, 1. Social Work, SUNY--
Binghamton University, Binghamton, New York, 2.
University at Buffalo School of Social Work, Buffalo, New
York
This study explored the influence of stress factors on
depressive symptoms among Korean immigrant elders (KIE).
We compared differential impacts of stressors (such as life-
course disruption) and the availability of culturally sensi-
tive services between KIEs living in two southwestern states
(Arizona and Texas).
A total of 237 KIEs (Texas, 120 and Arizona, 117)partici-
pated in cross-sectional face-to-face interviews using a stand-
ardized survey. The Geriatric Depression Scale-Short Form
was used to measure depressive symptom levels. Separate
regression analyses were performed to identify common and
different predictors in the two subsamples.
Total participant results revealed that location itself does
not matter. However, the presence of culturally sensitive
community-service-seeking behavior is an important pre-
dictor. The levels of life and family-relationship satisfaction
were the only common significant predictors for depressive
symptoms in both subsamples (b= 1.671, p < .01, b=1.416,
p < .001 for life satisfaction and b= 1.182, p < .05, b=.684,
p < .05 for family relationship,). For KIEs in Arizona (R
square=.494), age upon arrival in US, level of English profi-
ciency, and community-service-seeking behaviors were signif-
icant predictors of depressive symptoms. For KIEs in Texas
(R square=.460), the frequency of meeting with a physician
was a unique predictor.
The subsamples of Korean immigrant elders have unique
correlates of depressive symptoms, reflecting differences in
geographic location, immigration history, and availability of
ethnic community resources. This suggests that community
service providers need to take contextual differences into
account when planning for intervention.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
ELDERLY HEALTH DISPARITIES: TRANSLATING
RESEARCH INTO PRACTICE
M.Blanco1, D.Yee-Melichar1, A.Boyle2, K.Routt3, 1. participate in research. Therefore, innovative methods are
Gerontology, San Francisco State University, San Francisco,
California, 2. Dominican University of California, San
Rafael, California, 3. Magnolia Prime, Redwood California,
California
Information about health disparities among minority
elders is growing. Policymakers and practitioners may find it
difficult to translate this body of literature into effective and
efficient healthcare delivery for minority elders. Easier access
to information and programs on various health disparities
and social health determinants will enable healthcare profes-
sionals, minority advocates, policymakers and practitioners
to make better decisions on key issues that minority elders
will face in the near future. U.S. Department of Health and
Human Services Office of Minority Health launched a Youth
Health Equity Model of Practice (YHEMOP) Internship
Placement Program in Summer 2016 to support research in
health disparities. The YHEMOP program gathers a team of
experts across various disciplines and institutions including
the Regional Health Equity Council in Region IX (RHEC IX)
and San Francisco State Universitys Gerontology Program, to
conduct a comprehensive literature analysis on elderly health
disparities and to produce an annotated bibliography of key
peer-reviewed articles, audiovisual resources and data web-
sites. An executive summary (factsheet) will be drawn from
this annotated bibliography and directed to relevant fund-
ing agencies and legislators with recommendations for their
consideration and implementation in Region IX (Arizona,
California, Nevada, Hawaii, and the Islands: American
Samoa, Commonwealth of the Northern Mariana Islands,
Federated States of Micronesia, Guam, Marshall Islands, and
the Republic of Palau). The results of this research will be
discussed with IAGG 2017 participants.
IMPROVING ADVANCE CARE PLANNING FOR
OLDER LATINOS WITH CHRONIC ILLNESSES:
ACOMMUNITY-BASED APPROACH
F.R.Nedjat-Haiem1, I.V.Carrion2, S.Mishra3, 1. School
of Social Work, New Mexico State University, Las Cruces,
New Mexico, 2. University of South Florida, Tampa,
Florida, 3. University of New Mexico, Albuquerque, New
Mexico
Multiple factors contribute to educational barriers and
low participation rates for advance care planning (ACP)
among older Latinos. Innovative methods are needed to reach
this vulnerable population with vital information to improve
ACP and advance directive (AD) documentation. This paper
examines a community-based approach for implementing an
educational intervention in a Southern New Mexico rural
community for older Latinos with multiple chronic health
conditions.
Regardless of advancements in cultural competent prac-
tice for ACP, fewer Latinos participate in end-of-life (EOL)
communication or document an AD. Multiple factors con-
tribute to low participation in such care. While barriers exist,
it is important to consider that all people need individualized
care, especially when talking about dying and preparing ADs,
to ensure they are well-informed about treatment options
and have a voice in documenting EOL care preferences.
IAGG 2017 World Congress
481
Additionally, older Latinos living in rural areas of Southern
New Mexico are often harder to reach and may refuse to
needed to meaningfully engage and share information on
purpose and utility of ADs.
We used mixed-methods to study implementation of
a culturally tailored, multifaceted intervention model
Improving Advance Care Planning (ACP-I Plan). ACP-I Plan
is designed to overcome barriers to ACP with older Latinos,
to start conversations early, before the active dying phase.
Preliminary findings, based on data from 74 participants,
suggest significant improvements in AD communication and
documentation. 100% of participants were satisfied with the
information. Findings have implications for conducting com-
munity-based research with older Latinos residing in rural
geographies.
POST-SENTENCING COMPETENCE IN OLDER
DEATH ROW INMATES
A.Albright, R.S.Allen, University of Alabama, Tuscaloosa,
Alabama
The prison population in the United States is rapidly
aging, with 10% of inmates in 2014 being over the age of
65. Older inmates experience many risk factors of dementia,
particularly death row inmates who lack cognitive stimu-
lation and exercise (one hour per day outside of cell). The
average time between sentencing and execution is approxi-
mately 16.5years. Under current U.S.law, older death row
inmates who experience diminished competence following
sentencing may still be executed. This is incongruent with:
1)Ford v.Wainwright which offers protection to those who
cannot understand why and how they are to be punished,
2)Atkins v.Virginia which prohibits the execution of indi-
viduals with intellectual disabilities, and, potentially 3) the
Eighth Amendment, which prohibits cruel and unusual
punishment. Several states, including Georgia, Missouri,
and Oklahoma, have in the past ten years proceeded with
the execution of older death row inmates who exhibit dimin-
ished capacity to understand the antecedents and process of
their execution. Specifically, Brandon Astor Jones, who was
first sentenced to death in 1979, was executed by the state
of Georgia in 2016 despite evidence of dementia. Currently,
the U.S. 11th Circuit Court of Appeals is considering the case
of Vernon Madison, a 65-year-old Alabama inmate with
dementia who has appealed his sentence of death based on
cognitive incapacity. Cases such as these will become increas-
ingly common due to the aging of the prison population;
thus, the issue of post-sentencing competence should be con-
sidered by the United States legal system.
UTILIZATION OF COMMUNITY HEALTH COACHES
TO IMPROVE CHRONIC DISEASE MANAGEMENT IN
OLDER ADULTS
R.Little, Public Health, ECU Brody School of Medicine,
Ayden, North Carolina
Aims: Low health literacy is prevalent in minority popu-
lations with chronic disease. This population is often unable
to effectively self-manage their chronic disease. We hypoth-
esized that the use of community health coaches could
improve chronic disease self-management in older minority
populations.
482
Methods: Three focus groups were conducted with par-
ticipants utilizing community health coaches to support their
disease self-management.
Results: Community health coaches were effective in help-
ing participants improve their chronic disease self -manage-
ment facilitating improved health outcomes as measured by
weight loss, blood pressure reductions and care compliance.
Conclusion: These results suggest the use of community
health coaches supporting older adults with limited health
literacy fosters not only improvements in health conditions
but also resulted in social determinants of health improve-
ments for these participants.
MEETING THE NEEDS OF THE UNDERSERVED:
STRENGTH-BASED TECHNIQUES TO INFORM
POLICY AND PROGRAMMING
C.V.Browne, K.L.Braun, N.Mokuau, L.Kaopua, B.Kim,
Social Work, University of Hawaii at Manoa, Honolulu,
Hawaii
In the United States, the older population is becoming
more racially and ethnically diverse. Researchers from Ha
Kupuna National Research Center for Native Hawaiian
Elders (funded by the DHHS, Administration for Community
Living [ACL]) will provide a summary and update of their
10-year research plan, together with techniques for gathering
data from underserved elders refined through lessons learned
from a community-university collaborative partnership.
These techniques include, but are not limited to, listening ses-
sions, focus groups, key informant interviews, and surveys.
Examples from the authors experiences with indigenous
elders will be discussed with program, policy, and research
implications for other underserved groups including LGBT
and people with disabilities.
PAID AND UNPAID WORK IN THE REPUBLIC OF
KOREA AND THE UNITED STATES OF AMERICA
K.J.Johnson1, S.Lee2, J.Lyu4, 1. Indiana University,
Indianapolis, Indiana, 2. University of Massachusetts
Boston, Boston, Massachusetts, 4. National Institute
of Aging, Hallyum University, Chuncheon, Korea (the
Republic of)
Research from Western countries indicates participation
in paid and volunteer work is related to human and social
capital, yet less is known about factors related to these pro-
ductive activities in East Asian countries experiencing rapid
change. We investigate the prevalence and profiles of workers
and volunteers in Korea and the U.S, countries with different
cultures and institutional circumstances. We apply logistic
models to analyze data from the 2012 Korean Longitudinal
Study of Aging (KLoSA) and the 2012 American Health
and Retirement Study (HRS). The analytic sample consists
of 7,183 KLoSA respondents and 18,852 HRS respondents
age 51 and older. The proportions of adults volunteering dif-
fer considerably between Korea (6%) and the U.S. (38%),
while 43% and 46% of adults are working for pay in Korea
and the U.S.respectively. Significant factors associated with
voluntary work (e.g., female gender, religion, good health,
absence of disability) are fairly similar in both countries.
However, higher education, being unmarried, and work-
ing for pay are negatively related to volunteering in Korea
only. Working for pay is negatively related to poor health,
Innovation in Aging, 2017, Vol. 1, No. S1
disability, female gender, and being married in both Korea
and the U.S. Yet, higher education and voluntary work are
negatively associated with paid employment in Korea only.
In contrast, both volunteering and paid employment are
positively associated with higher education in the U.S. These
results suggest it is familial and health-related factors more
than formal education shaping contemporary participation
in productive activities among older cohorts in Korea.
UNDERSTANDING THE MEDICARE PROGRAM
AND RELATED SUBSIDIES: ARACIAL AND ETHNIC
COMPARISON
L.Bakk1, D.Oyler2, T.Cadet3, 1. Social Work, University at
Buffalo, West Henrietta, New York, 2. Health Foundation
of Western and Central NY, Buffalo, New York, 3. Simmons
College, Boston, Massachusetts
A major concern prior to the implementation of the
Medicare Modernization Act was the complexity of the
numerous coverage options. Understanding the structure
and benefits of Medicare and its related subsidies is criti-
cal in the management of health for older adults. While
evidence suggests that Blacks and Hispanics generally
have lower health literacy than Whites, little is known
about differences regarding Medicare knowledge. Using
a convenience sample (n=944), this study examined the
association between race, ethnicity, and Medicare com-
prehension. Logistic regression results indicated that older
non-Hispanic Blacks (NHBs) and Hispanics have more
concern about their ability to comprehend Medicare and
the various coverage options than non-Hispanic Whites
(NHWs). Understanding subsidies that can help pay for
Medicare costs was also a greater concern among NHBs
and Hispanics than NHWs. Accounting for gender, age,
income, and geographic location had little impact on these
findings. Moreover, individuals with an income less than
200 percent of the Federal Poverty Level reported greater
concern about their ability to understand Medicare and
related subsidies. Findings suggest that vulnerable popu-
lations in particular, older NHBs and Hispanics may
face significant challenges comprehending their health care
coverage and options that are available to help lower costs.
This is concerning, particularly given racial and ethnic dif-
ferences in heath. To promote understanding, interventions
are needed to increase education about the Medicare pro-
gram and related subsidies. Further, understanding that dif-
ferentials in comprehension exist is critical when evaluating
policy alternatives in order to achieve more equitable access
to health care and reduce disparities.
SESSION 955 (POSTER)
DEMENTIA AND ALZHEIMERS DISEASE III
INTRODUCING TOUCH SCREEN APPLICATIONS TO
PEOPLE WITH ADVANCED DEMENTIA THROUGH
STAFF-CLIENT CO-PLAY
A.M.Hernandez1, A.J.Astell1,2,3, D.Theiventhiran1,4,
1. Research & Academics, Ontario Shores Centre for
Mental Health Sciences, Whitby, Ontario, Canada, 2.
The University of Sheffield, Sheffield, United Kingdom,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
3. University of Toronto, Toronto, Ontario, Canada, 4.
University of Ontario Institute of Technology, Oshawa,
Ontario, Canada
In long-term care, there is growing attention to clients
quality of life, including provision of pleasant and meaning-
ful activities. There is also growing evidence that tablets are
accessible for people living with dementia. Identifying pleas-
ant technology-facilitated co-play activities for people with
advanced dementia would be of benefit for both the indi-
vidual and carers. Here we explore whether pre-existing iPad
games can provide an avenue for engaging and enjoyable
co-play activity for people with advanced dementia and car-
ers. Ten participants with a dementia diagnosis and MOCA
score of 8 or below and 5 staff co-played a strategic game,
a familiar rule-based game, a coloring game, and a sensory
game. In the first session, staff investigated which game was
best suited, and this game was played on two subsequent
sessions. Sessions were video-recorded and concluded with
a patient questionnaire and staff interview. Face- and screen-
view video recordings were used to: examine ability to play
over time and engagement, examine successful features of
game introduction by staff, and validate themes emerging
from staff post-play interviews. We will present results on
ability to learn, engagement and enjoyment of people with
advanced dementia and recommendations on how to best
introduce games. Pre-existing iPad games could provide an
avenue for facilitating co-play activities in advanced demen-
tia care. Incorporating staff experiences on game introduc-
tion and co-play into recommendations should support
knowledge translation and enhance iPad game play for peo-
ple with advanced dementia.
DEMENTIA CARE IN THE COMMUNITY:
RELATIONSHIPS BETWEEN QUALITY OF LIFE, AGE,
GENDER, AND CARER BURDEN
M.Boyd, R.Frey, University of Auckland, Auckland, New
Zealand
Over 50% of all people with dementia (PWD) live in the
community. Family members providing care for PWD are at
risk of lowered quality of life due to the stress of caregiving.
The aim of this study is to describe a comparison of level
of anxiety, depression and quality of life for PWD living in
the community and their carers in a large cohort of people
receiving support in Auckland, New Zealand (N=1071).
Correlational analyses were used to examine the relation-
ship between the ages of the person with dementia (PWD)
and their scores on two quality of life measures as well as
measures of carer quality of life and stress. Measures include
quality of life (DemQOL for PWD and WHOQOL for car-
ers) and carer stress (Carer Reaction Assessment). There was
a significant relationship between PWD age and quality of
life (DEMQUOL), r(99)=.20, p <.05, suggesting that older
PWD had better quality of life compared to younger PWD.
There is also a significant relationship between PWD qual-
ity of life and caregiver quality of life r(52) = .61, p <.01.
The analysis also showed that age and gender influenced per-
ceived carer stress.
The results of this study suggest that perceived carer stress
is influenced by age, gender, and overall quality of life Those
providing community interventions to support PWD should
IAGG 2017 World Congress
483
assess for the mulitple factors that can effect PWD and fami-
lies influence quality of life and carer stress.
DALCROZE RHYTHMIC MUSIC PROGRAM FOR
PEOPLE WITH DEMENTIA
J.Leners1, J.Jacquemart2, 1. LTCF ALA and Pontalize,
Ettelbruck, Luxembourg, 2. LTCF ALA, Erpeldange,
Luxembourg
Music as a universal communication can also easily be
applied to persons with dementia, who have partially or
totally lost their abilities to speak orally. Music listening and
music production activate several brain areas responsible for
cognition, sensori-motor activities and emotional regulation.
The specific Dalcroze rhythmic music program which runs as
a spontaneously music improvisation accompanied mainly
by piano sessions to which the patients move following spe-
cific sequences. Positive effects are to see in saver balance,
higher self-esteem, less falls, improved motor function and
numerous non-verbal communication. The typical simpli-
fied music instruments can be used as soon as given to the
patients, as they require no specific training to play music.
The repetition of movements allows persons with dementia
to imitate or to follow their own inner feeling. The leader of
a Dalcroze rhythmic music program need specific qualities
beside his musical back-ground, like personal competence to
understand expressed emotions and a high degree of inter-
personal communication skills. As most music excerpts are
known to all patients from their adolescence, therefore even
songs can easily be orally expressed, even though sentences
are no more produced. It is important to note that regular
sessions of at least one or two per week should be run for
some six months in order to see positive effects in most of the
persons with dementia. Side-effects are rare, major hypoten-
sion or cardiac arrhythmias may be seen as limited factors
for inclusion.
POSTTRAUMATIC STRESS AND FLUID COGNITION:
LONG-TERM OUTCOMES OF THE WORLD TRADE
CENTER DISASTER
S.Clouston1, R.Pietrzak2, R.Kotov1, M.Richards3,
A.Spiro4, S.Mukherjee5, B.Luft1, E.Bromet1, 1. Public
Health, Stony Brook University, Stony Brook, New York, 2.
Yale University, New Haven, Connecticut, 3. MRC Unit for
Lifelong Health and Ageing at University College London,
London, United Kingdom, 4. Boston University, Boston,
Massachusetts, 5. Florida International University, Miami,
Florida
During the World Trade Center (WTC) attacks, respond-
ers who helped in search, rescue, and recovery endured mul-
tiple traumatic and toxic exposures. One-fifth subsequently
developed posttraumatic stress disorder (PTSD), a chronic
stress disorder that has been shown to be associated with
risk of dementia in Veterans. To date only a few small stud-
ies have examined associations between intrusive stress and
cognitive functioning. We fielded an objective neuropsycho-
logical battery to a sequential cohort of World Trade Center
(WTC) responders (N=654) without any history of WTC-
related head injury or any previous strokes who attended
monitoring visits at the WTC health program on Long
Island, NY. Data were linked with diagnoses of WTC-related
PTSD, WTC-exposures, and other WTC-related conditions.
484
WTC exposure was associated with poorer cognitive func-
tion, but this association was attenuated upon adjustment
for PTSD. Analyses revealed that having current PTSD was
associated with slower reaction time and processing speed
as well as poorer working memory and cognitive through-
put. In subdomain analyses, associations were concentrated
amongst those who reported re-experiencing symptoms in
the years immediately following the WTC disaster (in all
cases, standardized effect sizes ranged from 0.851.20 SDs
and p<1.2E-04). Traumatized individuals are increasingly
believed to be at higher risk of cognitive impairment and
incident dementia. Results from this study support existing
studies, showing that intrusive stress influences a broad range
of cognitive functions absent traumatic head injuries. Future
studies should utilize brain imaging to examine the extent
to which neurodegeneration may explain these associations.
TRAINING NEEDS AND EDUCATION FOR
DEMENTIA CARE IN CHINA: THE PERSPECTIVES OF
MENTAL HEALTH PROVIDERS
L.Xu1, H.Hsiao2, W.Denq3, I.Chi2, 1. The University tively impaired category on the Brief Interview for Mental
of Texas at Arlington, Arlington, Texas, 2. University of
Southern California, School of Social Work, Los Angeles,
California, 3. University of California in Los Angeles, Los
Angeles, California
Purpose: The purpose of this paper is to identify needs of
training and public education for dementia care including
who should be the trainees, what would be the contents of
training and how to deliver the training in China.
Methods: Using a purposive sampling method, data were
gathered via four focus group discussions with 40 mental
health providers in Beijing, China in 2011. Data were tran-
scribed by two independent investigators, and then translated
into English. Content analysis was employed to separately
identify themes/codes among three researchers. Discrepancies
were fully discussed until final agreement achieved.
Results: All participants agreed there is a huge need for
training and public education on dementia care. Both for-
mal (physicians, nurses, hospital administrators, commu-
nity workers) and informal caregivers (family/non-kin hired
caregivers) were identified as two groups for receiving the
training. For formal caregivers, training topics for enhancing
clinical knowledge of dementia (i.e., pathogenesis, clinical
symptoms, approaches for dementia prevention) and clinical
practice skills (i.e., diagnostic, caregiving, counseling, com-
municating skills) were identified. For informal caregivers,
basic dementia knowledge and home-based caregiving skills
such as safety, rehabilitation, and stress management strate-
gies were identified as key training contents. Multilevel sup-
port from the government as well as community centers are
considered as crucial in delivering the training and public
education.
Conclusions: Culturally sensitive education and train-
ing specific for formal and informal dementia caregivers
are urgently needed. Policy and program implications were
discussed.
PREDICTION OF CAREGIVER BURDEN IN THE
CONTEXT OF DEMENTIA-SPECIFIC DAY CARE
N.S.Park1, D.A.Chiriboga1, V.A.Molinari1, M.M.Barnes2, comprehendible for PWD. However, the focus group meeting
K.J.Herd2, K.Gilbert2, 1. University of South Florida,
Innovation in Aging, 2017, Vol. 1, No. S1
Tampa, Florida, 2. Alzheimers Community Care, West Palm
Beach, Florida
Caregiving for a loved one with Alzheimers disease and
related disorder (ADRD) can lead to adverse caregiver out-
comes. Among the interventions for those with ADRDs
are day care programs. The purposes of the present study
were to: (1) assess the caregiver burden among caregivers
whose relative attended a dementia-specific day center; and
(2) examine gender and racial/ethnic differences in caregiver
burden. Data were collected by family nurse consultants in
10 day centers in Southeastern Florida, between February
2015 and January 2016. The centers are run as part of an
Alzheimers Community Care (ACC) intervention that oper-
ates under a comprehensive, community-based model of
care. Caregiver burden was measured with the Zarit Burden
Scale, which measures the caregivers self-perceptions of the
burden providing care. Among 306day center participants,
60% were aged 80 or older, 67% female, 51% non-Hispanic
White, 27% African American/Black, and 22% Hispanic/
Latino. Over 75% of enrollees scored in the severely cogni-
Status. About 10% of caregivers reported severe burden
followed by 29% moderate to severe, 42% mild to moder-
ate and 19% little to no burden. Caregiver burden was not
differentially associated with gender of the care recipient. In
racial/ethnic differences, African American caregivers were
the least burdened. Interactions indicated that caregivers to
Hispanic women were more burdened whereas caregivers to
White women were less burdened. Considering that caregiv-
ers of Hispanic/Latina women are at greater risk of burden,
more research is needed to understand gender and racial/eth-
nic differences in caregiver burden.
DEVELOPMENT OF AN INTERVENTION TO
IMPROVE COMMUNICATION WITH PEOPLE WITH
DEMENTIA IN NURSING HOMES
M.Machiels, S.Zwakhalen, S.Metzelthin, J.Hamers,
Department of Health Services Research, CAPHRI School
for Public Health and Primary Care, Maastricht University,
Maastricht, Netherlands
Nurses often report communication difficulties in caring
for people with dementia (PWD). Evidence-based interven-
tions to enhance communication are scarce. Therefore, we
developed a theory-informed intervention using the Behavior
Change Wheel with the aim to improve communication
between nurses and PWD. First, ideal communication was
defined (targeted behavior) based on the scientific literature,
policy reports and consultations of experts (n=7). Second, a
focus group meeting with relevant stakeholders (n=7) was
organized and observations of nurses (n=9) and PWD (n=9)
during daily nursing care were conducted to understand their
current behavior and to identify facilitators and barriers for
the targeted behavior. Reviewing the literature and consult-
ing experts have shown that ideal communication has to be
person-centered and therefore should be tailored to the needs
and capacities of PWD. Furthermore, next to verbal com-
munication, attention should be paid to non-verbal commu-
nication, including the use of pictograms, objects, and touch.
Additionally, the environment has to be recognizable and
and observations have shown that current behavior of nurses
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
is often characterized by a task-oriented instead of person-
centered approach. Furthermore, non-verbal communication
(e.g., eye contact) is insufficiently used. Identified facilitators
and barriers for the ideal communication relate to nurses
characteristics (e.g., knowledge, awareness, and skills), social
influences, and other environmental factors (e.g., resources).
These insights were used to develop a theory-informed inter-
vention in close collaboration with relevant stakeholders
(e.g., nurses, speech therapists, and policy makers). The sys-
tematic development of the intervention and its final version
will be presented.
PAIRED INTEGRATIVE EXERCISE FOR PEOPLE WITH
DEMENTIA AND CAREGIVIERS (PAIRED PLI STUDY)
W.Mehling, D.Marks, R.Woodstock, M.Ventura,
J.D.Flatt, M.A.Chesney, D.E.Barnes, University of
California San Francisco, San Francisco, California
We have recently developed a novel, multi-modal,
group movement program for people with mild to moder-
ate dementia and their primary caregivers called the Paired
PLI (Preventing Loss of Independence through Exercise)
Program. The program is offered in community classes
taught by trained exercise instructors to dyads of affected
individuals with their caregivers. Paired PLI is grounded
in neuroscience and focuses on abilities that are relatively
well-maintained in people with dementia (procedural mus-
cle memory, mindful body awareness, social connection).
We have performed two pilot studies of 4 dyads each. The
first pilot study met two days/week for 12 weeks followed
by 3monthly refresher classes. Study participants indicated
that they preferred ongoing classes; therefore, the second
pilot study met two days/week for 8 weeks followed by
weekly classes for another 8 weeks. Qualitative results sug-
gest noticeable improvements in physical function (ability to
sit and stand), cognitive function (ability to express thoughts
and feelings) and social function (ability to connect with
others in a group setting) in affected individuals and greater
acceptance and engagement in caregivers. Data analyses are
ongoing. At the end of the second pilot study, all participants
requested to continue the classes on a weekly basis. Alarger
randomized, controlled trial of the Paired PLIE program will
begin in August, 2016.
BEING USEFUL IN RARE AND TYPICAL DEMENTIAS
E.Harding1, M.Sullivan1,2, R.Woodbridge2, S.Crutch1,
1. University College London (UCL), London, United
Kingdom, 2. Brunel University London, London, London,
United Kingdom
Being useful, or doing something that serves a purpose,
has implications for wellbeing and underpins Eriksons psy-
chosocial developmental stage of generativity. However lit-
tle attention has been given to the concept of usefulness in
dementia research, with the literature extending to under-
standing activities which are meaningful for individuals,
but not to those which explicitly benefit others or a cause.
This work explores usefulness for individuals and families
living with typical Alzheimers Disease (tAD) and Posterior
Cortical Atrophy (PCA), a rare dementia usually early in
onset and characterised by dominant impairments in visual
IAGG 2017 World Congress
485
processing. In-depth individual and dyadic interviews with
37 couples (17 with tAD; 20 with PCA) were conducted and
analysed using grounded theory.
A sense of usefulness was challenged both practically, due
to the specific impairments characterising each diagnosis (i.e.
dominant perceptual versus memory difficulties), and exis-
tentially. Individuals and their family members attempted
to manage practical challenges by renegotiating roles and
responsibilities over time, with motivation to do so varying
according to levels of insight and memory function.
A diagnosis of dementia and its impact on subjective feel-
ings of usefulness may be best understood as a biographical
disruption. Further, notions of usefulness in dementia may
be most effectively explored through an interactionist lens
within the context of the family system and extended social
system. This work raises important questions about how
being useful is conceptualised, accessed and assessed, and by
whom, and has broader implications for wellbeing and the
provision of support in these and other degenerative diseases.
MIDLIFE SHIFT WORK AND RISK OF INCIDENT
DEMENTIA
K.Bokenberger1, A.K.Dahl-Aslan2,1, I.Karlsson1,
T.kerstedt3,1, N.L.Pedersen1,4, 1. Karolinska Institutet,
Stockholm, Sweden, 2. Jnkping University, Jnkping,
Sweden, 3. Stockholm University, Stockholm, Sweden, 4.
University of Southern California, Los Angeles, California
Research examining the long-term effects of midlife shift
work in relation to dementia risk is limited. The aim is to
investigate the association between shift work and incident
dementia in a population-based study.
Participants were 12,028 individuals from the Swedish
Twin Registry (STR) born 19261943 i.e. at least 30years
of age upon receiving a mailed questionnaire in 1973 that
included information on shift work history. A sub-sample
of STR twins (n=8,953) who participated in a telephone
interview in 19982002 also had data on duration of night
work employment. Dementia diagnoses were obtained from
Swedish national patient registers. Cox regression estimat-
ing hazard ratios (HR) was used for statistical analysis.
Confounding factors such as age, sex, education, cardiovas-
cular disease and type 2 diabetes were included in adjusted
models. In a subsample of participants with genetic data
(n=2,998), a genetic risk score (GRS) for morningness to
assess circadian rhythm differences and APOE E4 status
were considered in the models.
A total of 1,047 dementia cases (8.7%) were identified
after a median of 41.3 years follow-up. History of any-
type shift work (HR=1.22, 95% CI=1.071.40) and night
work (HR=1.24, 95% CI=1.051.46) were associated with
higher risk of dementia in multivariable-adjusted models.
Dose-response relationships between dementia with any-
type shift work duration and with night work duration were
observed (p=0.002 and p=0.001 for linear trend, respec-
tively). Adjusting for APOE E4 and GRS did not attenuate
the associations.
In summary, findings indicate mid-life shift work history
was significantly associated with increased dementia risk in
later life.
486
EXPLORING THE USE OF GROUP DIGITAL
ACTIVITIES FOR PEOPLE LIVING WITH DEMENTIA
E.Dove1, K.Cotnam4, A.J.Astell1,2,3, 1. Ontario Shores
Centre for Mental Health Sciences, Whitby, Ontario,
Canada, 2. University of Toronto, Toronto, Ontario,
Canada, 3. University of Sheffield, Sheffield, United
Kingdom, 4. Oshawa Senior Citizens Centre, Oshawa,
Ontario, Canada
Meaningful leisure activities are an important part of
well-being, although these activities become less accessible
for people with dementia. While digital technologies provide
an accessible form of entertainment, the way the technology
is introduced, how people are taught to use it, and how play-
ers are supported during these activities is important to con-
sider when working with this population. In this study, we
explore the use of a motion-based technology (Xbox Kinect)
as a group activity for people living with dementia.
The study was conducted in a community-based adult day
program for people living with dementia. Participants were
observed during a virtual bowling activity over a period of
12 weeks. Observations focused on; 1)methods for introduc-
ing, teaching, and supporting people to use this technology,
2)effects of repeated exposure on mastery of learned skill,
and 3)the influence of the group dynamic on the activity.
The findings highlight the importance of training staff
how to introduce, teach and support people with dementia
during these digital activities. Approaches must be tailored
to each individuals skills and abilities, including the use of
verbal prompts, gesture demonstrations, and/or physical
support for clients with mobility impairments (e.g. wheel-
chair users). Over time mastery was evident through reduced
prompting, with some participants even offering cues to
newer players. The group bowling activity provided a social
activity, with participants engaging through positive encour-
agement, friendly competition, and reminiscing. The findings
suggest motion-based digital activities have huge potential
for people living with dementia to enjoy meaningful leisure
activities.
THE PSYCHOSOCIAL APPROACH TO PATIENTS
WITH EARLY-ONSET DEMENTIA AND THEIR
CAREGIVERS
E.Makino, H.Kase, Waseda University, Tokyo, Japan
Background: The mental conflicts of the patients with
early-onset dementia and their family caregivers are serious.
Feelings of social isolation and negative emotions are espe-
cially so strong as to have a adverse effect on their relation-
ship. The importance of reinforcing measures not only for
elderly patients with dementia but also for those with early-
onset dementia has also been shown in Japan. Previous stud-
ies have indicated the need of family support by intervention
approach for both patients and family caregivers, but little
has been put into practice. The purpose of this study was to
clarify the changes of relationship between patients suffer-
ing from dementia and caregivers by using functions of CLR
focusing on their communication.
Methods: The CLR Approach is an individualized reminis-
cence method using a life-story book based on each couples
memories. Seven sessions (2 hrs. for each) were conducted
at each couples home over a 12-week period, followed by a
narrative analysis of the interview sessions.
Innovation in Aging, 2017, Vol. 1, No. S1
Results: Four findings were observed: 1) patients with
dementia regained a clear memory and exhibited self-
esteem and Reduced anxiety; 2)caregivers remembered the
past life of their partners, expressed gratefulness to them
and exhibited a change of consciousness such as recog-
nition of their personality: 3)sympathy and appreciation
were enhanced by their common memory: 4)positive feel-
ings toward the couples life was fostered by creating a life
story book.
Conclusions: CLR can help couples struggling with early-
onset dementia to reevaluate and rebuild their relationship to
regain their dignity as a couple.
SESSION 960 (POSTER)
DEMENTIA III
KNOWLEDGE TOWARD DEMENTIA AMONG
MEDICAL STUDENTS IN BRAZIL
V.F.Mayoral1,2, M.Garuzi1, J.Cabral1, A.G.Leite1,
R.Thomazi1, D.Veiga Antonangelo1, P.J.Villas Boas1,
A.F.Jacinto1, 1. Medical Clinic, Universidade estadual
Paulista Julio de Mesquita Filho, Botucatu, Brazil, 2. State
University of Botucatu, Botucatu, Sao Paulo, Brazil
Dementia is common in the elderly and its prevalence
has increased in the last decades. Curricula of the Brazilian
Medical Schools include teaching of dementia issues, but
there are no reports in the medical literature about qual-
ity of this teaching. A study on the knowledge towards
dementia among hundred fifty-five students in the final of
the last semester of the medical graduation (2 public medi-
cal schools-FMB/UNESP and EPM/UNIFESP, has been pro-
posed. In this transversal study, a British self-administered
instrument (already culturally adapted to Brazil) on knowl-
edge towards dementia was used; 92(59.7%) had good
training on cognitive impairment during their undergraduate
medical course, and of these, 67(58,7%) had only theoretical
basis. 142 (93.4%) reported taking extracurricular courses
them during under graduation course. The students obtained
a mean of 6.9 on the general knowledge score, considering
a scoring scale from 0 to 14 points. The results can be used
in the analysis of mandatory content during medical train-
ing. Curricula of the Medical Schools should be in line with
epidemiological aspects of the country.
EXPERIENCE AND PERCEPTION OF NURSES
ON DEMENTIA CARE IN GERIATRIC WARDS IN
ASINGAPORE HOSPITAL
P.S.Yoon, Z.Di, Geriatric Medicine, Changi General
Hospital, Singapore, Singapore
Caring for persons with dementia in the geriatric wards
of an acute hospital is challenging. This study in Changi
General Hospital, Singapore, was to explore, understand and
interpret the nurses experience, aiming to improve the cur-
rent care approach. This was a qualitative exploratory study
using phenomenological method with purposive sampling.
Inclusion criteria were nurses, with at least 2years of expe-
rience of working in the geriatric wards. 3 semi-structured
focus group interviews, facilitated by a researcher trained in
focus group facilitation, were conducted over the period of
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
1month, with a total of 12 participants. These were audio-
recorded and transcribed verbatim. Data analysis was done
using thematic content analysis. The mean age of partici-
pants were 38.5years old, with a mean 18.5years of nursing
experience with 10.5years in geriatric wards. The experience
described was categorized into 3 themes: Reality of caring,
Priority of caring & Challenges of caring. Issues discussed
include clinical, ethical, system & environmental challenges,
and psychological and professional reality. Coping of chal-
lenges (both emotionally and problem-focused) were also
discussed. The perceived experience was generally more
positive than those quoted in literature. Conflict existed
between perceived optimal care of patients and routine hos-
pital practices. Amore dementia-centred and elderly friendly
approach with flexible workflow and improved resources
was advocated.
EFFECT OF MELATONIN OVER SLEEP QUALITY
IN OLDER ADULTS WITH MILD TO MODERATE
DEMENTIA
R.Morales, G.Guajardo lvarez, C.Camara Lemarroy,
D.G.Gamez Trevio, A.Arredondo Jaime, E.Hernandez
Maldonado, R.Salinas Martinez, Geriatrics, Universidad
Autnoma de Nuevo Len, Monterrey, Nuevo Len,
Mexico
Background: Sleep disturbances are common in patients
with dementia. Melatonin treatment is purported to improve
sleep, and benefit those patients. Methods: Randomized,
placebo-controlled, double blind clinical trial. Older adults
with mild to moderate dementia with poor sleep quality
were included and randomized to receive melatonin (5mg,
by mouth, once daily) or placebo for 8 weeks. PSQI was
assessed at baseline and every 2 weeks. Mini mental state
examination (MMSE), Katz and Lawton Brody score were
assessed at baseline and last visit. Numerical variables
were compared using student T test and repeated measures
ANOVA; and Chi square test for categorical variables. (IBM
SPSS version 17.0). Results: 22 patients were included, 12
in Melatonin Group (MG) and 10 of placebo group (PG).
There were no statistical differences for gender (MG: 58%
and PG: 50% females) and mean age of 82.46 (MG) and
84.92 (PG). There was no statistical difference between
groups at baseline: GDS, MMSE, evolution of dementia,
comorbidities or medication use and PSQI (MG:13.43.1
and PG:13.33.8, p=0.9). In melatonin group, there was
a statistical significant decrease from baseline and all sub-
sequent evaluations, reaching 6.83.6 (a reduction of 6.6
points) at week 8 (p=0.01). There was no statistical differ-
ence of PSQI for placebo group through the study (9.45.4
at week 8, p=0.4). Conclusions: We found a significant
improvement in PSQI scores in melatonin group and no
adverse events were reported. Treatment with Melatonin is
safe, tolerable and effective in improving quality of sleep in
older people with dementia.
BARRIERS AND FACILITATORS TO GUIDELINE USE
IN DEPRESSION AND ANXIETY IN PARKINSONS
DISEASE OR DEMENTIA
Z.Goodarzi1, H.Hanson1,2, N.Jette1, S.Patten1,
T.Pringsheim1, J.Holroyd-Leduc1, 1. University of Calgary,
IAGG 2017 World Congress
487
Calgary, Alberta, Canada, 2. Alberta Health Services,
Calgary, Alberta, Canada
Background: Despite the availability of clinical practice
guidelines for the management of depression or anxiety in
dementia or Parkinsons disease (PD), these comorbidities
remain under-diagnosed and under-treated.
Objectives: Our primary objective was to understand the
barriers and facilitators associated with the implementation
of high quality CPGs for depression and anxiety in patients
with dementia or PD.
Methods: Focus groups and interviews were conducted
with participants experiencing PD, their caregivers and phy-
sicians involved in the care of persons with dementia or PD
in Calgary, Alberta. The Theoretical Domains Framework
and Behaviour Change Wheel were used to guide data col-
lection and perform a framework analysis. Evidence from
the available guidelines was compared to reported physician
behaviours.
Results: Atotal of 33 physicians and 7 PD patients/caregiv-
ers participated. We were unable to recruit patients/caregiv-
ers with dementia. Data were divided into three categories
based on the barriers and facilitators to the implementation
of guideline recommendations for diagnosis, management
and the use of the guidelines. An overarching theme was
the lack of evidence for depression or anxiety disorders in
dementia or PD. This was more prominent for anxiety versus
depression. Other themes included the lack of consistency
between guidelines, lack of clarity in the language used, lack
of applicability to the practice population, and impractical or
out of date recommendations. Patients noted difficulties with
communication of symptoms and access to services.
Conclusions: Although there are available guidelines,
physicians have difficulty with the implementation of certain
recommendations due primarily to a lack of evidence.
ENGAGING PEOPLE WITH DEMENTIA IN USING
AN ELECTRONIC PILL DISPENSER: RESEARCH
PROTOCOL
M.Tellier1,2,3, L.Demers1,2, C.Auger1,3,4, 1. Occupational
Therapy, Universit de Montral, Laval, Quebec, Canada, 2.
Centre de Recherche de lInstitut Universitaire de Griatrie de
Montral (CRIUGM), Montral, Quebec, Canada, 3. Centre
de Recherche Interdisciplinaire en Radaptation (CRIR),
Montral, Quebec, Canada, 4. Centre de Radaptation Lucie-
Bruneau (CRLB), Montral, Quebec, Canada
Many studies show that people with dementia are able
to learn skills, but findings concerning their ability to use
technologies are inconsistent. Therefore, details about active
ingredients that make intervention using technologies suc-
cessful are needed. This study describes the development and
evaluation of a rehabilitation approach integrating specific
learning strategies that engage people with mild Alzheimer
Disease (AD) and their caregivers, in managing their medica-
tion with an electronic pill dispenser. Phase 1 will consist in
developing an approach that is based on the state of knowl-
edge concerning the cognitive profile of people with AD and
their learning capacities. Validation of this approach will be
iterative and involve semi-structured interviews with nine
key actors (three persons with AD, three caregivers and three
health professionals). Content analysis will help to identify
which elements should be modified in order to maximize the
488 Innovation in Aging, 2017, Vol. 1, No. S1

acceptability and coherence of this approach. In phase 2, five individual observations. We calculate the accumulated prob-
dyads (person with AD and caregiver) will be implicated in ability of death for age between 31 and 99. This approach
the evaluation of the efficacy of this approach with an ABA takes into account selective mortality.
multiple baseline across participants design. Medication The largest relative difference in mortality between low
management will be quantified using an observation chart income and high income is at age 55 (RR: 3.7). The larg-
and will also be filmed once a week to be rated by blinded est absolute difference in mortality between low income and
evaluators. Phase 3 will involve five semi-structured inter- high income is at age 82 (10 % difference). Both measures
views with the caregivers to understand their experience. decrease after their peak, with relative inequality converging
This study could become a proof of concept that a rehabili- at age 90 and the absolute inequality converging above age
tation approach, integrating evidence-based training strate- 95.
gies that engage people with mild AD and their caregivers in The results support the age-as-a-leveller theory as we see
using technology, can improve task performance in a home a closing of the mortality gap between high and low income
environment. at the oldest ages. The results also support the cumulative
disadvantage theory; as absolute inequalities increase at
SESSION 965 (POSTER) younger ages. We find support for both theories but dur-
ing different periods over the life course depending on what
measure we look at.
DEMOGRAPHIC PERSPECTIVES ON AGING
The findings in this study highlight the need for careful
consideration when choosing what measures we use to assess
WHAT ARE THE UNIQUE DEMOGRAPHIC TRENDS
inequality. This choice can even be seen as a normative judg-
AND PATTERNS FOR GLOBAL AGING?
ment by the researcher and need to be explicit.
W.He, US Census Bureau, Washington, District of
Columbia
WHO LIVES ALONE? TRENDS OVER TIME IN THE
While it is well known that the world population is aging,
CHARACTERISTICS OF SWEDENS SOLITARY LIVING
what may surprise some is the variation and diversity among
OLDER ADULTS
world regions and countries. Using population estimates and
B.A.Shaw1, N.Agahi2, S.Fors2, C.Lennartsson2, J.Fritzell2,
projections data from the U.S. Census Bureaus International
1. SUNY at Albany, Albany, New York, 2. Aging Research
Data Base, this poster illustrates the unique demographic
Center, Stockholm, Sweden
trends and patterns for global aging by region and country.
Sweden maintains one of the worlds highest rates of older
In the near future, the countries of Europe and North
adults who live alone, and the number of solitary living older
America will continue to lead the world in aging. However,
adults in Sweden continues to rise. Given the potential health
Asia and Latin America are experiencing an unprecedented
impact of living alone, it is critical that the factors which
speed of aging due to rapid fertility decline in the past
select individuals into the living alone arrangement be under-
30years. In contrast, Africa will remain young through 2050.
stood. While prior studies have examined the determinants
This poster presents multiple indicators of aging, includ-
of living alone among older adults, few have examined how
ing size of older population, share of 65 and older in total
these determinants may have changed over recent decades, as
population, speed of aging, dependency ratios, and median
the overall rates of living alone during old age have stabilized
age. These data provide answers to multiple demographic
and declined in Sweden. The purpose of this study is to assess
questions: Which world region is the oldest now and in
how the associations between living alone and a variety of
2050? What are the differences in fertility levels among
socioeconomic, social, behavioral, and functional factors
regions? What are the 25 oldest countries now and in 2050,
have changed in successive cohorts of older adults in Sweden,
and where does the United States rank? What is the speed
from 1992 to 2014. Data come from the Swedish Panel
of aging for countries, measured in doubling of percent 65
Study of Living Conditions of the Oldest Old (SWEOLD), a
and older (or is it tripling)? How do the two population
nationally representative survey of adults aged 77 and older
billionaires, China and India, differ in aging? How do the
who are living in Sweden. Our findings suggest that todays
components of the dependency ratio change over time at
population of older men who live alone in Sweden are more
the country, region, and world level? These data will inform
likely to be socioeconomically disadvantaged and function-
researchers, health practitioners, policymakers, and families,
ally impaired compared to previous cohorts of solitary living
allowing them to better understand and prepare for further
older men in Sweden; similar patterns were found in women,
global aging.
but were not statistically significant. These findings indicate
that while successive cohorts of the oldest old have gener-
DIVERGENCE AND CONVERGENCE: HOW DO
ally seen improvements in socioeconomic status, health and
INCOME INEQUALITIES IN MORTALITY CHANGE
functioning over recent decades, the cohorts of men who live
OVER THE LIFE COURSE?
alone have become increasingly disadvantaged.
J.Rehnberg, J.Fritzell, S.Fors, Aging Research Center,
Stockholm, Stockholm, Sweden
MORTALITY TRENDS IN ELDERLY INDIVIDUALS IN
Do inequalities in health increase or decrease with age?
ABRAZILIAN WESTERN AMAZON CAPITAL CITY
Evidence is not conclusive and competing theories arrive at
P.C.Bezerra1, G.Torres2, 1. Center of Health and Sport
different conclusions. This study aim to examine the income
Sciences, Federal University Of Acre, Rio Branco, Acre,
inequality in mortality in a synthetic cohort aged 30 to age
Brazil, 2. National School of Public Health, Rio de Janeiro,
99 between the years 1990 to 2009, following each individ-
Rio de Janeiro, Brazil
ual for 19years. We use Swedish register data with 4 772 044

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
Objective: To analyze the trends of general mortality as
well as of that resulting from diseases of the circulatory sys-
tem in elderly individuals in Rio Branco between years 1980
and 2012. Methodology: Study on a secondary database of
the System of Information on Mortality in Brazil, accord-
ing to the International Classification of Diseases. The gross
mortality rate of people aged 60years or older in the capital
of Acre state, Rio Branco, located in the Western Brazilian
Amazon, was calculated. The standardized mortality rate
was obtained by the direct method, based on the world pop-
ulation as the standard population. The trend analysis was
performed by the JoinPoint Regression, which calculates the
inclination of the straight line segment, or annual percent
variation with a 95% confidence interval. Results: General
MR was higher among males and among individuals aged
80years and older for all the years analyzed. It also showed
a tendency to reduction, thus increasing longevity in this
population. Mortality resulting from diseases of the circu-
latory system was more frequent in relation to other death
causes; however, it showed tendency to decrease over the
years, which was more pronounced in women and among
the elderly aged 70 years or older (VPA -2,98; CI -3,7 to
-2,1). Conclusion: Primary health care must be trained on
the care of this population in order to ensure that the trend
to increase in the number of years of life is accompanied by
improvement or maintenance of good health, quality of life
and health promotion.
EDUCATIONAL GRADIENTS IN MORTALITY
AMONG OLDER ADULTS IN SINGAPORE: 6 YEARS
FOLLOW-UP
A.Chan1, S.Ma3, Y.Saito2, 1. Duke-NUS Medical School,
Singapore, Singapore, 2. Nihon University, Tokyo, Japan, 3.
Ministry of Health, Singapore, Singapore, Singapore
The effect of education on adult mortality is well known
based on studies conducted in western countries. People with
higher education tend to have lower mortality, in general.
The effect is not always clear and/or significant in the stud-
ies conducted in Asian countries. In this study, we examine
the effect of education on mortality among older adults in
Singapore based on a longitudinal survey conducted in 2009
and mortality follow-up by Ministry of Health. The baseline
survey is a nationally representative of community dwellers
aged 60 and above in 2009. The sampling frame consisted of
a random sample of 8,700 individuals. Combined with infor-
mation from decedent questionnaires in two follow-up sur-
veys conducted in 2011 and 2015, and mortality matching in
2012 and 2016, we will have relatively complete information
on mortality among those who participated in the baseline
survey. Using this data we examine mortality patterns by sex
and education.
LONGITUDINAL PERSPECTIVES ON
HOMEOWNERSHIP FOR MEXICAN ORIGIN ELDERLY
P.Cantu, J.L.Angel, The University of Texas at Austin,
Austin, Texas
Objectives: To examine health and financial correlates of
homeownership longitudinally for Mexican Origin elderly
individuals over the age of 65.
Methods: We analyze data from multiple waves
(Waves 17) of Hispanic Established Populations for the
IAGG 2017 World Congress
489
Epidemiologic Study of the Elderly (H-EPESE). Our focus
is specifically on the health and financial situation of elderly
individuals as well as familial considerations, such as number
of surviving children and childs marital status. We will first
examine the correlates of home ownership at baseline and
follow up (Waves 1 and 7). We will then explore changes in
household rosters and living arrangements between waves
(All waves). Finally we will need use a competing risk model
to take into account mortality and loss to follow up in the
survey (Waves 1 and 7).
Results: Preliminary analysis shows that Mexican Origin
Elderly exhibit high rates of ownership at baseline (64%)
as well as at follow up (58%). What is less clear is what the
roles of mortality and transfer of ownership are. Furthermore
we not yet fully characterized living arrangements within
households.
Discussion: Previous research on cross sectional corre-
lates of home ownership have revealed that motivations for
of Mexican Origin Elderly living with others are clearly more
complex than simple filial piety considerations might hold.
Extended living arrangements provide concrete financial and
instrumental benefits for both elderly parents and their adult
child caregiver. This research will build upon these ideas by
adding longitudinal analysis.
HOUSEHOLD ARRANGEMENT TRANSITIONS
AMONG GRANDPARENTS
Y.Chen, Brandeis University, Waltham, Massachusetts
Census reports shown that grandparents living with
grandchildren fare worse in economic and health status than
their counterparts living in other types of households, and the
number and percentage of grandparents living with grand-
children have increased since 1990s. This study investigated
the determinants and patterns of household arrangement
transitions among middle-aged and older grandparents, with
focuses on racial-ethnic differences as well as households
where grandparents are living with their grandchildren. This
study is among the few national and longitudinal investiga-
tions into this issue.
Using survival analysis and data from the 19982012
Health and Retirement Study, this study found that white
grandparents were less likely to co-reside with grandchil-
dren, and among them, moving from co-residing with grand-
children to living as a couple was higher in number and
frequency than that among their black and Hispanic coun-
terparts. Higher resources (grandparents socioeconomic
resources, retirement, and health) strongly decreased the
probability of co-residing with grandchildren among white
grandparents, but barely decreased this probability among
black and Hispanic grandparents. Having a child living
nearby or/and a deceased child increased the probability of
moving to skipped-generation households among black and
Hispanic grandparents, but not among white grandparents.
The results suggest that black and Hispanic grandparents
are more likely than white grandparents to co-reside with
grandchildren in response to childrens needs. White grand-
parents are more likely than black and Hispanic grandpar-
ents to co-reside with grandchildren when lacking resources.
This study has implication on how racial and ethnic varia-
tions in intergenerational relations may influence grandpar-
ents wellbeing.
490
EXPLORING THE REPRODUCTIVE CELL CYCLE
THEORY OF AGING IN SOCIAL DATA
J.A.Yonker, University of Wisconsin-Madison, Madison,
Wisconsin
The Reproductive Cell-Cycle Theory of Aging (RCCTA)
posits that hypothalamic-pituitary-gonadal axis (HPG axis)
hormones fundamentally regulate cellular change (division,
differentiation, and apoptosis). Balanced HPG hormone
signaling is critical to normal growth, development, and
maintenance from conception through the reproductive
period. However, when this becomes unbalanced in later
life (i.e., post-menopausal endocrine dyscrasia), dyotic
signaling to somatic and reproductive tissues drives senes-
cence. The RCCTA predicts that the longer the HPG axis
is maintained in equilibrium, the longer an organism will
live and the lower the likelihood of illness or functional
deterioration.
Using longitudinal survey data from the Wisconsin
Longitudinal Study, I test whether age of menopausea
proxy for onset of endocrine dyscrasiais associated with a
range of health outcomes for a cohort of women over a two-
decade follow-up (approximate ages 5572). These include:
mortality; major illnesses; multiple self-reported measures of
health; multiple measures of physical functioning; and multi-
ple domains of cognition.
I find a pattern of results indicating that earlier meno-
pause is associated with greater risk of death, greater risk of
vascular illnesses (hypertension, cardiovascular disease, heart
attack, and stroke), greater risk of osteoporosis, poorer self-
reported health, poorer physical functioning (ADL/IADL),
and poorer cognitive functioning. These results are robust
to typical demographic, socioeconomic, and health behav-
ior controls. Other reproductive factors, such as number
of children and natural versus surgical menopause, are not
significant after controlling for age of menopause. However,
there is some evidence that use of hormone replacement
therapy (HRT) may attenuate the negative effects of earlier
menopause.
SESSION 970 (POSTER)
DISABILITY, IMPAIRMENT, AND MOBILITY
USING PERFORMANCE-BASED ADL/IADL DATA TO
EXPLORE ASELF-REPORT MODEL OF PRECLINICAL
DISABILITY
P.Toto, L.Terhorst, J.C.Rogers, M.Holm, Occupational
Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
Background: Preclinical disability is a transitional state
between the onset of impairment in functioning and depend-
ence in activities of daily life (i.e. disability). Preclinical dis-
ability in older adults can serve as an early warning and
critical intervention point for prevention of further decline
and adverse events. However, methods for identifying pre-
clinical disability in older adults are not well developed and
have been limited to self-report.
Objective: This study examined a classification model of
preclinical disability based on self-report using performance-
based measures of activities of daily living (ADL)/instrumen-
tal ADLs (IADL) in older women.
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: We conducted a secondary data analysis of ADL/
IADL performance data collected using the Performance
Assessment of Self-Care Skills (PASS). Participants were com-
munity-dwelling older women (N=217) with chronic conditions
representing five primary diagnostic groups. After construct-
ing a first-order confirmatory factor analysis model using the
three factors included in the preclinical disability model based
on self-report (i.e. intrinsic, extrinsic, assistance), we assessed
model appropriateness using goodness of fit statistics.
Results: The overall model fit was acceptable. Intrinsic
and assistance variables had strong loadings on the intended
factors; one extrinsic variable had strong loadings on the
intended extrinsic factor. Intrinsic and assistance factors
were highly correlated and the extrinsic factor was moder-
ately associated with intrinsic and assistance.
Conclusion: Our performance data provides preliminary
support for a preclinical disability classification model based
on self-report. Both self-report and performance based meas-
ures that quantify use of intrinsic factors, extrinsic factors,
and assistance may be effective methods for identifying pre-
clinical disability in older adults.
HOW AND HOW MUCH CAN LEISURE ACTIVITIES
MEDIATE PROGRESSION TOWARD FUNCTIONAL
DISABILITY?
Y.Chen, Y.Tu, R.Chang, D.Chen, T.Chiang, H.Yu,
Institute of Health Policy and Management, National
Taiwan University, College of Public Health, Taipei City,
Taiwan
The aims of this study were to investigate (1) whether
and (2) the extent to which the trajectory of Taiwanese older
adults leisure activities (LA) mediated the potential asso-
ciation between their sociodemographic factors and their
functional disability trajectory. Longitudinal data from four
waves of the Taiwan Longitudinal Study on Aging (TLSA),
collected between 1996 and 2007, were used for analysis
(N = 3,429). A parallel-process latent growth curve mod-
eling was adopted to evaluate the mediational process of LA
between sociodemographic factors (age, gender, education,
self-rated health, comorbidities, and depression) and the out-
come process of functional disabilities.
When mediated by baseline level of LA, five sociode-
mographic factorsage, gender, education level, self-rated
health, and number of comorbiditieshad significant and
negative mediating effects on baseline or change in functional
disability, thus improving disability outcomes. However, four
of the sociodemographic factors (age, education level, and
number of comorbidities), when mediated through the rate
of change in LA, were found to have significant and positive
mediating effects, which indicated these older adults were
less likely to increase LA engagement over time and therefore
increased disability levels. The proportion of effects mediated
by the LA trajectory ranged from 0% to 318%.
ROLE OF FAMILY RELATIONSHIP ON DEATH
ANXIETY CAUSED BY DISABLED CHILDREN AND
PARENTS DEPRESSION
C.Yoo, Seoul National University, Seoul, Korea (the
Republic of)
Death anxiety of older parents caring for children with
intellectual disability (CID) include not only worries about
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
their own death but also the circumstance that they could
no longer care for their disabled children. This study investi-
gates whether satisfaction of family relationship (SoFR) can
moderate the effects of death anxiety caused by disabled chil-
dren (DACDC) on older parents depression. Sample includes
279 parents aged 60 and over who participated in the
Korean National Survey on Individuals with Developmental
Disabilities and their Families in 2011. DACDC was used as
independent variable; depression was used as dependent var-
iable; and SoFR was used as moderator. Socio-demographics
were controlled. In order to address research objectives, mul-
tiple regression analyses were used. The model fit was solid
and major findings are as follows. Older parents with higher
levels of SoFR were less likely to be influenced by DACDC
compared to those with lower levels of SoFR, indicating
that SoFR moderates the relationship. Specifically, when
the level of SoFR is high, the relationship between DACDC
and depression is negative, so positive family relationships
can decrease the negative effect of DACDC on depression,
significantly. However, when the rate of SoFR is low, the
results were reversed. The findings suggest that the SoFR was
verified as moderating variable in the relationship between
DACDC and depression. In order to develop practice and
policy implications for mitigating negative effects of DACDC
on older parents depression, these results should be taken
into account.
IMPACT OF DISABILITY ON ACCESS TO DIABETES
CARE AMONG OLDER ADULTS WITH DIABETES
S.Chun, K.Chan, P.McCallion, L.Ferretti, J.Shi, the two groups. This group of participants with higher health
University at Albany SUNY, Cambridge, Massachusetts
Although previous studies have established a strong
association between diabetes and disability, little is known
regarding the impact of disability on access to diabetes care
among older adults with diabetes. The purpose of this study
is to examine the impact of disability on accessing diabetes
care among older adults who are living with diabetes. This
study used survey data from the 2014 Behavioral Risk Factor
Surveillance System (BRFSS). The sample included adults age
50 and over who have diabetes. Multivariate logistic regres-
sion analysis was conducted to examine the impact of dis-
ability on accessing diabetes care among older adults with
diabetes. Two dependent variables were identified to meas-
ure diabetes care access: (1) receipt of a course or class on
managing diabetes and (2) visit to a health professional in
the past year for diabetes. 47.30% of the sample reported
not having received diabetes education and 10.86% did not
visit health professionals for diabetes in the past year. Older
adults with diabetes who had disabilities were more likely
to have received diabetes management education (OR=1.17,
p<0.01), but were less likely to have visited health profession-
als for diabetes (OR=0.80, p<0.05). Compared to White and
Black, Hispanic (OR=0.62, p<0.01) and Asian (OR=0.47,
p<0.01) elders were much less likely to have received dia-
betes education. The results suggest that further efforts are
needed to facilitate visits to the health professionals regard-
ing diabetes for diabetic elders with disabilities. Additionally,
language and culturally-specific diabetes education should
be promoted to reach more Hispanic and Asian older adults
with diabetes.
IAGG 2017 World Congress
491
PHYSICAL PERFORMANCE AND ADVERSE HEALTH
EVENTS IN OLDER ADULTS WITH DEMENTIA
T.Eagen, E.McGough, R.G.Logsdon, S.M.McCurry,
M.Cagley, A.Cunningham, L.Teri, Rehabilitation
Medicine, University of Washington, Seattle, Washington
Community-dwelling older adults with dementia are
at increased risk for adverse health events, including falls.
Physical performance measures, including gait speed, short
physical performance battery (SPPB) and performance-ori-
ented mobility assessment (POMA), may help clinicians bet-
ter understand the occurrence of falls and health events in
older adults with dementia. An in-home physical performance
assessment was conducted in 82 older adults with demen-
tia (mean Mini Mental Status Exam (MMSE) = 16.41) at
baseline. Adverse health events were collected (via caregiver
report) one month later, defined as a fall or health occur-
rence requiring medical attention. All participants were in
the non-intervention stage of an exercise intervention study
(Reducing Disabilities in Alzheimers Disease). At baseline,
physical performance measures included gait speed (m/sec),
SPPB, and POMA. Participants demonstrated impaired lower
extremity function and high fall-risk (mean gait speed=0.73
m/s, SPPB = 6.89, POMA = 22.84). At one-month follow-
up, 18 (22%) participants had an adverse health event.
Interestingly, participants with adverse health events had
higher baseline scores on the SPPB (mean =8.28) compared
to those without an adverse health event (mean = 6.61)
(p = 0.048), and were slightly younger (mean=77.01 vs.
80.93; p=0.05). There were no statistically significant dif-
ferences in MMSE or gender (male =50% vs. 61%) between
events may represent older adults with cognitive impairment
who remain active despite elevated fall risk. This finding is
important for clinical care and the development of health
services for older adults with dementia.
EVALUATING APEER-LED FALLS APPROACH TO
FALLS PREVENTION EDUCATION FOR OLDER
PEOPLE
A.Hill1, L.Khong2, R.Berlach2, K.D.Hill1, 1. School of
Physiotherapy and Exercise Science, Curtin University,
Perth, Western Australia, Australia, 2. The University of
Notre Dame Australia, Fremantle, Western Australia,
Australia
Health education is an important means of raising older
peoples knowledge and awareness about falls preven-
tion. This study aimed to evaluate the effect of delivering
a new peer-led falls prevention education presentation on
older community-dwelling peoples:1) beliefs and knowl-
edge about falls prevention; 2)motivation and intention to
engage in falls prevention strategies; compared to delivering
an existing presentation. A two-group quasi-experimental
pre-test post-test design was used. A new falls prevention
education program was designed, which incorporated adult
learning and behavior change principles. This new presenta-
tion was delivered to intervention groups and the existing
presentation was delivered to control groups. Response to
the presentation was measured at baseline, immediately post-
presentation and at one-month follow-up. Beliefs, knowl-
edge, motivation and intention outcomes were compared
across these three points of time, within and between the
492
intervention and control groups, using generalized estimating
equation modelling. Participants (control n=99; intervention
n=133) in both groups demonstrated significantly increased
levels of belief and knowledge about falls prevention, and
intention to engage in strategies over time, compared to base-
line. The intervention group was significantly more likely to
report they had developed an action plan to undertake to
reduce their risk of falling compared to the control group
[OR=1.69, 95% CI (1.032.78)]. Women in both groups
were significantly more likely to report increased knowledge,
intention to take action and development of an action plan
to reduce their risk of falling. Peer led education could form
an effective component of health programs that target falls
prevention.
RELATIONS BETWEEN NEUROPSYCHIATRIC
SYMPTOMS AND INSTRUMENTAL ACTIVITIES OF
DAILY LIVING IN MCI
T.Ginsberg, C.White, M.Forsberg, N.Alterman, A.Patel, and military experience, adjusting for age, race, marital sta-
T.Cavalieri, A.Chopra, D.J.Libon, Rowan SOM NJISA,
Stratford, New Jersey
Mild cognitive impairment (MCI) is viewed as a prodrome
often leading to the emergence of a dementia syndrome. Past
research suggests that despite relatively intact neurocogni-
tive functioning, some MCI patients can present with mild
Instrumental activities of daily living (IADL) dysfunction.
However, less is known about how and or if neuropsychiat-
ric symptoms affect IADLs in MCI. In the current research
neuropsychiatric symptoms, along with memory test per-
formance, were obtained in patients diagnosed with MCI.
Regression analysis were conducted to assess the relative con-
tribution of neuropsychiatric illness and memory impairment
as related to IADL functioning. All participants were evalu-
ated by a multidisciplinary team including a neuropsycholo-
gist, geriatric psychiatrist, and a social worker. Participants
were diagnosed with MCI using Jak, Bondi et al., (2008)
criteria (M age=76.395.96; M education= 14.002.46; M
MMSE=26.782.06). IADLs were assessed using E-Cog (M
1.83+0.51). Neuropsychiatric symptoms were calculated as
the total score derived from the Neuropsychiatric Inventory
(M 8.277.62). Delay recognition memory was assessed
using the California Verbal Learning Test-II (z= -.231.17).
Step-wise regression accounted for .381% of variance (R=
.617, R2= .381 df=1, 18, F=4.73 [1, 18; p< .043). In the final
model neuropsychiatric illness entered first (beta=.461; p<
.023) followed by recognition memory test performance
(beta=-.403; p< .043). Follow-up regression analysis found
greater IADL dysfunction associated with greater apathy (R=
.710, r2= .505, [4,16], p< .018, beta= .990, p< .003). These
data suggest that both cognitive and neuropsychiatric status
should routinely be assessed when IADL impairment is sus-
pected. These data also suggest that behavioral health treat-
ment could significantly improve IADL dysfunction in MCI.
PAIN, VETERAN STATUS, AND FRAILTY AMONG
OLDER AMERICAN MEN
L.Quach4,1, D.R.Gagnon2,1, E.Dugan4, R.McLean3,1, levels of fatigue. These findings not only add to the exist-
M.Yang4, K.Cho1,3, J.A.Burr4, 1. VA Boston Healthcare
System, Boston, Massachusetts, 2. Boston University,
Boston, Massachusetts, 3. Havard Medical School, Boston,
Innovation in Aging, 2017, Vol. 1, No. S1
Massachusetts, 4. University of Massachusetts Boston,
Boston, Massachusetts
Relatively little is known about if or how pain and
Veteran status are related to frailty. Our objectives were to
determine the association between pain and frailty among
community-dwelling older men, and examine how combat
experience among Veterans might modify this associa-
tion. The study sample included 3,136 men from the 2012
Health and Retirement Study, a nationally representative
sample of older Americans (mean age 77, range 6899).
The dependent variable was based on a frailty index that
included at least three of the following: 1)weight loss of
10%; 2)difficulty lifting 10 pounds; 3)no physical activity
or being tired all the time; 4)vision impairment,5) cogni-
tive impairment. Key independent variables were reporting
trouble with pain, Veteran status, and combat experience
(fired a weapon in combat). Multivariable logistic regres-
sion was used to calculate the odds of frailty by pain status,
tus, education, income, and comorbidities. Twelve percent
of the men were frail, one-third reported trouble with pain,
39.3% non-veterans, 6.2% and 54.5% veterans with and
without combat experiences respectively. Men reporting
pain had twice the odds of frailty as those without pain.
In stratified analyses, and non-Veterans showed a similar
association between pain and frailty. Veterans trouble with
pain increased the odds of frailty by 2.7 times compared
to non-Veterans, and there was no association between
pain and frailty among Veterans with combat experience.
Further research is needed to understand how military
experiences are related to frailty in later life.
AM IJUST TIRED OR UNABLE TO DO DAILY TASKS?
IMPACT OF PERSONALITY AND FATIGUE ON
FUNCTIONAL HEALTH
J.Kim1, Y.Baek1, A.Jasper1, P.Martin1, L.W.Poon2, 1. Iowa
State University, Ames, Iowa, 2. University of Georgia,
Athens, Georgia
The purpose of this study was to assess the impact of per-
sonality and fatigue on functional health in old and very old
adults. The participants included 239 centenarians and 82
octogenarians from the Georgia Centenarian Study. Multiple
linear regressions were performed to assess the relationship
between NEO personality domains and facets (neuroticism,
extraversion, trust, competence, and ideas), fatigue, and
functional health (activities of daily living). Results indicate
a significant direct effect for fatigue to functional health,
=-.30, p < .001, when controlling for demographic vari-
ables (age, gender, and ethnicity), such that lower levels of
fatigue are associated with higher independent functioning.
In addition, the personality domains extraversion, =-.40, p
< .001, and neuroticism, =.16, p < .05, along with the NEO
personality facet ideas, =-.17, p < .05, were significantly
associated with fatigue when controlling for demographic
variables. The results indicate low levels of extraversion and
ideas along with high levels of neuroticism predict higher
ing body of knowledge regarding functional health in older
adulthood, it sheds light on the impact of enduring personal
factors and fatigue on functioning in later life.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
DIFFERENCES BETWEEN AGING WITH DISABILITY
AND DISABILITY WITH AGING IN HEALTH
TRAJECTORY
C.Yoo, Seoul National University, Seoul, Korea (the
Republic of)
This study aims to (1) estimate the trajectory of self-rated
health (SRH) among Korean older adults with disabilities,
(2) examine its associated factors including sociodemo-
graphic, health behaviors, and environmental factors (3) test
whether there are differences between aging with disability
and disability with aging in the health trajectory and its asso-
ciated factors. Sample includes 341 older adults with dis-
abilities who participated in the Korea Social Welfare Panel
Study (KSWPS), which is a nationally representative data. We
used KSWPS data from 2006 to 2015. In order to address the
research objectives, we used (1) latent growth curve modeling
to estimate the trajectory and its associated factors and (2)
multi-group analysis to examine differences between aging
with disability and disability with aging. The model fits were
solid and major findings are as follows. (1) Korean older
adults with disabilities presented increasing SRH trajectory
with time. (2) Age, education, income, employment status,
number of outpatient visits & physical checkup, amount of
alcohol consumption, social support and residential environ-
ment were associated with the SRH trajectory. (3) The SRH
trajectory and its associated factors differed between aging
with disability and disability with aging. The findings suggest
that (1) older adults with disabilities tend to increase SRH
with time, (2) SRH trajectory is associated with sociodemo-
graphic, health behaviors, and environmental factors, and (3)
SRH trajectory and its associated factors differed between
aging with disability and disability with aging. Based on
these findings, we will discuss implications on practice/policy
for health of older adults with disabilities.
SOCIAL SUPPORT AND STRAIN COMBINE TO
PREDICT CHANGES IN ACTIVITIES OF DAILY LIVING
L.Hawkley1, M.Huisingh-Scheetz2, L.J.Waite1, 1.
Academic Research Centers, NORC at the University
of Chicago, Chicago, Illinois, 2. University of Chicago
Medicine, Chicago, Illinois
Social engagement and social support have been associ-
ated with disability onset and severity (Mendes De Leon,
2003; Seeman etal., 1996). However, the context in which
support is experienced can affect its impact on health out-
comes. In married couples, for example, the benefit to health
status of support from friends was diminished the greater
the strain in friendships (Walen & Lachman, 2000). In the
present research, we consider the impact of combinations
of baseline support and strain on changes in the ability to
conduct activities of daily living. We use two waves of data,
five years apart, from the National Social Life, Health and
Aging Study (N=2,261). Social support and social strain are
each dichotomized to contrast high and low support, and
high and low strain, in relationships with friends and family
separately. Regression models, run separately for men and
women (Seeman etal., 1996), are adjusted for age, race/eth-
nicity, education, income, marital status, and social activity.
In women only, respondents with distressed relationships
with friends (high strain embedded in low support) exhibited
a larger increase in disabilities over a five-year period than
IAGG 2017 World Congress
493
respondents with ambivalent relationships with friends and
family (high strain embedded in high support). Contrary to
expectations, women with positive relationships with friends
and family (high support embedded in low strain) had
larger increases in disabilities than women with ambivalent
relationships with friends (high support embedded in high
strain). Results highlight the importance of contextualizing
the effects of support and strain, especially in women, and
especially in relationships with friends versus family.
MEANING OF TRAUMATIC BRAIN INJURY TO
OLDER ADULTS
M.T.Vogel, H.J.Thompson, Health Services; Social Work,
University of Washington, Lake Forest Park, Washington
Traumatic brain injury (TBI) among the growing popu-
lation of older adults in the United States is a paramount
public health concern. In-depth, patient-centered analyses of
the experiences of older adults who have sustained TBI are
relatively absent from the literature. Therefore, the objective
of this phenomenological study is to explore the perceptions
of older adults who have sustained a TBI and how the per-
ceived meaning of the injury experience changes over time.
Qualitative inductive content analysis was used to analyze
the data derived from this multiple case study design (N=12)
of longitudinal, semi-structured interviews. Interviews were
conducted with participants at 1 week, 1, 3, 6, and 12months
post-injury. Aconceptual model derived from the data was
created to visualize the change in perceived meaning of TBI
among older adults. Results from this study can be used for
developing patient-centered provider training and interven-
tions for traumatic brain injury that will be easily translated
into home, care and community settings.
THE MEDIATING EFFECT OF DISABILITY
TRAJECTORY ON DISABLEMENT FACTORS AND
LONG-TERM CARE USE IN TAIWAN
H.Yu1, Y.Chen1, Y.Tu3, D.Chen2, T.Chiang1, 1. Institute
of Health Policy and Management, National Taiwan
University, Taipei, Taiwan, 2. Institute of Health Behaviors
and Community Sciences, National Taiwan University,
Taipei, Taiwan, 3. Institute of Epidemiology and Preventive
Medicine, National Taiwan University, Taipei, Taiwan
Taiwan has a fast-aging population, and it is expected
to see an associated increase in the number of older adults
with disabilities. We aimed to understand whether Taiwanese
older adults disability trajectories mediated the association
between disablement process factors and later long-term care
(LTC) service use. Data were from the nationally representa-
tive Taiwan Longitudinal Study on Aging Survey, 19962007
(N = 3,429). Trajectories of disability in activities of daily
living and instrumental activities of daily living were iden-
tified by using growth mixture modeling. Structural equa-
tion modeling was applied to examine the effect of disability
trajectory as mediator on disablement process factors, such
as demographics, number of comorbidities, depression, and
leisure activities (LAs), and on later LTC service use. Three
distinct disability trajectories were identified among the
group of surveyed older adults: healthy (N = 2,998, 87.43
%), progressive disability (N = 363, 10.59 %), and main-
tained disability (N = 68, 1.98 %). These disability trajec-
tories, either progressive disability or maintained disability
494
trajectory, were found to have a positive mediating effect on
the association between disablement process factors (older,
lower educational attainment, larger number of comorbidi-
ties, and depressive symptoms) and greater use of LTC ser-
vices. However, encouraging older adults to engage in LAs
reduced later use of LTC services through both total and sig-
nificant mediating effect of postponing development of dis-
ability trajectory in older Taiwanese adults. These findings
suggest that an active lifestyle is important for older adults
physical health and to decrease the societal burden of LTC
service use.
RACIAL DIFFERENCES IN UNMET ADL NEEDS AND
CONSEQUENCES OF UNMET ADL NEEDS AMONG
OLDER MEN
L.Parker, R.J.Thorpe, Health, Behavior, & Society, Johns
Hopkins Bloomberg School of Public Health, Baltimore,
Maryland
Unmet need for activities of daily living (ADL) among dis-
abled older adults can lead to adverse consequences resulting
in worsening health outcomes. Previous studies have identi-
fied race and gender as risk factors for unmet ADL need,
however few studies have examined this among older men.
Using baseline data from the National Health and Aging
Trends Study, the study aimed to examine if racial differences
in unmet ADL need, and its associated adverse consequences,
exists among 2,777 older men. For each ADL domain dis-
ability-related need for assistance was calculated, and the
prevalence of adverse consequences of unmet need. Black
men had a higher prevalence of unmet need with household
activities for doing laundry (64.7% vs. 38.8%), shopping
(52.5% vs. 27.8), and meal preparation (36.5% vs. 20.2%)
than White men (p<0.001). Further, Black men had a higher
prevalence of needing assistance for going outside the home
(16.0% vs. 12.5%), and with one or more mobility tasks
(28.4% vs. 23.6%) than White men (p<0.05). With respect
to adverse consequences, White men had a higher prevalence
of mistakenly taking prescribed medicine than Black men
(21.0% vs. 12.2%) (p<0.05). Black men had a higher preva-
lence for staying in bed (8.23% vs. 1.5%) (p<0.001), and
experiencing one or more adverse consequences of unmet
need for mobility tasks (4.4% vs. 2.9%) (p<0.05). Efforts to
reduce the observed disparities in unmet need and adverse
consequences should be a key priority among older men.
MOTIVATION FOR PHYSICAL ACTIVITY MEDIATES
MOBILITY IMPROVEMENT IN HIV-INFECTED
OLDER ADULTS
K.N.Shah1, Z.Majeed1, T.Senn1, D.Walck2, F.V.Lin1, 1. tified four main themes. Things are different now described
University of Rochester, Rochester, New York, 2. Warner
School of Education, Rochester, New York
We previously demonstrated the effect of a self-deter-
mination theory (SDT) guided physical activity (PA) coun-
seling intervention on multiple mobility outcomes among
HIV-infected older adults (HOA). However, the mecha-
nism underlying the intervention effect is unclear. Here we
investigated the intervention effects on PA motivational
regulation and assessed whether PA motivational regula-
tion mediates the interventions effect on mobility in HOA.
Community-dwelling HOA with mobility impairments
Innovation in Aging, 2017, Vol. 1, No. S1
(N=67) were randomized to a 12-week intervention group
or a usual care control group. PA motivational regulation,
battery of mobility tests (physical performance test and
gait speed) and PA level were assessed at baseline and post-
intervention. Fifty-nine participants completed the study
(M age=55years; M CD4 count=675 cells/mm3; dura-
tion since HIV diagnosis=17years; 39% female). The two
groups were similar in their demographic and clinical char-
acteristics. Regulatory motives for PA such as amotivation
reduced and introjected and identified regulation increased
in the treatment group compared to the control group.
Mobility and PA level were higher in the treatment group
compared to the control group post-intervention (p<0.05).
Increased introjected and identified regulation mediated
the interventions effect on PA and gait speed, respectively.
Our findings suggest that a PA counseling intervention
grounded in SDT can improve motivational regulation for
PA in HOA. Increases in introjected and identified regula-
tion mediated the effects of the intervention on mobility
outcomes. These results underscore the role of interven-
tions targeting the internalization of PA motivational regu-
lation in preventing mobility limitations.
A LONGITUDINAL PERSPECTIVE ON POWER
MOBILITY USE BY OLDER USERS
D.Labb1,2, B.Mortenson1,2, P.W.Rushton3,4, L.Demers3,5,
B.Miller1,2, 1. Occupational Science and occupational
therapy, University of British Columbia, Vancouver, British
Columbia, Canada, 2. Rehabilitation Research Program
and GF Strong Rehabilitation Research Lab, Vancouver,
British Columbia, Canada, 3. Universit de Montral,
Montreal, Quebec, Canada, 4. CHU St-Justine research
center, Montreal, Quebec, Canada, 5. Centre de recherche
de linstitut universitaire de griatrie de Montral, Montreal,
Quebec, Canada
Power wheelchairs (PWC) are essential devices, especially
for people with severe disability. Research has suggested that
PWC can have a positive impact on mobility, participation
and well-being. However, they may also be problematic in
terms of usability, safety, and cost. Currently, little is known
about power mobility use over time. This study investigates
user experiences of PWC over time, from a life-span perspec-
tive. A series of four semi-structured qualitative interviews
(baseline, 3months, 1year, 2years) were conducted with 21
participants recruited in Vancouver, Montreal and Qubec
city (Canada). They shared their daily experience of power
mobility, the changes in use over time, and what were the bar-
riers and facilitators in their environment. The analysis iden-
how participants use of power mobility changed over time
because of their changing physical capabilities and evolving
power mobility experience. Being in the world explored
the feeling of freedom and the opportunities of participa-
tion associated with the PWC. Its my legs explored how
participants learned to use their devices and how it related
to their sense of self. Not sure what to expect described
the physical and attitudinal barriers encountered. The find-
ings emphasize that the experience of power mobility is not
static. This study provides new insights on the experience of
a group of PWC users, and thus will help stakeholders to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
understand the complexity of power mobility provision and
users engagement in meaningful activities
VALIDITY OF ASCALE TO MEASURE COMMITMENT
TO HIP PROTECTORS AMONG CARE PROVIDERS IN
LONG-TERM CARE
A.M.Korall1,5, J.Godin2, I.Cameron3, F.Feldman4,
P.Leung4,7, J.Sims-Gould5,6, S.N.Robinovitch1,5, 1.
Biomedical Physiology & Kinesiology, Simon Fraser
University, Burnaby, British Columbia, Canada, 2. Nova
Scotia Health Authority, Halifax, Nova Scotia, Canada, 3.
University of Sydney, Sydney, New South Wales, Australia,
4. Fraser Health Authority, Surrey, British Columbia,
Canada, 5. Centre for Hip Health & Mobility, Vancouver,
British Columbia, Canada, 6. University of British
Columbia, Vancouver, British Columbia, Canada, 7. The
New Vista Care Home, Burnaby, British Columbia, Canada
Hip fractures are a major threat to healthy aging, often
triggering declines in health, mobility, quality of life, and
even death. Wearable hip protectors represent a promising
strategy to prevent hip fractures, but uncertainty surround-
ing their efficacy exists due to poor user adherence. In long-
term care (LTC), adherence may depend on the commitment
of caregivers to support use of hip protectors among resi-
dents, but empirical evidence is limited. Therefore, our objec-
tive was to develop and test the psychometric properties of
a scale to measure caregiver commitment to hip protectors.
We wrote 15-items to measure three components of commit-
ment: affective (belief in value), cognitive (belief in efficacy),
and behavioural (willingness to act). We surveyed 535 paid
caregivers (92% female) from thirteen public LTC homes
in British Columbia, Canada. Responses were subjected to
exploratory factor analysis (EFA) and internal reliability test-
ing. EFA supported a higher order structure, with two fac-
tors. Affective and cognitive items loaded highest on Factor
1, and behavioural items on Factor 2. Both factors loaded
onto a higher order factor. One item was removed due to low
loadings. Cronbachs alpha coefficients for the affective/cog-
nitive subscale, the behavioural subscale, and the full scale
were .97, .87, and .96, respectively. Overall, 8% of the vari-
ability in commitment was explained by LTC home. Mean
commitment was lower in caregivers with 20+ years of ten-
ure, and those aware of a resident breaking their hip despite
being protected (p<0.01). Findings could inform policy and
practice to enhance caregiver commitment to hip protectors
in LTC.
NEXT STOP . . . THE BLINK BLINK PLACE
E.E.Liang, Art for All, Hong Kong, Hong Kong
Report and study of how a group of visually inpaired
elderly residing in nursing home, in their last stage of life
worked hand in hand with artists through a yearlong thera-
peutic expressive arts program, co-created an arts event:
Next Stop the Blink Blink Place. An art exhibition
of multiple arts discipline, showcasing not just the wit and
genius of their lives, but also in their own creative process,
the way to peace, imagination and self worth. End of life
becomes an envision future they are looking forward to:
When we are at the last stop of life, must there be only
fear? No! theres happiness waiting! we know, we see it in
our minds eye!
IAGG 2017 World Congress
495
EFFECTS OF DUAL TASKING ON AUDITORY
SELECTIVE ATTENTION IN THREE DIFFERENT
ENVIRONMENTS
A.Helseth, T.Leeder, S.Myers, M.Schieber, J.A.Blaskewicz
Boron, University of Nebraska Omaha, Omaha, Nebraska
Performing attention-demanding tasks in a Virtual real-
ity (VR) environment may show promise for improving
fall prevention programming. Twenty healthy older adults
(749years) completed a Dichotic Listening task with three
auditory selective conditions: non-forced (NF), right forced
(RF), and left forced (LF). Tasks were performed in a non-
walking single task session (ST) and in both virtual reality
(VR) and non-virtual reality (NVR) dual-task sessions on a
self-paced treadmill. All individuals tested for normal hear-
ing (20 dB) at low frequency (500) in both right and left ears,
including the five that wore hearing aids. Repeated meas-
ures ANOVAs (p<0.05) were used to examine condition
(NF, RF, LF) and environment (ST, VR, NVR) comparisons
with the right and left ear responses and spatial temporal
gait parameters as dependent variables. Results showed
right and left ear dichotic measures in the VR environment
approached significance (p=0.057) in comparison to the ST
and NVR environments. Specifically in the VR condition,
the FL condition approached significance (p=0.056), for
both right and left ear responses compared to the FR condi-
tion. Gait results showed a significant increase for double
support time in the NVR compared to the VR environment
(p<0.05). Right step time in the VR environment also had a
significant main effect (p=0.047)while dual-tasking. These
preliminary results suggest that a VR environment may
positively influence dual-task performance, as both gait
and cognition scores were better. Further investigation of
dual tasking in a VR environment will strengthen methods
and application of fall prevention programming for older
adults.
SESSION 975 (POSTER)
ELDER ABUSE
ELDER ABUSE BY PERSONS WITH SUBSTANCE USE
AND/OR MENTAL HEALTH CONDITIONS: RESULTS
FROM THE NEMS
T.Labrum, P.Solomon, School of Social Policy & Practice,
University of Pennsylvania, Philadelphia, Pennsylvania
Persons who commit elder abuse have long been known
to disproportionately have indicators of substance use and/
or mental health conditions (SUMHC). However, few studies
have examined factors related to elder abuse by persons with
SUMHC vs. persons without such conditions. Such informa-
tion is important for developing more targeted interventions.
Using data from the National Elder Mistreatment Study, the
current analysis examined victim, perpetrator, and interaction
characteristics between cases of elder mistreatment in which
the perpetrator has indicators of SUMHC vs. not having
such indicators. Chi-square and Mann-Whitney-Wilcoxon
non-parametric tests were performed. 210 perpetrators of
emotional mistreatment were reported to have indicators of
SUMHC with 412 perpetrators reported to not have such
indicators. 57 perpetrators of physical mistreatment were
496
reported to have indicators of SUMHC with 38 perpetrators
not having such indicators. Emotional mistreatment commit-
ted by persons with SUMHC was associated with the fol-
lowing characteristics: perpetratorunemployment, history
of involvement with police, and limited friendships; victim
female gender, greater emotional problems, and history of
greater emotional mistreatment; interactionco-residence,
and reporting of mistreatment to authorities. Physical elder
mistreatment by persons with SUMHC was associated with
police involvement of perpetrator and history of greater
physical mistreatment of victim. These findings indicate that
victims of elder mistreatment by persons with SUMHC are
in particular need of support and services as they appear to
have greater histories of mistreatment and experience greater
emotional problems. Perpetrators with indicators of SUMHC
particularly seem to struggle in occupational and social func-
tioning, which should be addressed in interventions.
PSYCHOLOGICAL ELDER ABUSE IN PERSPECTIVE:
MEASURING SEVERITY LEVELS OR POTENTIAL
FAMILY CONFLICTS?
A.J.Santos1,2, B.Nunes2, I.Kislaya2, A.P.Gil3,2, O.Ribeiro1,4,
1. Institute of Biomedical Sciences Abel Salazar, University
of Porto, Porto, Portugal, 2. Epidemiology Department,
National Health Institute Doutor Ricardo Jorge, Lisbon,
Portugal, 3. CESNOVA Centre for Sociological Studies
of the Universidade Nova de Lisboa, Lisbon, Portugal, 4.
CINTESIS, Institute of Biomedical Sciences Abel Salazar,
University of Porto, Porto, Portugal
Psychological Elder Abuse (PEA) assessment is described
with different thresholds. This study aimed to examine how
the prevalence of PEA and the phenomenons characteriza-
tion varied using two different thresholds.
Participants from the cross-sectional population-based
study, Aging and Violence (n=1123), answered three ques-
tions regarding PEA. The less strict measure considered
PEA as a positive response to any of the three evaluated
behaviors. The stricter measure comprised the occurrence,
for more than 10 times, of one or more behaviors. Amulti-
nomial regression compared cases from two measures with
non-victims. Relative risk ratios (RRR) were computed to
show the relative likelihood of being victim in each group
with a given characteristic.
Results show different prevalence rates and identified per-
petrators. The two most prevalent behaviors (ignoring/refus-
ing to speak and verbal aggression) occurred more frequently
(>10 times). Prevalence nearly tripled for threatening
from the less strict measure (110 times) to the stricter (>10
times). Most of the same RRRs were found for both groups
of victims. Cohabiting differentiated PEA cases occurring
>10 times: individuals experiencing more frequent abusive
behaviors (>10 times) are more likely to live as a couple or as
a couple with children.
Rather than a specific threshold between PEA and nor-
mal family conflicts, the results suggest PEA as a continuous
phenomenon with different severity levels. Development of
a valid and reliable measure for PEA that includes different
ranges is needed.
Innovation in Aging, 2017, Vol. 1, No. S1
ELDER ABUSE: MAIN EVOKED EMOTIONS
A.J.Santos1,2, B.Nunes2, A.P.Gil3,2, O.Ribeiro4,1, 1.
Institute of Biomedical Sciences Abel Salazar, University
of Porto, Porto, Portugal, 2. Epidemiology Department,
National Health Institute Doutor Ricardo Jorge, Lisbon,
Portugal, 3. CESNOVA Centre for Sociological Studies
of the Universidade Nova de Lisboa, Lisbon, Portugal, 4.
CINTESIS, Institute of Biomedical Sciences Abel Salazar,
University of Porto, Porto, Portugal
The emotional complexity inherent to older adults emo-
tional responde to Elder Abuse (EA) highlights the impor-
tance of considering individual differences and the varied
emotional response patterns.
The study explores the main emotions and feelings evoked
by older adults experiencing abuse by a relative.
The data was collected by convenience sampling of 495
older adults self-reporting EA in four institutions. Responses
to an open question were classified in four categories: (i)
negative thoughts, such as shame, doubt, remorse, envy, frus-
tration, guilt, loneliness; (ii) negative and forceful emotions
such as hatred, anger or disgust; (iii) negative and not in con-
trol emotions such as anxiety, fear and panic; and (iv) nega-
tive and passive emotions such as disappointment; sadness;
resentment or bitterness.
A very similar proportion of individuals reported both
passive (35.3%) and not in control emotions (34.1%). Less
common were the forceful (17.2%) and negative thoughts
(13.4%) categories.
Individuals from the oldest age group (80+) tended to
select less frequently forceful or thoughts (e.g., anger or sad-
ness) and more frequently not in control emotions (e.g., fear
and worry). Compared to EA perpetrated by spouses or part-
ners, abuse at the hands of children and grandchildren elicits
more frequently not in control and passive emotions and less
frequently forceful emotions.
Overall, the results indicate the preponderance of emo-
tions (e.g., passive and not in control) that reflect a reduce
sense of mastery over the environment and feelings of help-
lessness. Different elicit emotional patterns may be associ-
ated with individual and EA characteristics.
SUPPORT STRATEGY IMPACT ON HARMFUL
BEHAVIOUR OF CAREGIVING RELATIVES AGAINST
RELATIVES WITH DEMENTIA
M.Neise, R.Kaspar, S.Zank, University of Cologne,
Cologne, Germany
According to a stress-related paradigm, caring for a rela-
tive suffering from dementia represents a considerable bur-
den for caregiving relatives and may evoke potential harmful
behaviour (PHB) as well as abuse (elderly abuse). The long-
term trajectories of caregivers PHB have not been well
explored, and there is no consistent evidence with respect
to the influence of intra-individual and external support
strategies on the development of caregivers PHB over time.
This study explores trajectories of PHB in caring for a rela-
tive with dementia and estimates the impact of individual
coping strategies and the use of external support services.
Caregivers PHB was followed over five measurement points
at nine month intervals (n=888 respondents at baseline).
In a first step of analysis, we estimated individual inter-
cept and slope factors for caregivers PHB using censored
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
growth-curve modelling. Second, we explored the effects of
care receivers cognitive status and decline over time, car-
egivers individual coping strategies (i.e. accepting coping,
reaction suppression, planning and concentration) and the
use of external support services (i.e. family support, day care
services, outpatient services) on PHB level and trajectories.
Factors with well-established impact on caregiver PHB, such
as housing situation or mobility status, were used as covari-
ates in all analyses. The results show a significant decline in
the magnitude of PHB over time. Moreover, individual cop-
ing and external support strategies contribute significantly to
the observed variance with respect to the level and trajectory
of PHB in caring for a relative with dementia.
MISTREATMENT AND RESILIENCE AMONG OLDER
CHINESE ADULTS, AND THE MODERATING ROLE
OF SOCIAL SUPPORT
Y.Yang, M.Wen, S.Salari, University of Utah, Salt Lake
City, Utah
Elder mistreatment has been found to be associated with
a range of health and psychological outcomes. Research on
the relationship between elder mistreatment and psychologi-
cal resilience, however, is lacking. The present study explored
the association between mistreatment and psychological
resilience and examined the possible moderating role of
social support on this proposed link, using a sample of 432
community-dwelling older adults aged 6079 years inter-
viewed in 2014 from Linxi County, Inner Mongolia, China.
We examined reports of the presence of any mistreatment
(verbal, financial, or physical). We measured social support
using the 8-item family and friends support subscale of the
Multidimensional Scale of Perceived Social Support (MSPSS),
while resilience was measured by a seven-item scale used
in previous studies. Ordinary least-squares (OLS) regres-
sion analysis confirmed a significant association between
mistreatment and resilience. Mistreatment victims reported
lower resilience than non-victims, net of demographic/socio-
economic characteristics and health status. A significant
moderating effect of elder mistreatment social support
on resilience was also found (p<. 05), indicating that social
support moderated the direct relationship between mistreat-
ment and resilience. Mistreatment victims were less likely to
experience low resilience when they had high social support.
Mistreatment seemed particularly detrimental to resilience
among respondents with low social support. Findings reveal
that intervention programs aiming to improve older adults
psychological wellbeing should consider enhancing social
support, especially for those who were abused.
RESPECT SENIORS: STATISTICAL ANALYSIS OF
THE CALLS RECEIVED FROM JANUARY 2003 TO
DECEMBER 2015
N.G.Berg1,2, D.Langhendries2, D.Giet3, 1. Geriatric, CHR vulnerability was the only significant predictor of financial
de la Citadelle Liege Belgium, Liege, Belgium, 2. Respect
Seniors, Namur, Wallonia, Belgium, 3. University of Liege,
Liege, Belgium
Context:
The fight against elderly abuse is effective on the whole
territory of the Walloon region since 2003 at first on basis
of associations working together and since 2009 on a legal
basis with the RESPECTSENIORS association.
IAGG 2017 World Congress
497
The most media known action is a freefone 0880 30 330
Statistical analysis of the calls received during period from
January 1st, 2013 to December 31st, 2015
I. Total of received calls: 27271
Contacts with not recognizable contents: 2093
Contacts with recognizable contents: 25178
Contacts concerning mistreatment: 17352
II. Mentioned elderly abuse cases treated: 7609
Most of the announced abuses are financial and psycho-
logical violence.
The mentioned victims are women in 71 %, men in
20% and a group of people in 8% of the cases.
74% of the victims live at home.
25% of the callers are the elderly abused persons
themselves.
The mentioned author of abuse or negligence is a family
member in 64% of the situations.
The rate of anonymity is high: 23% of the callers, 42% of
the mentioned authors, 31% of the victims.
The victim lives alone in 25% of the cases.
MEASURING FINANCIAL VULNERABILITY
TO EXPLOITATION AND LACK OF CAPACITY
THROUGH APSYCHOSOCIAL LENS
L.J.Ficker, E.Gross, L.Hall, P.A.Lichtenberg, Institute of
Gerontology, Wayne State University, Detroit, Michigan
Longitudinal research indicates that young-old, bet-
ter educated and depressed elders were more vulnerable
to financial fraud, a major form of financial exploitation.
Lachs & Hans model (2016) describes financial vulner-
ability to exploitation primarily as an age-related phenom-
enon characterized by declines in cognition and money
management skills, among other health, psychological
and social variables. The purpose of this study was to test
the psychosocial factors in this model to determine if they
could identify seniors at risk for financial exploitation
or lack of financial capacity, without objective cognitive
or money management data. These psychosocial factors
included anxiety about finances, depression, social isola-
tion, loneliness, and environmental stressors (e.g., finan-
cial dissatisfaction). Perceived cognitive impairment was
included as a psychological factor that has demonstrated
association to health and mobility problems in previous
research. Data was collected from 200 community-dwell-
ing elders from both urban and suburban settings with a
variety of education levels and financial resources (~ 50%
African American and 50% White non-Hispanic) who
were all in the process of making a major financial deci-
sion. Two logistic regression analyses were used to predict
financial exploitation since age 60 and financial decision
making capacity. Age, education, race, and psychosocial
vulnerability were the independent variables. Psychosocial
exploitation and also predicted financial capacity with age
emerging as an additional significant factor. Psychosocial
vulnerability is an under-recognized construct in preven-
tion of financial exploitation and potential lack of deci-
sional capacity, which has important implications for
financial and health professionals.
498
WHAT DISTINGUISHES DEPRESSED ELDER ABUSE
VICTIMS: ABUSIVE EXPERIENCE OR INDIVIDUAL
CHARACTERISTICS?
A.J.Santos1,2, B.Nunes2, I.Kislaya2, A.P.Gil3,2, O.Ribeiro4,1,
1. Institute of Biomedical Sciences Abel Salazar, University
of Porto, Porto, Portugal, 2. Epidemiology Department,
National Health Institute Doutor Ricardo Jorge, Lisbon,
Portugal, 3. CESNOVA Centre for Sociological Studies
of the Universidade Nova de Lisboa, Lisbon, Portugal, 4.
CINTESIS, Institute of Biomedical Sciences Abel Salazar,
University of Porto, Porto, Portugal
Often studied correlates of Elder Abuse (EA) include
depression or depressive symptom; assumed to be of particu-
lar importance and often conceptualized as both a risk factor
for and a consequence of EA.
The study was designed to (a) estimate proportion of
older adults self-reporting EA that screened positive for
depressive symptoms; and (b) examine whether individual
characteristics and/or abusive experience aspects correlate
with depressive symptoms.
The data was collected by convenience sampling.
Participants were 510 older adults self-reporting experiences
of abuse in family setting enrolled in a cross-sectional vic-
tims survey through four institutions.
Depressive symptoms were assessed through the 5 items
Geriatric Depression Scale. Poisson regression was used to
determine the prevalence ratio (PR) of screening depressive
symptoms according to individual and abusive experience
covariates: sex; age group; cohabitation; perceived social
support; chronic diseases; functional status; violence type;
perpetrator and number of conducts.
More than half (66.3%) reported 3 or more depressive
symptoms and almost half (46.8%) screened positive for 4
or 5 depressive symptoms. Women (PR=1.18, 95%CI=[1.04
1.35]), individuals perceiving low social support level
(PR=1.36, 95%CI=[1.161.60]) and with long-term illness
(PR=1.17, 95%CI=[1.021.33]) are associated with increased
risk for screening depressive symptoms. In regards to abusive
experience only the number of abusive conducts increased
the prevalence ratio (PR=1.07, 95%CI=[1.051.09]).
Results suggest preponderance of individual, rather than
abusive experience characteristics, on the prevalence ratio of
screening depressive symptoms.
INTERGENERATIONAL ELDER ABUSE: WHY IT IS SO
HARD TO ASK FOR HELP
B.Dow1,2, F.Vrantsidis1, M.Joosten1, A.Walmsley3,
J.Blakey3, 1. National Ageing Research Institute, Royal
Melbourne Hospital, Victoria, Australia, 2. University
of Melbourne, Melbourne, Victoria, Australia, 3. Seniors
Rights Victoria, Melbourne, Victoria, Australia
The very nature of elder abuse harmful behaviour by
a trusted family member takes a heavy toll on emotional
wellbeing, making it difficult to take action. In this study we
sought to understand the outcomes of abuse from the older
persons perspective. Twenty-four people who had experi-
enced elder abuse and sought help were interviewed. Twenty-
three had been abused by their adult son (16) or daughter
(7). Most were living with the perpetrator at the time of the
abuse (18). Most experienced psychological/emotional abuse
(21), or financial abuse (19), with the two usually occurring
Innovation in Aging, 2017, Vol. 1, No. S1
together. Physical abuse was reported in 7 cases and social
abuse in three.
Participants felt ambivalent about the situation they were
in they wanted the abuse to stop but did not want to have
to take action to make it happen. They were concerned about
how their child was dealing with what they saw as the rea-
son for the abuse (mental illness, financial difficulties, marital
breakdown), and they were worried about the consequences
to their parentchild relationship if they took decisive action
against their child to stop the abuse.
Their advice to others in the same situation was to rec-
ognise it early and to take action. To service providers their
advice was they needed to know that they were there (adver-
tise your service) and to be given the time and space to make
their own decision about intervention, based on knowing
what their options were. They also wanted help for the
perpetrator.
ABUSE OF OLDER CHINESE BY FAMILY CAREGIVERS
E.Yan1, G.Fang2, 1. The Hong Kong Polytechnic University,
Hong Kong, Hong Kong, 2. The University of Hong Kong,
Hong Kong, Hong Kong
The present study examined rates and factors associated
with elder abuse by family caregiver in a cross-sectional sam-
ple of 1002 older Chinese in the Peoples Republic of China
(PRC). High rates of abuse and neglect were observed with
52.6% of care-recipient reporting neglect, 40.8% financial
exploitation, 16.5% verbal abuse, and 1.2% physical abuse.
Results of logistic regression analyses showed that neuropsy-
chiatric symptoms, cognitive impairment were prominent
factors associated with different forms of mistreatment.
Arewarding pre-morbid relationship with the caregiver and
use of emotional focused coping mitigated abuse.
FEMICIDE IN LATER LIFE: THE ROLE OF POLICY IN
PREVENTION
S.Salari, Family and Consumer Studies, University of Utah,
Salt Lake City, Utah
Severe family violence can result in injuries or death
across the life course. Policy and structural conditions create
cross-national variations, particularly in methods (such as
use of firearm, asphyxiation or beatings) and outcome (i.e.,
survival versus fatalities). Utilizing multiple data sources, this
research provides insight into prevalence and characteristics
of lethal incidents in later life. According to 2012U.S. FBI
Supplemental Homicide Reports, eldercide (persons 60 and
over) represents about 7.3% of the nearly 14,000 annual
U.S.homicides. Gender patterns exist, where men are more
often murdered, but the offenders tend to be acquaintances
or strangers. Womens killers are more likely current or for-
mer spouse/cohabitants, reflecting femicide among family
members. Female vulnerability for those age 60 and over
includes those who know they are endangered, as well as
others who remain unaware. Perpetrators who are suicidal
represent a unique threat to women in long term relation-
ships, particularly those with no known history of violence.
A sample of 225U.S. intimate partner homicide suicide
events illustrates cases where offenders varied in motives
and lethal methods. For comparison purposes, international
variations in elder fatalities are discussed, with special atten-
tion to firearm regulations and victim rights. Typical services
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
for battered women, such as protective orders and shelters,
may not be ideal for older victims. Prevention strategies to
reduce male suicidality and limit firearm availability in cases
of domestic violence or mental illness could help reduce
U.S. femicide. Adaptations are important to adequately
respond to the aging of the population.
HUMAN DIGNITY AND THE RIGHT OF
PERSONHOOD: LEGAL PROTECTION FOR ELDERS
AT HOME IN GERMANY
A.Schwedler1, N.Konopik2, L.Schulz2, F.Oswald2,
M.Wellenhofer1, L.Salgo1, G.Zenz2, 1. Faculty of Law,
University, Frankfurt, Germany, 2. Faculty of Educational
Sciences, Frankfurt, Germany
Most older people wish to stay and be cared for in their
own home. In Germany approx. 1.25 milion people are
cared for without any professional help, usually with great
effort and attention. However, domestic care by relatives is
also known to be a risk of elder abuse. The research pro-
ject Human Dignity and the Right of Personhood of People
depending on Long-Term Care at Home - Legal Protection
for Carers and the Cared-For deals with elder abuse in
German domestic care settings from a legal and social sci-
ences perspective. The aim of the research project is to
develop a regulatory framework providing aid-oriented pre-
vention and intervention in family care of vulnerable elders
by public agencies and courts. First, empirical data on the
situation in family care for older people will be analysed.
Second, the existing legal framework of family care will be
examined with respect to gaps and potentials for the pro-
tection of vulnerable elders. In a third step, recommenda-
tions for legislation and administration will be developed
in exchange with practitioners. Preliminary results with
respect to the first two steps of the analysis disclose a lack
of legal regulations on the issue of elder abuse in family care,
especially in comparison with German legislation on child
protection. Thus, the legal framework should reinforce pre-
vention of care problems by giving more efficient support
to carers and permit legal intervention in case of abuse. The
proposed legislation should take account of the high value of
the individual self-determination right.
FEAR OF PHYSICAL, EMOTIONAL, AND FINANCIAL
EXPLOITATION AMONG OLDER ADULTS
E.Grinshteyn, University of San Francisco, San Francisco,
California
Much, though not all, of the previous research has shown
that older adults have higher levels of fear of victimization
than younger adults. However, it is not well understood
whether older adults are afraid of the types of victimization
they are most at risk of and whether they are afraid of those
who are most likely to perpetrate crimes against older adults.
Pilot data were collected among community dwelling
older adults in Nevada (n=467). Questions regarding finan-
cial, physical, and emotional abuse were asked as well as
from whom they were afraid of each type of abuse. Questions
were also asked regarding demographics, social cohesion,
neighborhood safety, gun ownership, and other risk and pro-
tective factors.
The majority of older adults report feeling not afraid of
financial victimization (56%), physical victimization (54%),
IAGG 2017 World Congress
499
and emotional victimization (54%). However, when asked
which they were most afraid of, 42% reported being most
afraid of financial victimization, 34% reported being most
afraid of emotional victimization and 34% reported being
most afraid of physical victimization. Older adults were most
often afraid of strangers for all three forms of victimization
and rarely afraid of family members. A higher proportion
of older adults were afraid of acquaintances with respect to
financial abuse.
These data provide insight into which types of crimes
older adults are afraid of, from whom they fear abuse, and
protective and risk factors associated with each. It seems that
fear is somewhat well aligned with risk, however it is not
clear that older adults are suspicious of the most common
perpetrators.
MISTREATMENT ACROSS THE LIFE COURSE
AS AMAJOR PREDICTOR OF ELDER ABUSE:
ACANADIAN NATIONAL STUDY
L.McDonald, University of Toronto, Toronto, Ontario,
Canada
Few researchers have claimed that abuse at an earlier
stage in life may be a risk factor for elder abuse later in
life. Indeed, the elder abuse literature frequently highlights
that the social learning model causes abuse in later life,
the argument being that abusers learn how to be violent
from witnessing or suffering from violence. The aim of this
research was to test the hypothesis that if an older person
was abused earlier in their lives, they were more likely to
be abused as older adults. Anational telephone survey was
conducted to estimate the prevalence of five forms of elder
abuse in community dwelling older Canadians who were
55 years and older. A representative, stratified sample of
8,163 Canadians completed the survey, the largest study to
date. Information was collected about socio-demographic
factors, health, wealth, risk factors for abuse, and preva-
lence for the usual five subtypes of abuse. Unlike other
prevalence studies, a life course perspective was the guiding
theoretical framework. The analyses included descriptive
statistics about the sample, bivariate analyses correlating
the risk factors with abuse and a logistic regression model
with the main the predictors of abuse. The results showed,
in order of importance, higher depression scores as meas-
ured on the C-DES, having been abused as an adult (2554),
a child (117) a youth (1824), having higher unmet ADL/
IAD needs, not feeling safe with those closest to respond-
ent, geographical location; being single compared to being
married and lastly, being female were significant (p .001)
predictors.
SESSION 980 (POSTER)
EMOTIONS AND AGING
OVER-RELIANCE ON THE MOUTH AREA IN THE
VISUAL SCANPATHS ARE ALSO OBSERVED WITH
OLDER EMOTIONAL FACE
Y.Dion-Marcoux, C.Blais, D.Fiset, H.Forget, Universit
du Qubec en Outaouais, Gatineau, Quebec, Canada
500
Previous studies have shown that aging is associated with
a reduced accuracy at recognizing some facial expressions
(Calder etal., 2003; West etal., 2012). It has been proposed
that this deficit is linked with altered visual scanpaths: elderly
fixate more the mouth area than younger participants (Wong
et al., 2005). However, these results were obtained using
pictures of young individuals face instead of individuals of
the same age group as the participants. This study therefore
compared the visual scanpaths of older (N=31; Mage=71.8)
and younger adults (N=31; Mage=22.6) during the recogni-
tion of facial emotions displayed by young and older faces
(five identities each). The task consisted in categorizing the
six basic emotions, while eye movement were recorded.
Accuracy scores were calculated for each expression and
stimulus age. A repeated-measures ANOVA conducted on
participants accuracy scores revealed an interaction between
participants age, stimulus age and emotion [F(5,300)=7.13,
p<.001]. Paired t-tests indicated that young adults were more
accurate than older adults with fear, no matter the stimu-
lus age[t(61)=8.57, p<.001, t(61)=-3.32, p<.01 with young and
old faces respectively]. They were also more accurate with
sadness[t(61)=6.89, p<.001], but only when they were dis-
played by young faces, as well as with disgust[t(61)=-4.49,
p<.001], and neutral[t(61)=-3.10, p<.01] when they were dis-
played by older faces. Moreover, the ratio of fixations dura-
tion on the eye vs. the mouth was significantly higher for
younger than older adults[t(57)=2.22, p=.03]. These results
confirm that the visual scanpath of adults is altered, even
when older face stimuli are used.
HOW AND WHEN DO OLDER ADULTS EXPERIENCE
BETTER EMOTIONAL WELL-BEING?
S.Raposo, T.Sims, J.Barnes, L.L.Carstensen, Stanford
University, Stanford, California
According to socioemotional selectivity theory (SST;
Carstensen & Lang, 1996; Lang & Carstensen, 2002), per-
ceiving time as limited motivates people to selectively struc-
ture their daily lives in ways that enhance emotional meaning
and experience. To our knowledge, however, no studies have
tested whether future time perspective is associated with
emotional well-being as a function of selectivity. We pre-
dicted that positive emotional experience results when time
is perceived as limited and environments provide opportu-
nities to be selective. In Study 1, a life-span sample of 177
adults (aged 1893) reported their future time perspective
(Carstensen & Lang, 1996). We operationalized selectivity as
participants perceived level of autonomy and environmental
mastery (using subscales of Ryffs Psychological Well-Being
Scale; Ryff, 1989). Participants also reported emotional expe-
rience on 35 occasions randomly sampled over one week.
Positive emotional experience was calculated by subtracting
mean negative affect from mean positive affect, disaggre-
gated by arousal level (e.g., low arousal positivehigh arousal
negative). We found that limited future time perspectives
predicted greater low-arousal positive emotional experience,
but only for people who reported a high level of perceived
selectivity. These findings demonstrate that perceiving time
as limited enhances emotional experience under conditions
that permit selectivity. Results from a related study of emo-
tional experience and inescapable daily stressors in family
caregivers will also be presented. The findings lend support
Innovation in Aging, 2017, Vol. 1, No. S1
to SSTs claim that enhanced emotional experience in people
who perceive a limited future is due to selectivity, and help
to clarify the understanding of age-related improvements in
emotional functioning.
IS DAILY PHYSICAL ACTIVITY PLEASANT FOR
OLDER ADULTS? BETWEEN- AND WITHIN-PERSON
ASSOCIATIONS
T.Nakagawa1, M.Kabayama2, K.Matsuda2, S.Yasumoto2,
Y.Gondo2, K.Kamide2, K.Ikebe2, 1. University Research
Priority Program Dynamics of Healthy Aging, University
of Zurich, Zurich, Switzerland, 2. Osaka University, Suita,
Japan
Interventional and experimental studies suggest that
physical activity improves well-being across ones lifespan.
However, if and how daily physical activity influences well-
being in advanced old age in natural settings is yet to be elu-
cidated. An intensive longitudinal study was conducted with
older adults (aged 82 85years; N=38) over seven days.
Daily positive affect and physical activity were measured
using daily diaries and accelerometers, respectively. Positive
affect was reported at the end of each day, and physical activ-
ity was assessed by the average walk counts per hour every
day. Between-person physical activity was positively asso-
ciated with daily affect, thus indicating that a more active
person exhibited higher positive affect. However, physical
activity and positive affect was negatively associated within-
person; On days when a typical older individual was more
physically active, he/she experienced lower positive affect.
Gender, mental health, and Body Mass Index did not mod-
erate this within-person association. These findings indicate
that, although usual physical activity could increase positive
affect, i.e., feelings of energy, daily physical activity might
decrease it in older adults. Practitioners and clinicians should
recognize the short- and long-term effects of physical activity
on the well-being of very old individuals. Future studies are
required to further explore the underlying mechanism and
understand how age-related changes limit a within-person
revitalization process.
AGE AND THE RELATIONSHIP BETWEEN STRESS,
AFFECTIVE REGULATION, AND LIFE SATISFACTION
P.Goodwin, R.C.Intrieri, Western Illinois University,
Macomb, Illinois
Attachment theory posits a relationship between affect
regulation and well-being (Mikulincer, Shaver, & Pereg,
2003). Mikulincer etal. (2003) proposes the attachment sys-
tem becomes activated via exposure to a stressor. Activation
of the system leads the individual to engage in proximity-
seeking behavior(s) as a way of managing distress. In the
event that proximity-seeking fails, the individual relies upon
secondary attachment strategies in order to regulate distress
associated with perceived stress (i.e., hyperactivating versus
deactivating regulation of emotion). The current study exam-
ines whether age influences the relationship between stress,
affective regulation and life satisfaction. 155 younger adults
and 130 community-dwelling older adults participated in a
study examining affective experience and daily life. The sam-
ple of 155 young adults includes 71 women and 84 men with
an average age of 20.29 (SD=1.92). The sample of 131 older
adults includes 80 women and 51 men with an average age
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of 67.568 (SD=8.873). All participants completed a modi-
fied version of the Day Reconstruction Method (DRM). In
addition, participants completed several measures of psycho-
social functioning, including the Perceived Stress Scale and
the Satisfaction with Life Scale. Comparing younger and
older adults, the current analysis examines the construction
of a path model linking perceived daily stress and general life
satisfaction, with attachment-related styles of affect regula-
tion (i.e., anxiety or avoidance) serving as mediators. Results
indicate a well-fitting model (CFI=.952, SRMR=.041), sug- adults (N=31; Mage=22.6). The Bubbles method (Gosselin
gesting the relationship between daily stress, affect regula-
tion, and well-being is similar for younger and older adults.
A DAILY DIARY ANALYSIS OF THE RELATIONSHIP
BETWEEN STRESS, EMOTIONAL SUPPORT, AND
POSITIVE AFFECT
H.Chai, J.Hyun, Human Development and Family
Studies, The Pennsylvania State University, University Park,
Pennsylvania
Stress and emotional support are two of the main ele-
ments that influence everyday well-being. Although previous
studies show that stress functions as a risk against positive
affect and receiving support enhances positive affect, how
these relationships differ by gender in daily basis remain
largely unknown. Therefore, using the respondents aged
45 and higher in the second wave of the National Study of
Daily Experiences (NSDE) from the Midlife in the United
States (MIDUS) survey, this study looked at the relation-
ship between stress, emotional support, and positive affect
(N=1,618) and how gender moderates these relationships.
The results showed that on days when individuals expe-
rienced stress, both men and women showed lower posi-
tive affect compared to stress-free days. However, women
showed more decrease in positive affect than men. As for
receiving emotional support, whereas women showed lower
positive affect on days when they received social support,
men did not. Additional analysis showed that women seek
more support on days they showed lower positive affect.
These results show that women are psychologically more
vulnerable to both stress and receiving support compared to
men, presumably due to womens higher emotional reactivity
to daily dynamics. Also, considering that women are usually
the providers rather than receivers of support, women may
not have received enough support they needed. Not receiving
adequate support could have hindered women from obtain-
ing benefit from getting support. In conclusion, this study
shows that daily stress and emotional support can have dif-
ferent implications on emotional well-being for men and
women.
AGE-RELATED IMPACT OF ABILITY AT IDENTIFYING
FACIAL EXPRESSION ON UTILIZATION OF VISUAL
INFORMATION
Y.Dion-Marcoux, C.Blais, H.Forget, D.Fiset, Universit Ghent, Belgium
du Qubec en Outaouais, Gatineau, Quebec, Canada
Previous studies have shown that aging is associated with
difficulties at recognizing some facial expressions (Calder and
al., 2003; West and al., 2012). Circelli etal., (2013) showed
that this alteration in performance is linked to changes in
the older adults visual scanpaths. We recently showed that
IAGG 2017 World Congress
501
despite displaying different visual scanpaths, older and
younger participants use the same facial features on aver-
age to accurately categorize the basic facial expressions
(Dion-Marcoux et al., 2016). However, we also observed
some heterogeneity in the ability of our participant to cat-
egorize expressions, and these differences in the ability may
be linked to the visual strategies used. This study compared
the impact of ability at categorizing expression on the use of
visual information of older (N=31; Mage=71.8) and younger
& Schyns, 2001) was used to measure information utiliza-
tion during a facial expression categorization task of basic
emotions displayed by young and elderly faces (five identities
each). A separate facial expression categorization task was
used to measure ability. Classification images representing
the visual information that was correlated with the ability
at identifying facial expressions were separately obtained for
each facial expression, facial age, and participants age group.
The results showed that participants ability modulate the
visual information utilized by older, but not younger, adults.
Future analyses will allow verifying if the older participants
with the highest performance alteration reveal visual strate-
gies that differ from those of young participants, and if these
differences can predict their alteration.
THE INFLUENCE OF AGE ON EXPERIENCING SELF-
CONSCIOUS EMOTIONS IN DAILY LIFE
H.Wang, H.H.Fung, Chinese University of Hong Kong,
Hong Kong, Hong Kong
By using data from 1996 General Social Survey (GSS), we
explored the relationships between age and peoples experi-
ence of self-conscious emotions. 1447 participants (aged 18
to 89years) reported the number of days in which they had
experienced shame, embarrassment, and pride in last 7days.
Correlation analysis showed that participants self-reported
happiness positively correlated with the frequencies of pride
experiences (r=.118, p < .001), while negatively correlated
with the frequencies of both shame (r=-.081, p < .01) and
embarrassment experiences (r=-.075, p < .01). Hierarchical
regression results showed that older adults tended to experi-
ence less embarrassment ( = -0.062, p = .026) and pride
( = -0.058, p = .033) in daily life. In addition, males had
higher frequencies of pride experiences (=0.084, p=.002)
than females. The results implies that older adults may be
skillful at avoiding not just negative emotions and also posi-
tive emotions such as pride that may hinder their interper-
sonal relationships.
THE ROLE OF PERSONALITY IN EMOTIONAL
REACTIVITY: ACOMPARISON BETWEEN OLDER
AND YOUNGER ADULTS
P.Steenhaut1,2, I.Demeyer2, R.De Raedt2, G.Rossi1, 1. Vrije
Universiteit Brussel, Brussels, Belgium, 2. Ghent University,
Despite the losses older adults (OA) experience, they
demonstrate more emotional wellbeing than younger adults
(YA). According to the socio-emotional selectivity theory,
OA are better in regulating emotions. They also seem to react
physiologically less strongly to emotional stimuli than YA.
Moreover, in YA a link between personality and emotional
502
reactivity has been found. This study investigates whether
emotional reactivity and its link with personality differs
between YA and OA. To do this 120 YA (2550years) and
OA (65+) were recruited. Personality was measured with the
MMPI-2-RF-PSY-5-r and BFI scales. Physiological measures
(HRV, SCL, fEMG (corrugator, zygomaticus)) were assessed
while participants viewed a happy and sad film. Subjective
reactivity (VAS) was registered after each film. We found that
OA had stronger subjective reactivity for happy and sad films
than YA, but that the only difference in physiological reac-
tivity was that YA showed more arousal (SCL) during the
happy film. OAs stronger subjective reactivity to sad films
was related to higher scores on neuroticism and negative
emotionality. In YA, negative emotionality went along with
more frowning (corrugator) during sad films. Moreover, in
YA, neuroticism was related to less arousal when seeing the
happy (trend significant) and sad films, and higher HRV dur-
ing the happy film. To conclude, differences in physiologi-
cal reactivity to emotional stimuli between OA and YA are
limited, which implies that techniques like biofeedback dont
need to be adapted to ageing. Relationships between person-
ality and reactivity were, with the exception of neuroticism
in YA, in the expected directions.
GIVING AND RECEIVING SOCIAL SUPPORT
IN LATER LIFE ELICITS UNIQUE BLENDS OF
EMOTIONS
D.Wang, University of Southern California, Los Angeles,
California
While the benefits of social integration and support on
well-being in later life are well-documented, research has
largely focused on the perspective of the support-recipient.
Growing evidence suggests parallel benefits for support-
giving, but the psychological pathways remain unclear. We
investigated whether a brief experimental manipulation of
reflection regarding ones support-giving or support-receiving
behavior elicited distinct cognitive-affective states. 203 sub-
jects age 55 and over completed a 30-minute online experi-
ment in which they were randomly assigned to write about
their roles as support-givers, support-receivers, or the previ-
ous days activities. After the writing manipulation, subjects
completed assessments of feelings of social connectedness,
positive and negative affect, and self-achievement. Written
narratives generated in response to the writing manipulation
were also analyzed with the Linguistic Inquiry and Word
Count software to assess expression of each cognitive-affec-
tive state. Those in the support-giving group had lower levels
of self-reported negative affect, and higher levels of perceived
social contributions (p<.05) and accomplishment (p<.05),
compared to the support-receiving group. Text analyses
show that those in the giving group had greater expressions
of achievement and lower expression of negative emotion
than those in the receiving group, while those in both the
giving and receiving conditions had greater expressions of
positive emotion, social connectedness and achievement than
the neutral condition. Findings indicate that support-giving
and receiving are associated with common, as well as unique,
cognitive-affective states, suggesting shared and unique path-
ways through which each may be linked to well-being.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 985 (POSTER)
END-OF-LIFE AND PALLIATIVE CARE
COMPREHENSIVE ASSESSMENT UPON HOSPICE
ADMISSION: WHAT DRIVES NON-COMPLIANCE?
N.Zheng, N.Sherif, Q.Li, I.Broyles, N.Chong, J.Frank,
F.Rokoske, RTI International, Waltham, Massachusetts
The Centers for Medicare & Medicaid Services Hospice
Quality Reporting Program recently proposed a hospice
comprehensive assessment composite quality measure
(QM). This QM assesses whether patients received all
seven critical care processes at admission, as measured by
the seven currently implemented QMs. These QMs address
important physical symptoms and patient preferences
regarding life sustaining treatments and support for spir-
itual/existential concerns. To construct the composite QM,
we used the Hospice Item Setstandardized patient-level
hospice quality datafrom 1,215,247 patients in 3,922
hospices discharged from 10/2014 to 09/2015. The perfor-
mance scores varied across hospices. On average, hospices
performed a comprehensive assessment for approximately
70% of patients, but 5% of low-quality hospices per-
formed a comprehensive assessment for 30% or fewer of
their patients. We constructed the composite QM itera-
tively, omitting one care process each time, and compared
scores. We found that comprehensive pain assessment,
which addresses multiple characteristics of pain symptoms,
was the least frequently completed process. Our findings
revealed that the comprehensive pain assessment is most
often the missing portion of the overall comprehensive
assessment. Strategies focusing on this care process will
yield overall quality improvement. Additional results from
factor analysis, Cronbachs alpha and item-response theory
analyses will be available and inform whether the seven
care processes can be statistically reliably combined into
one composite QM and the level of difficulty of completing
each care process in order for the hospice to complete the
comprehensive assessment.
The abstract is sponsored by the Social Research, Practice,
and Policy Section of The Gerontological Society of America.
A REVIEW OF CLAIMS BASED QUALITY INDICATORS
USED TO MONITOR THE MEDICARE HOSPICE
BENEFIT
M.Plotzke1, T.Christian1, P.Gozalo2, J.Teno3, 1. US
Health, Abt Associates, St. Louis, Missouri, 2. Brown
University, Providence, Rhode Island, 3. University of
Washington, Seattle, Washington
Through the Medicare Hospice Benefit (MHB), hospices
submit claims containing information that allows policy
makers to identify outcomes with large variation across hos-
pices. Identifying outliers that have poor outcomes can help
policy makers improve the MHB and increase the quality of
care being provided. Our research identifies hospices that are
outliers in the provision of hospice services along five differ-
ent quality indicators (QIs): Provision of General Inpatient
care days, Provision of skilled visits at the end of life, Average
lifetime length of stay, Live discharge rates, and Nursing
minutes provided per day. QIs are calculated using 100%
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of Medicare hospice claims from January 1, 2010 through
September 30, 2014. For each indicator, hospices are grouped
into deciles. We count how many times a hospice appears
in the highest three deciles for each indicator to determine
which hospices are outliers. Out of 3,946 hospices, there are
15 hospices which are in the highest three deciles for all five
indicators. 235 hospices are in the highest three deciles for
four or five indicators. The majority of hospices in the high-
est three deciles for four or five indicators are located in the
south census region (72.3%). 8.8% of for profit hospices
have four or more QIs in the three highest deciles compared
to only 1.8% of other hospices. The average spending per
beneficiary for hospices with four or more QIs in the highest
three deciles is $27,365 compared to $15,441 for hospices
with 3 or fewer indicators in the highest three deciles.
OLDER ADULTS WITH ADVANCED HIV/AIDS AND
THEIR INFORMAL CAREGIVERS COMMUNICATION
ON END-OF-LIFE CARE
V.H.Raveis1, M.Carrero1, D.Karus1, P.A.Selwyn2, 1. supports they faced while attempting to navigate Ontarios
New York University, New York, New York, 2. Montefiore
Medical Center, Bronx, New York
Little is known about the priorities and end-of-life care
preferences of older adults living with advanced HIV/ADS,
although palliative and end-of-life issues are essential aspects
of their care. Even less attention has been focused on their
informal support network, who provide emotional support,
practical assistance and function as surrogate decision-mak-
ers. Data is drawn from a mixed methods investigation on
care preferences and life goals at the end-of-life. Older (50+),
minority (59%-Black, 28%-Hispanic), low-income adults
living with advanced HIV/AIDS and their informal caregiver
(n= 29 dyads) completed a survey and comprehensive inter-
view in English or Spanish. Both patients and caregivers
reported a high communication quality -- 83% (patients)
72% (caregivers) definitely agreed that: Caregiver knows expanded model for applying palliative care principles, and
kinds of treatment patient would want if patient got too sick
for speak for him/herself. The narratives substantiate that
while there is concordance on a number of important care
considerations, fundamental differences in choice of end-of-
life care co-exists within some dyads. When present, these
differences intensify caregivers distress associated with their
execution of surrogate decision-making. The accounts also
document that shared misperceptions of consensus on the
care choice can occur within a dyad. Further the reports
revealed the fluid and situational nature of patients priori-
ties for care; resulting in some instances in the caregivers
being unaware of the change. Appreciation of the complexity
of these issues, and recognition of the necessity to include
social context considerations, will enhance timely communi-
cation between the health care team, patient and caregiver to
facilitate person-centered care.
ENVISIONING AND DEVELOPING ASYSTEM TO
MEET LAST STAGES OF LIFE CARE NEEDS OF
PATIENTS AND FAMILIES
M.Chiu1,2,3, V.Wesson1,2,3, S.Meerai3,5, L.Nelles3,4, (CMS, 2014). As hospice enrollment continues to increase,
A.Grek1,2,4, J.Sadavoy1,2,3, 1. Department of Psychiatry,
Mount Sinai Hospital, Sinai Health System, Toronto,
Ontario, Canada, 2. Department of Psychiatry, University
of Toronto, Toronto, Ontario, Canada, 3. Cyril & Dorothy,
IAGG 2017 World Congress
503
Joel & Jill Reitman Centre for Alzheimers Support
and Training, Mount Sinai Hospital, Toronto, Ontario,
Canada, 4. Outpatient Geriatric Psychiatry Clinic, Mount
Sinai Hospital, Toronto, Ontario, Canada, 5. Lunenfeld-
Tanenbaum Research Institute, Sinai Health System,
Toronto, Ontario, Canada
A multiple-perspective qualitative study applying the
Appreciative Inquiry (AI) framework was carried out with
the goal of (re-)building the system of care for individuals in
their last stages of life in Ontario, Canada. The Discover
and Dream phases within the AI framework aimed at
understanding what factors enable patients and their fam-
ily caregivers to positively perceive and appropriately access
available services and supports in the current system of
care. 26 clinically frail elderly patients and/or their family
caregivers were interviewed, and their lived experience and
encounter with the system were documented and coded
using grounded theory principles. Rich narratives revealed
the needs of patients and caregivers, and the barriers and
system for care. They identified the following processes as
potential platforms for positive changes: diagnosis, progno-
sis, assessment, access, resources, advocacy, and communi-
cation. Patients/Caregivers narratives were presented to 11
expert stakeholders from different professional groupings
medical, social, legal and ethics, administration and policy
who were then interviewed as part of the Design and
Destiny phases within the AI framework. Expert stake-
holders considered patients/family caregivers lived experi-
ence in the broader context, and made recommendations
on how to motivate and implement a path and vision for
system change. Stakeholders commented on the need for
professional training in communicating sensitive issues with
patient/family, public education and awareness regarding
hospice and palliative care, enhanced advocacy supports, an
the need for different professional sectors to work collabora-
tively towards these goals.
LIVE DISCHARGE FROM HOSPICE: SOCIAL WORK
PERSPECTIVES
S.Wladkowski1, C.Wallace2, 1. School of Social Work,
Eastern Michigan University, Ypsilanti, Michigan, 2. Saint
Louis University, Saint Louis, Missouri
Hospice and palliative care is holistic support for indi-
viduals living with terminal illness throughout the illness and
bereavement for the caregivers. However, some individuals
who enroll onto hospice services do not decline as quickly as
determined by current regulations leading to what is referred
to as a live discharge. This interruption can impact the phys-
ical and psychosocial care needs for individuals and caregiv-
ers and leave hospice clinicians with questions with how to
best support them.
Between 2010 and 2012, which is the most recently col-
lected data on live discharge, 10.6% of hospice patients
across the US were discharged alive from hospice care
it is expected the numbers of individuals discharged alive
will also grow (Campbell, 2015) and the need for special-
ized support for both patients and caregivers will be critical.
Social workers as hospice clinicians are positioned to offer
504
substantial support to individuals and their caregivers who
experience a live discharge.
This qualitative study (N=24) explored the current prac-
tices of hospice social workers across the US engaged in the
live discharge process. Results from this study emphasize
the need to bridge the gaps between policy and practice.
Specifically, the challenges of hospice social workers to rep-
licate or supplement the holistic support and unique services
hospice provides for individuals discharged alive, and sug-
gests further research to develop an assessment framework to
identify appropriate support for patients and their caregivers
who no longer meet hospice eligibility requirements.
INDELIBLE MEMORIES: THE IMPACT OF END-OF-
LIFE DECISIONS ON BEREAVED CAREGIVERS
D.P.Waldrop, J.McGinley, University at Buffalo, Buffalo,
New York
Advance care planning (ACP) is a process which involves
the consideration of end-of-life wishes, communication
about them with family and providers and their written doc-
umentation. ACP can both clarify and facilitate a persons
end-of-life wishes. Yet, caregiving for a dying person remains
one of lifes most distressing experiences. Beyond treatment
decision-making, ACP has the potential to relieve distress,
assist older people with life closure and ease the transition
to bereavement. The purpose of this study was to investigate
how ACP and provider communication influenced end-of-life
care and caregivers adaptation in bereavement. This mixed-
methods longitudinal study involved in-depth interviews
with 67 caregivers at 4 and 10 months after a loved one
died in hospice care. Quantitative data was collected using
the Core Bereavement Items (CBI) and categorical questions
about health and coping. Qualitative data was collected from
open-ended questions about the caregivers perceptions of
the illness trajectory, experiences with end-of-life care and
bereavement. CBI scores decreased over time (T1M=18.23;
T2M=15.76); Self-reported health improved (T1M=2.57;
T2M=2.63); Overall coping improved (T1M=2.05;
T2M=2.30). However, 18% (T1) and 6% (T2) reported cop-
ing Not too well or Not well at all. Qualitative data structured in-person interviews. We assessed how the HHAs
analysis yielded a theme of Indelible Memories with sto-
ries repeated at T1 and T2 about the intense recall of: (a)
Unresolved misunderstandings, (b) Unexpected transitions;
and (c) Undesired locations at death. These findings suggest
the importance of ACP that is enhanced to encompass car-
egivers needs and the opportunity to begin preparing for the
dying process, loss and resulting grief.
IMPROVING END-OF-LIFE CARE FOR MINORITIES
IN SOUTH FLORIDA: KNOWLEDGE, CHOICES, AND
POLICIES
A.M.Perez2, K.Ray2, A.Turner3, N.Cook2, K.Cerminara4, adjustment reported that it was a negative experience. Not
G.Suciu2, D.Cohn Steinkohl2, 2. College of Osteopathic
Medicine, Master of Public Health program, Nova
Southeastern University, Ft. Lauderdale, Florida, 3. College
of Health Care Sciences, Nova Southeastern University,
Ft. Lauderdale, Florida, 4. Shepard Broad College of Law,
Nova Southeastern University, Ft. Lauderdale, Florida
Ethnic and racial minority groups suffer dispropor-
tionately from higher rates of cancer and other chronic ill-
nesses. However, research shows that minority groups utilize
Innovation in Aging, 2017, Vol. 1, No. S1
hospice/palliative care services less than other groups. Many
different factors seem to account for this disparity, among
those, insufficient knowledge about hospice/palliative care
services available and the exclusion of concurrent curative
care once the person starts receiving hospice services. The
Affordable Care Act, section 3102, has provided the oppor-
tunity to launch a three-year demonstration project for
adults suffering with life-threatening illnesses were Medicare
beneficiaries could receive hospice care while still receiving
curative treatment for the life- threatening illness with the
goal of improving access and quality of end of life care.
We conducted a study desgined to ascertain the exist-
ing knowledge and choices of racial and ethnic minorities
in South Florida regarding end-of-life care and to evaluate
potential changes in interest and acceptance of Hospice care
if curative treatment were offered concurrently with tradi-
tional hospice services. Results indicated that 30 percent
of participants had little or no knowledge of what hospice
or palliative care were, however, 71 percent favored end-
of-life care that would concurrently provide curative treat-
ment, comfort and supportive care. The results of this study
could be used to inform policy makers and practitioners on
alternatives and solutions to improve knowledge, access and
quality of end of life care for ethnic and racial minorities in
South Florida.
THE EXPERIENCES OF HOME HEALTH AIDES
AFTER CLIENT DEATH: GETTING NOTIFIED AND
REASSIGNED
A.Barooah1, K.Boerner1, H.Gleason1, I.van Riesenbeck2,
O.Burack3, 1. Gerontology, University of Massachusetts
Boston, Somerville, Massachusetts, 2. APP Cologne-
Academy for Applied Psychology and Psychotherapy,
Cologne, Germany, 3. The New Jewish Home, New York
City, New York
This study explored the experiences of Home Health
Aides (HHAs) following the death of a client. 80 HHAs who
had lost a client in their care within the last two months
participated. Data collection involved comprehensive semi-
were notified about the death of a client and how the process
of reassignment to a new client was handled. Overall, being
notified about client death prior to arrival at work resulted
in more positive responses compared to notification upon
arrival at work. Specifically, being called in advance by a
clients family led to more positive and neutral experiences
while being called by staff elicited more neutral or negative
experiences. Reassignment to a new client was viewed as an
adjustment for some HHAs, whereas others were eager to be
reassigned as quickly as possible. More than three fourths of
the HHAs who saw reassignment to a new client as a time of
having a speedy reassignment for those eager to be quickly
reassigned and swift reassignments when they did not want
to both led to a negative experience. HHAs who were tem-
porarily reassigned had a negative experience and needed
more hours. Findings have important implications for han-
dling transitions around client death, suggesting benefits of a
more mindful approach to notification after client death and
thoughtfulness around reassignment.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
GUIDANCE FROM UK EXPERTS ON HOW TO
ENABLE BETTER END-OF-LIFE CARE AND
FACILITATE HOME DEATHS
A.Ahmed1,2, D.Kerwat1,3, S.Wahid1,2, S.Jamshaid1,2, ios, eight articulated preferences that were fully aligned with
M.Sayma1,4, D.Saleh1,2, F.Oyewole1,2, 1. Imperial College
Business School, London, United Kingdom, 2. Imperial
College School of Medicine, London, United Kingdom, 3.
Barts and the London School of Medicine, London, United
Kingdom, 4. Peninsula College of Medicine and Dentistry,
Exeter, United Kingdom
Despite a growing desire amongst patients to spend their
last days at home, many are unable to do so, leaving a lasting
effect on both patients and families. We undertook a qualitative
study with in- depth, semi-structured interviews in England,
UK. A combination of face-to face and telephone interviews
were conducted with 33 experts in the field of end-of-life care.
These included policy makers, academics and hospital and
community healthcare professionals from leading UK organi-
sations. Interviews were transcribed and thematically analysed.
As a result, three overarching themes were identified: educa-
tion; planning and managing people. These were further Business School, London, United Kingdom, 2. Imperial
divided into a total of 12 sub themes containing practical guid-
ance on enabling better end-of-life care. The theme of plan-
ning contained seven subthemes including policy, cost and London, United Kingdom, 4. Peninsula College of Medicine
coordination. The education theme included communica- and Dentistry, Exeter, United Kingdom
tion and perceptions of death. Of particular significance was
the identification of the growing stigma and fear surrounding
end-of-life amongst patients and healthcare professionals alike.
Managing people as a theme included the impact of patient
preferences and family influences on enabling comfortable
death at home. In conclusion, multiple barriers and facilitators
to achieving death at home were identified in this study. The
lack of training, education and funding within the National
Health Service was highlighted, as was the importance of
sociopolitical factors. These include the lack of social networks
amongst elderly patients and the inequality of resource provi-
sion in hospitals and communities. We offer a list of recom-
mendations to combat these barriers, paying specific attention
to UK end-of-life policy and education.
PATIENT PREFERENCES FOR LIFE-SUSTAINING
TREATMENT AND CONCORDANCE WITH THE
POLST FORM
M.Henry, NCQA, Washington, District of Columbia
The Physician Order for Life Sustaining Treatment
(POLST) Paradigm is a promising system for document-
ing treatment preferences of patients with advanced illness.
Studies show that orders documented on POLST forms are
largely concordant with care provided, but to align patient
goals, preferences, and values with care provided, POLST
forms must reflect patient goals, preferences and values.
Using the Willingness to Accept Life-Sustaining Treatment
(WALT) Instrument to elicit treatment goals, this study
evaluated sensitivity of participants preferences to treat-
ment intensity and outcomes (cognitive impairment, physical
disability, and probability of death), and alignment between
WALT responses and POLST forms. A convenience sample
of 42 residents with POLST forms was recruited from three
nursing homes and two assisted living facilities. Participants
responses to the WALT and orders abstracted from par-
ticipants POLST forms were compared to evaluate align-
ment. Preferences remained stable across different treatment
IAGG 2017 World Congress
505
intensity scenarios for 48% of participants and across differ-
ent outcome scenarios for 33% of participants. Among 14
participants whose preferences were stable across all scenar-
their POLST. Three of 16 participants whose POLST ordered
full treatment wanted comfort measures only. One of nine
participants whose POLST form ordered comfort measures
only wanted full treatment. Research is needed to develop
decision-making strategies to assure that treatment-sensitive
or outcome-dependent patient preferences are accurately
reflected in POLST forms. Additionally, more research is nec-
essary to understand the potential for misalignment between
POLST forms and patient goals, preferences, and values to
assure alignment with care provided.
POLICY CHALLENGES FACED BY THE CURRENT
UK HEALTHCARE SYSTEM IN ACHIEVING PATIENT
DEATH AT HOME
A.Ahmed1,2, S.Jamshaid1,2, D.Kerwat1,3, F.Oyewole1,2,
D.Saleh1,2, M.Sayma1,4, S.Wahid1,2, 1. Imperial College
College School of Medicine, London, United Kingdom, 3.
Barts and the London School of Medicine and Dentistry,
Evidence suggests that the majority of patients wish to die
at home. However, this is attainable for few.
A systematic literature review (SLR) was conducted with
a mixed methods approach by analyzing qualitative and
quantitative studies. In the SLR 3241 papers were retrieved.
72 primary data articles remained after the screening and fil-
tering processes. Qualitative articles were synthesised using a
meta-ethnography technique in order to develop key themes.
Quantitative articles were analysed using a descriptive
approach to highlight further themes. The emerging themes
from the meta-ethnography synthesis and the analysis of the
quantitative papers were amalgamated to produce a set of
overarching barriers and facilitators.
6 barriers and 4 facilitators to achieving death at home
were identified primarily from the meta-ethnography pro-
cess. Further concepts of demographics and interven-
tions were produced from the quantitative data analysis
that had both barrier and facilitator components. The over-
arching topics included logistical issues in getting both the
patient and equipment home, lack of continuity of care
and geographic variation in resource provision, including
24/7 care, all that pertained to policy influence. In conclu-
sion, this review shows that addressing these identified fac-
tors by reviewing and amending surrounding policy, could
allow more patients to achieve death at home. However, it
is important to acknowledge the qualitative nature of these
results as such, further research is required to identify the
relative impact that changing specific policies would have on
patients ability to achieve home death.
RESPONDING TO THE END-OF-LIFE OPTION ACT IN
CALIFORNIA
L.Forbes, L.Petrillo, E.Dzeng, K.L.Harrison, B.Scribner,
B.Koenig, Institute for Health & Aging, University of
California, San Francisco, San Francisco, California
The legalization of physician-assisted death in California,
via the End of Life Option Act, expands the possible
506
pathways open to older adults facing the end of life. The law
raises many questions, ranging from the practical to the phil-
osophical. In order to prepare healthcare providers to care
for adults who might request physician-assisted death, we
invited 112 key stakeholders from across California to share
their expertise in the areas of ethics, medicine, advocacy,
and the law in a statewide conference. Six healthcare profes-
sionals and researchers from Oregon and Washington pre-
sented their experience with their states laws, and California
healthcare leaders led discussions on a range of topics. The
goal of the conference was to identify issues providers and
healthcare systems may consider in responding to the law, in
order to expand and improve end-of-life care generally. We
report major themes identified by participants: (1) All health-
care systems should develop policies that reflect the values of
the organization; (2) Institutions must anticipate and address
the implications for vulnerable patients, such as older adults,
in order to mitigate harm; (3) Institutions should create
policies that account for conscientious objection and moral
distress among providers; and (4) Palliative care should be
an essential part of the response. The process of developing
a response to the End of Life Option Act provides health-
care systems the opportunity to reflect on the laws ethical
and social implications and thereby implement system-wide
changes that can benefit all patients facing the end of life.
VOLUNTEER-PARTNERED END-OF-LIFE CARE:
ACOMMUNITY INITIATIVE
V.Lou1, K.Chan1, A.Chan1, A.Leung2, K.Lam2, according to the content of the free written comments.
F.Wong2, B.Cheng3, C.Chan1, 1. Social Work & Social
Administration, The University of Hong Kong, Hong
Kong, Hong Kong, 2. S.K. H.Holy Carpenter Church,
Hong Kong, Hong Kong, 3. Tuen Mun Hospital, Hospital
Authority, Hong Kong, Hong Kong
Providing choices on places to be cared during the end
stage of life is considered as significant in achieving qual-
ity of death. In response to this pressing need, The Hong
Kong Jockey Club Charities Trust initiated a Project in whi-
cha Volunteer-Partnered End-of-Life Care (VPEoLC) Model
was developed to support community-dwelling elders with
advance illnesses in Hong Kong. This paper will present
a pilot test on the VPEoLC model. The VPEoLC model is
developed under a collaborative effort of a social service
agency and the palliative care unit of a hospital. It aims to
optimize quality of life of dying patients through the seamless
collaboration of volunteers, social care team, and hospital.
It contains four core elements: 1)regular case review based
on feedbacks from a service team with members from hospi-
tal palliative team, community social care team, volunteers,
and family members; 2)C-I-E volunteer training (Classroom
teaching-Internship-experiential training); 3)timely debrief-
ing after each volunteer service; and 24-hours professional
support. Apilot test was conducted on 14 elders. Apre-post-
follow up design was adopted and participants were assessed
on their symptoms, information needs, practical concerns,
anxiety or low mood, family anxieties and feeling of being
at peace with the Integrated Palliative care Outcome Scale.
Data were collected from the clinical records. The pilot test
results support the effectiveness of the VPEoLC model in
Innovation in Aging, 2017, Vol. 1, No. S1
symptom control and emotional support. Learning from the
pilot test will also be discussed.
DEVELOPMENT OF COLLABORATION INDEX
BETWEEN NURSES AND CARE WORKERS IN END-
OF-LIFE CARE
T.Nagahata1, K.Eguchi1, K.Yamaji1, C.Matsuda3,
M.Sasatani2, K.Yamauchi1, 1. Osaka Prefecture University,
Osaka, Japan, 2. Aino University, Osaka, Japan, 3. Setsunan
University, Osaka, Japan
Purpose: It is predicted that there will be an increasing
need for in-house end of life care services at Japans intensive
care homes for the elderly. Therefore, collaboration between
nurses and care workers will become essential in order to
ensure the quality of nursing care. The purpose of this study
is to develop a tool for both nurses and care workers to be
used in order to conduct a self-evaluation on how they col-
laborate with each other.
Method: We conducted a qualitative and inductive analysis
of semi-structured interview survey with both nurses and care
workers. We then made a list of items as a suggestion for form-
ing a collaboration index for each job. We examined the validity
of the content of the suggested items by conducting an anony-
mous self-written questionnaire among nurses and care workers
of intensive care homes for the elderly throughout the country.
We considered items with a content validity index (CVI) above
0.8 to be valid, and those below 0.8 to be invalid. Those con-
sidered invalid were either deleted or the expression was revised
Result: From the result of the analysis of the interview
survey, for nurses collaboration index, we drew out 74 items
under 3 concepts. For care workers collaboration index,
we drew out 59 items under 3 concepts. Of the 74 items
of nurses collaboration index, 57 items scored above 0.8
on CVI, and 17 items scored below 0.8 (CVI 0.45 to 0.79),
among which 8 items were deleted and 9 items were revised
according to the content of the free written comments, finally
leaving 66 items on the table. Among the 59 items of care
workers collaboration index, 38 items scored above 0.8
on CVI, and 21 items scored below 0.8 (CVI 0.61 to 0.79),
among which 8 items were deleted and 13 items were revised
according to the content of the free written comments, finally
leaving 51 items on the table.
Conclusion: Based on the interview survey conducted
among expert staff of intensive care homes for the elderly,
we were able to form collaboration index that systematically
organizes the content of collaboration between nurses and
care workers.
A RELATIONAL MODEL OF AGING, ILLNESS, AND
PALLIATIVE CARE AND ITS APPLICATIONS
M.M.Perkins1,2, M.M.Ball1, C.L.Kemp3, 1. Department of
Medicine, Emory University School of Medicine, Atlanta,
Georgia, 2. Birmingham/Atlanta Geriatric Research,
Education, and Clinical Center (GRECC), Atlanta, Georgia,
3. Gerontology Institute, Georgia State University, Atlanta,
Georgia
Relational perspectives continue to gain prominence in
ethics in health and long-term care and in aging research.
Akey focus of this theoretical approach is the social nature
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Innovation in Aging, 2017, Vol. 1, No. S1
of personhood, including the ways individuals negotiate their
individual and collective identities within interconnecting
social, cultural, economic, political, and historic contexts.
This approach promotes a critical analysis of and response
to conditions at the micro-, meso-, and macro levels that
threaten social justice and contribute to limitations imposed
by age, disability, and illness. In this paper, we present a mul-
tilevel relational model of aging, illness, and palliative care
that is derived from a synthesis of our previous empirical and
theoretical research conducted over more than two decades
in diverse residential care settings for older adults merged
with salient concepts from the literature. Important con-
cepts in the model include four intersecting and overlapping
forms of capital (material, human, social, psychological)
that shape older adults ability to cope with illness, decline,
and other age-related challenges. We posit that these human
conditions have both objective (objective conditions of indi-
viduals lives) and subjective (ways individuals define their
situation and ability to cope) properties. We illustrate how
the model is used as a guiding conceptual framework to
inform research on end-of-life in assisted living (AL) as well
as illness experiences outside AL (i.e., different clinic popu-
lations experiences aging with HIV/AIDS). Our examples
highlight how the model can inform the study of illness and
end-of-life experiences across care settings and is applicable
to both qualitative and quantitative research.
WERE MAKING THIS UP AS WE GO ALONG: EARLY
PERFORMANCE OF THE MEDICARE CARE CHOICES
MODEL
L.F.Ralston, Department of Health Promotion and
Behavior, University of Georgia, Athens, Georgia
Patients with terminal illnesses often do not take advan-
tage of hospice services. Those who do tend to enter hospice
care very near the end of life. The Centers for Medicare and
Medicaid Services (CMS) has identified the requirement that
hospice patients give up curative care as a major barrier
preventing early use of hospice. The Medicare Care Choices
Model (MCCM) is designed to address this problem by allow-
ing patients with terminal diagnoses to receive hospice care
without giving up curative care. Testing of the model began
in January 2016 at 70 sites across the US. Almost immedi-
ately, conflicts between the models eligibility requirements
and its aims became apparent. Further problems emerged in
the realms of data collection, ordering of medical supplies,
and the mismatch between workload and reimbursement.
This presentation is based on experiences in the first four
months of the MCCM at one of the test sites, Compassionate
Care Hospice of Athens, GA, with input from a discussion
group created for other participating sites.
FAMILY COMMUNICATION CONCERNING END-OF-
LIFE CARE WISHES: AMIXED-METHODS STUDY
L.J.Peterson1, D.J.Dobbs1, K.Hyer1, H.Meng1,
A.Gamaldo2, K.ONeil3, H.Buck4, 1. School of Aging
Studies, University of South Florida, Tampa, Florida,
2. Pennsylvania State University, University Park,
Pennsylvania, 3. Ascension Health, St. Louis, Missouri, 4.
College of Nursing, University of South Florida, Tampa,
Florida
IAGG 2017 World Congress
507
EOL communication involving individuals, families,
and health care providers is recognized as critical to reduc-
ing unwanted, aggressive end-of-life (EOL) treatment and
providing high-quality EOL care. Research, however, has
focused largely on doctor-patient communication. This study
addressed the topic of individual-to-family communica-
tion. It used a mixed-methods design, with questionnaires
(N=364) providing the quantitative data and focus groups
(7 groups of 57 people each) drawn from the quantitative
sample providing explanatory qualitative data. The quanti-
tative analysis showed that 31% of the sample had not dis-
cussed their (EOL) treatment wishes with family members. In
addition, 75% of the sample was female, 25% was Black and
23% was Hispanic. Alogistic regression model was used to
identify factors associated with whether a family conversa-
tion had occurred. We found that controlling for demograph-
ics and health, being Hispanic was associated with 67%
lower odds of having the conversation (CI 0.130.82, p=.02).
A lower level of family involvement with everyday health
care decision-making was associated with 59% lower odds
of having the EOL-care conversation (CI 0.270.60, p<.001).
Also a low knowledge of palliative care was associated with
59% lower odds of having the conversation (CI 0.210.75,
p=.004). The qualitative analysis identified several thematic
obstacles to holding the conversation, including resistance
and separation of family members, beliefs that the conversa-
tion is unnecessary, and fears of discussing death, in addition
to a lack of awareness of tools to promote EOL-care con-
versations. Further analysis of these results could lead to the
development of interventions to promote family EOL-care
conversations.
CERTIFIED NURSING ASSISTANTS RESPONSE
TO RESIDENT DEATH: POSITIVE AND NEGATIVE
EFFECTS OF SUPPORT
H.Gleason, K.Boerner, A.Barooah, University of
Massachusetts Boston, Boston, Massachusetts
Direct care workers provide the bulk of hands-on care
to elders. Though this workforce is integral to the provi-
sion of quality long-term care, their role is often overlooked.
Certified Nursing Assistants (CNAs), aides who provide care
in skilled nursing facilities, work closely with residents, often
for years, resulting in strong bonds. Yet, limited research has
examined how this may impact their response to a residents
death. This study conducted comprehensive semi-structured
in-person interviews to explore the experiences of 140 CNAs
who had lost a resident in their care within the previous two
months. Quantitative and qualitative data were examined to
determine to what extent CNAs felt there was support avail-
able to them, whether they sought out support, the type of
support received and desired, and how the support impacted
employment outcomes. Results indicated that only one third
of CNAs felt there was supervisory support available to them,
though over 60% felt they had the support of their cowork-
ers. Only 16% sought support from their supervisor before
the death and even fewer, 9%, sought it after. Yet, over half
sought support from coworkers. These findings indicate that
CNAs are not likely to seek out support from their supervi-
sor but do experience coworker coworker in the context of
resident death. Though perceived as helpful by the CNAs,
support from coworkers was found to be positively linked
508
to burnout and grief suggesting that support from cowork-
ers may not necessarily be protective against the negative
impacts of resident death, but instead may increase distress.
OUTCOMES OF ADVANCE DIRECTIVES AND
DURABLE POWER OF ATTORNEY AT END-OF-LIFE
D.Hoe, S.Enguidanos, Gerontology, University of Southern
California, Los Angeles, California
Studies show that individuals at end-of-life (EOL) are
more likely to have advance directives (AD) or a durable
power of attorney (DPA). However, most of these studies
do not investigate the outcomes of decision-making at EOL.
This paper examines the association between individuals
with ADs and DPAs and the care received by those individu-
als, and it compares the appointed decision maker to the
actual decision maker at EOL. The study will use a nation-
ally representative sample from the Health and Retirement
Study (HRS) Core and Exit interviews conducted between
2008 and 2014, and it will compare its findings to those of
Silveira, Kim & Langa (2010).
Analysis was conducted on data compiled from 5,000
participants age 60 and older and from proxies following
participant death. 45.8% of decedents required decision-
making, of whom 69.3% lacked decision-making capacity.
About half (51.0%) of these decedents had advance direc-
tives and 68.3% had a DPA. However, there was only 15.1%
agreement between the appointed decision maker and the
actual decision maker. Logistic regression revealed that par-
ticipant preferences for prolonged care (OR=12.64) and
limited care (OR=2.63) were consistent with the care they
received. Participants who elected comfort care were more
likely to receive limited care.
These findings are consistent with those of Silveira, Kim
& Langa (2010), who examined the HRS interviews con-
ducted between 2000 and 2006, and thus further supports
AD. More research is needed to understand the incongruence
between appointed and actual decision makers at EOL.
ADVANCE CARE PLANNING IN GERIATRIC
PRACTICE: AMONTEFIORE MEDICAL CENTER
QUALITY IMPROVEMENT STUDY
D.F.Greenberg1, H.Blumen1,2, M.Ceide1, R.Marx3, 1.
Montefiore Medical Center, Bronx, New York, 2. Albert
Einstein College of Medicine, Bronx, New York, 3.
University of Pennsylvania, Philadelphia, Pennsylvania
In 2016, The Division of Geriatrics of Montefiore
Medical Center received a grant through the New York
Foundation for Elder Care to train primary care providers
(PCP) in advance care planning (ACP) skills including: the
explanation of prognosis and treatment options, clarifica-
tion of the older adults wishes, and the utilization of the
new Medicare reimbursement code for advance care plan-
ning. A teaching module directed to the PCP was designed
as a multidisciplinary consultation service using actual clini-
cal cases presented by providers. Training in advanced care
planning by the Geriatrics faculty was offered at the PCP
sites. After initial implementation of this module, a quality
improvement project conducted in the Division of Geriatrics
during June 2016 through a chart review (n=101) examined
the documentation of advance care planning discussions by
Innovation in Aging, 2017, Vol. 1, No. S1
the geriatrics faculty at its Geriatric Ambulatory Practice.
Demographic data included age (M age=82), gender
(75%=women), ethnicity (42%=Latino), preferred language
(77%=English) and cognitive impairment (42%). The rate of
documented advance care plans (32%) was analyzed. Results
reinforced the need for training of geriatricians in ACP as
well. Limitations include recent transition to a new electronic
medical record, which complicated documentation; whereas
49% of patients reviewed had ACP on file in the previous
EMR, only 32% had such documentation in the new EMR.
The teaching module was modified based on the studys find-
ings to both improve the skills of attending physicians, fel-
lows, and residents and to improve ACP conversations and
documentation rates.
EFFECTS OF AN ADVANCE CARE PLANNING
EDUCATIONAL PROGRAM FOR CARE STAFF IN AN
ACUTE HOSPITAL
M.Hamayoshi1, S.Goto1, C.Matsuoka1, K.Miwa3,
A.Kono2, M.Ikenaga3, 1. Bukkyo University, Kyoto, Japan,
2. Osaka City University, Osaka, Japan, 3. Yodogawa
Christian Hospital, Osaka, Japan
Purpose: Advance Care Planning (ACP) is a crucial end-
of-Life Care practice. However, an ACP educational pro-
gram for care staff in an acute care setting has not yet been
established.
The present study aimed to examine the effects of an ACP
educational program in this clinical context.
Method: The design was a single-arm study to evaluate
staff attitudes pre-and post-program. A 90-minute inter-
vention program was attended three times, along with
self-directed study. The study outcomes included attitudes
towards Advance Directrives (AD), the Death Attitude
Inventory (DAI), and the Frommelt Attitude Toward Care of
Dying scale (FATCOD-Form B-J).
Result: A total of 57 care staff participated in the
entire program (average age was 44.6 years old (SD 7.8);
11 men). The most common occupationai description was
nurse (n=37). The scores on the attitudes towards AD scale
increased from 9.96 (SD 1.0) to 10.3 (SD 0.9), which reached
statistical significance (P=0.03). The score for death relief in
the DAI increased from 13.9 (SD 0.9) to 15.3 (SD 5.9), also
P=0.03. The score for positive attitude for end of life care in
the FATCOD-Form B-J scale increased from 9.0 (SD 1.6) to
9.8 (SD 2.0), with P=0.01.
Conclusion: These results suggest that the present ACP
educational program was effective at improving staff atti-
tudes relating to three key domains: attitudes towards AD,
death, and the care of terminally ill patients.
REDUCING EMERGENCY ROOM VISITS AND
HOSPITAL DEATHS AT END-OF-LIFE FOR LONG-
TERM CARE RESIDENTS
S.Kaasalainen1, T.Sussman2, P.Durepos1, J.Ploeg1,
L.Venturato3, L.McCleary4, P.V.Hunter5, 1. McMaster
University, Hamilton, Ontario, Canada, 2. McGill
University, Montreal, Quebec, Canada, 3. University of
Calgary, Calgary, Alberta, Canada, 4. Brock University,
St Catharines, Ontario, Canada, 5. University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
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Innovation in Aging, 2017, Vol. 1, No. S1
Burdensome interventions and hospital use can negatively
affect the quality of end-of-life (EOL) for long-term-care
(LTC) residents and their families. The goal of this study
was to examine Emergency Department (ED) use at EOL
and hospital deaths for LTC residents, and explore with LTC
staff ways to minimize hospital use.
This study used a mixed methods approach. Chart audits
were conducted in four LTC homes in southern Ontario to
capture trends in hospital use over a one-year period for the
following indicators: (1) resident deaths at hospital versus
LTC home; (2) ED visit in the last year, month, and week of
life; (3) average number of ED visits/resident; (4) planned
versus unplanned ED visits; (5) ED visits that became hos-
pital admissions. These chart audit findings were presented
to staff to raise awareness and stimulate reflections on local
factors affecting hospital use at EOL. All deliberations were
transcribed and thematically analyzed.
Chart audits revealed that 59% of residents across sites
visited ED during the last month of life and 26% of resident
deaths occurred in hospital. Staff expressed surprise at the
amount of hospital use during EOL. Reflections suggested
that clinical expertise, comfort with EOL communication,
clinical resources and family availability for EOL decision-
making could all impact non-desirable hospital use at EOL.
Staff appeared motivated to address these areas of practice
following this reflective process.
Localized chart data combined with group reflective
opportunities can serve to raise awareness and engage staff
in collective solutions to address hospital use at EOL.
SESSION 990 (POSTER)
END-OF-LIFE TREATMENTS AND SETTINGS
TRADITIONS, CHALLENGES, AND ADAPTATIONS:
THE HMONG COMMUNITYS END-OF-LIFE
EXPERIENCE IN THE U.S.
Y.Her, T.Schroepfer, University of Wisconsin, Madison,
Wisconsin
It has been over forty years since the first Hmong refu-
gees arrived in the United States, and as the generations
have sought to adjust to a new way of life, many elders have
continued to honor their traditional healthcare beliefs and
rituals concerning care at end of life. With much known
about beliefs and rituals after death occurs, little is known
about those practiced in the dying process. Studies have
found evidence that lacking such information has resulted
in misunderstandings and barriers between the Hmong and
their health care professionals, who struggle to provide the
Hmong with culturally competent care. This study sought to
address this gap by conducting in-depth face-to-face inter-
views with 20 Hmong elders born in Southeast Asia, who
are now living in the United States. The rich qualitative data
provided by these elders was analyzed using conventional
content analysis to identify and categorize the main themes.
The results provide information regarding traditional beliefs
and rituals surrounding end of life care, the challenges faced
by the Hmong when seeking to practice these traditions, and
adaptations made by some Hmong elders to integrate both
IAGG 2017 World Congress
509
western and traditional medicines. In addition, insights were
gained regarding the heterogeneity among Hmong elders due
to those who have converted to Christianity and those who
have chosen to remain steadfastly committed to their tra-
ditional practices. Implications for healthcare professionals
and facilities seeking to provide culturally sensitive care to
Hmong elders at end of life will be discussed.
DEVELOPING EXPERTISE IN END-OF-LIFE CARE
THROUGH COLLABORATIVE REFLECTION:
AQUALITATIVE INQUIRY
Y.Harasawa1, R.Hirayama2, C.Shimada2, M.Ito2, 1.
School of Nursing Graduate School of Nursing, Nagoya
City University, Nagoya, Japan, 2. Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan
In Japan, with a steady increase in older adults who
spend their final days in non-medical facilities such as nurs-
ing homes, staff members of such facilities are increasingly
required to become prepared for end-of-life caregiving to
older residents. Because of greater individual differences in
terminal processes, however, there is no universal approach
to older residents in an end-of-life phase; thus, it is neces-
sary for staff members to accumulate practical knowledge to
handle individualized cases through reflecting on and learn-
ing from their end-of-life care experiences. To provide staff
members with the opportunity for such learning, we have
developed Collaborative Reflection Program, where partici-
pants discuss their care experiences while giving feedback to
each other. Guided by Korthagens (1985) reflection model,
namely ALACT, we sought to identify whether and how such
learning process might occur among Program participants.
To do so, we used audio-recorded data from multiple groups
in which care workers and nurses from different nursing
homes participated and, in line with the Program format,
conversed on their end-of-life care experiences. Through
systematic content analysis on transcripts of audio-recorded
data, we found participants narratives that represented two
components of ALACT model: awareness of essential aspects
of experiences and creating alternative methods of actions.
Our findings indicated that the Program helped participants
to reflect on and gain a new insight into their care experi-
ences, suggesting the potential of the Program as a method
for staff members of nursing homes to develop expertise in
end-of-life care.
FACTORS AFFECTING KOREAN OLDER ADULTS
WILLINGNESS TO RECEIVE LIFE-SUSTAINING
TREATMENTS
H.Noh, Y.Guo, G.Kim, The University of Alabama,
Tuscaloosa, Alabama
Being one of the fastest aging countries, Korea is faced
with various end-of-life (EOL) issues. However, little is
known about what affects older adults views toward EOL
options, such as use of life-sustaining treatments (LSTs). To
address the gap, this study aimed to examine the relationship
between attitude toward LSTs and background character-
istics among older adults in South Korea. Using a national
survey data of 10,267 older adults, binomial logistic regres-
sion analysis was conducted to examine the likelihood of
willingness to receive LSTs with background characteristics.
510
The correlations (.02 r .04) and tolerance statistics ( .40)
were checked during preliminary analysis. Though very few
participants (4%) agreed to receive LSTs, some significant
relationships were found: those who were female (OR=.24,
p=.03) and older (OR=.02, p=.00) and had higher geriatric
depression score (OR=.05, p =.02) and more close friends
and neighbors to talk openly with (OR= .08, p=.00) were
more likely to agree to receive LSTs. However, those having
any religion (OR= -.19, p = .03) were less likely to do so.
This result suggests that religion in Korean culture may play
a role in older adults preference for LSTs and may provide a
buffering effect against the pursuit of aggressive treatments.
Our society should recognize the potential burden of LSTs
among Korean older adults and should consider factors, such
as gender, age, mental health, and social relationship, in EOL
discussion about LSTs and alternative EOL care options.
INCREASING HOSPICE UTILIZATION IN THE
PENSACOLA AREA: POTENTIAL MEDICARE SAVINGS
D.W.Durkin1,3, A.Bolden3, 1. Social Work, University
of West Florida, Pensacola, Florida, 3. Center on Aging,
Pensacola, Florida, 3. School of Social Work, University of
Pittsburgh, Pittsburgh, Pennsylvania
Research shows that older adults receive higher quality
care under Hospice care compared to hospitalization or nurs-
ing home care and this care is also considerably less expen-
sive. For example, the costs for hospital care, nursing home
care, and Hospice care per day are $6,200, $620, and $153
respectively. Despite the benefits in quality and cost, Hospice
utilization rates at the end of life continue to be problematic.
In addition, of those who use Hospice, 35% are enrolled for
less than a week despite eligibility of up to 6months.
Using 2010 Medicare data obtained from The Dartmouth
Atlas of Health Care we found that the Hospice utilization
rate for the Pensacola area during the last 6months of life
was 57% and that these patients were enrolled for an aver-
age of 27 days. The average Medicare expenditure in the
6months prior to death was $32,330.
Based on this information, we formulated the following
research question: How much cost savings would there be
if the Pensacola area increased the Hospice utilization rate
by 5% and 10% respectively? If the utilization rate was
increased by 5%, Medicare expenditures would decrease by
$1,616 per person. If the utilization rate was increased by
10%, Medicare expenditures would decrease by $3,233 per
person.
These findings suggest that even modest increases in the
Hospice utilization rate would lead to significant cost savings
for the Medicare program. In addition, these patients would
receive higher quality care and most would be cared for in
their home.
REASONS FOR JOINING ARIGHT-TO-DIE
SOCIETY: DIFFERENCES DEPENDING BY ON THE
CHARACTERISTICS OF MEMBERS
S.Cavalli1, S.Beltrami1, M.Pott2, L.Stauffer2, 1. Centre of
Competence on Aging, University of Applied Sciences and
Arts of Southern Switzerland (SUPSI), Manno, Switzerland,
2. HESAV - University of Applied Sciences and Arts of
Western Switzerland (HES-SO), Lausanne, Switzerland
Innovation in Aging, 2017, Vol. 1, No. S1
Right-to-die societies are becoming increasingly popu-
lar in Switzerland as in other countries. Members are more
likely to be female, older, and better educated than the gen-
eral population. However research has paid limited attention
to personal reasons and motivations for joining.
This communication reports a survey of the membership
of a Swiss right-to-society EXIT A.D.M.D. Suisse romande.
Aself-administered questionnaire was sent by mail to a ran-
dom sample of members aged of 65years old and more. The
answers of approximately 1,200 participants (about 30%
response rate) provide insight into reasons that had led to a
decision to join.
Motives for membership included the concerns related
to their own end-of-life (anticipation), the commitment to
right-to-die philosophy (ideology), and the past involvement
with serious illness or deaths of loved ones (experience).
Reasons for joining vary according to the characteristics of
the members. For instance, women mention more personal
experiences than men (because they are more likely to live
critical events and play more often the role of caregiver); peo-
ple with a high level of education, and the non-religious, have
more resort to ideological motivations.
The combined analysis of the current age of the members
and the length of membership in the society allows identify-
ing different profiles. The early joiners, regardless of their
current age, say more often to have adhered for ideological
reasons. Among the most recent members, the older (75+)
reported mainly concerns related to the end-of-life, while the
youngest (6574) cited more personal experiences.
WHEN ISAID IWANTED TO DIE AT HOME,
IDIDNT MEAN ANURSING HOME: END-OF-LIFE
CARE TRAJECTORIES
M.J.Penning, D.S.Cloutier Fisher, Sociology, University of
Victoria, Victoria, British Columbia, Canada
Given concerns around population aging and future
health care costs, issues around end-of-life care have attracted
increasing attention in recent years. Although the focus tends
to be on reducing hospital deaths and increasing those that
take place in peoples own homes, many older adults end
their lives in nursing home care. Yet, little is known regard-
ing the pathways that lead older adults to end their lives in
these settings, nor the factors that influence them. This study
draws on a structural life course perspective and administra-
tive data to examine the long-term care (LTC) trajectories
experienced by older adults who end their lives in nursing
home care (NH) and compare them to those of LTC recipi-
ents who end their lives in home and community-based care
(HCC) or hospital care (HC) settings. The overall sequenc-
ing of care transitions is considered along with the role of
social structural factors, social and economic resources, and
health factors in influencing them. Data were obtained from
client assessments on individuals aged 65+ who received
publicly-subsidized LTC services in one Canadian health
region and who died between April 1, 2008 and December
31, 2012 (n=13,466). Only 10.2% of clients died at home in
the community. Most died in NH settings (56.5%) or in hos-
pital following a transfer from NH (12.0%) care. Just over
one-fifth (20.9%) died in hospital following a transfer from
HCC. Multinomial logistic regression analyses reveal the
importance of social structural factors, social and economic
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
resources, and health factors in shaping these trajectories.
These findings support the utility of a structural life course
perspective and suggest avenues for enhancing equitable and
desirable end-of-life care.
ASSESSING PALLIATIVE CARE DELIVERY IN
ANEURO ICU: PREDICTING END-OF-LIFE
EXPERTISE
E.Mroz, S.B.Bluck, J.Baron-Lee, University of Florida, SD=1.97) and the intervention page (M=12.29, SD=1.61);
Gainesville, Florida
This study assesses palliative care implementation in the
Neuro ICU of a large medical center. The expectation of
death at admission is high, making comprehensive palliative
care vital. The aim was to examine how providers views of
palliative care are related to their end-of-life (EOL) exper-
tise. Forty-one providers responded to 25 questions (Likert-
type scales) concerning their views of palliative care delivery.
EOL expertise (e.g., ethical issues, clear definition of pallia-
tive care, avoiding futile care) was also assessed. Exploratory
factor analysis of views of care delivery (Varimax rotation,
44.26% variance explained) resulted in three factors reflec-
tive of increasing levels of palliative care provision: initiat-
ing the process, providing basic comfort-care, and delivering
holistic care. Linear regression analyses used these three fac-
tors to predict EOL expertise. Endorsing Delivery of Holistic
Care predicts the use of ethics consults to aid complex care
decisions (B = .96, p = .001) and avoidance of administer- between heath care and social care settings. The Hong Kong
ing futile care (B = .68, p = .05). Endorsing Provision of Jockey Club Charities Trust initiated an EoLC project in
Basic Comfort Care predicts greater previous palliative care
involvement (B=1.23, p=.008). Endorsing Initiation of the stand the needs of the community.
Process predicts having a more comprehensive definition of
palliative care (B=2.34, p=.005) and of Advance Directives join telephone survey, and 1600 (62%) completed the study.
(B=1.23, p=.013). Results suggest that different ways of The findings have four key points. Firstly, public knowledge
viewing palliative care exist even within a single unit and
that these views are related to providers expertise in dealing
with ethical issues, end of life planning, and delivery of care.
PILOTING WEB-BASED INTERVENTIONS TO
IMPROVE KNOWLEDGE OF PALLIATIVE CARE
E.Kozlov1,2, B.D.Carpenter2, 1. Geriatrics and Palliative
Care, Weill Cornell Medical College, NY, New York, 2.
Washington University in St. Louis, St. Louis, Missouri
Introduction: Palliative care is a team-based, specialty
service that improves the quality of life for individuals with
serious illness and their families. However, current research
suggests that this life-improving service is drastically underu-
tilized. Patient knowledge of a healthcare service is theorized
to drive utilization. If people do not know what palliative
care is, they cannot be expected to seek out or accept a refer-
ral for the service.
Objectives: The purpose of this study was to pilot an
intervention to improve knowledge of palliative care for the
general population.
Methods: Using a 2 (content) X 2 (format) between-
subjects design, an age-stratified, web-based sample of 229
adults were recruited and randomized into four conditions:
intervention video, intervention information page, control
video and control information page. Palliative care knowl-
edge was assessed using the Palliative Care Knowledge Scale
(PaCKS), a 13-item true/false scale with strong psychometric
properties. Data analysis utilized an ANCOVA with contrast
IAGG 2017 World Congress
511
coding for two factors: intervention vs. control (intervention
n=77, control n=75) and information page intervention vs.
video intervention (reading n=43, video n=34).
Results: There was a significant difference between inter-
vention group means at post-test (M = 12.15, SD = 1.77)
and control group means (M = 11.18, SD = 2.34); F(1,
139) = 11.10, p = .00, hp2 = .074. There was no signifi-
cant difference between the video intervention (M=12.00,
F(1, 67)=.011, p=.92.
Conclusions: This randomized control trial demonstrates
that both educational videos and text-based interventions
increase knowledge about palliative care services in the gen-
eral population.
INTEGRATIVE AND HOLISTIC END-OF-LIFE CARE:
INSIGHTS FROM ACOMMUNITY-WIDE SURVEY IN
CHINESE SOCIETY
C.Fong, A.Chow, C.Chan, Department of Social Work,
The University of Hong Kong, Hong Kong, Hong Kong
Every year, there are over 40000 deaths in Hong Kong,
affecting over 240000 individuals in the illness process
and bereavement. Current end-of-life care (EoLC), which
is mainly provided by health care settings, will fall short in
meeting the growing demand. The World Health Assembly
urged for international actions in strengthening interfaces
response to the emerging needs, with this survey to under-
A randomly drawn sample of household was invited to
of EoLC concept is limited. Only around 30% of partici-
pants ever heard of palliative care and EoLC. Advance direc-
tives were known to 13.4%. Secondly, EoLC is considered
as a multi-dimensional care. Psychosocial care (30.4%) and
spiritual care (14.7%) were the first and second common-
est content perceived by the participants. Thirdly, the loca-
tion of EoLC provision is not restricted to hospitals (86.4%)
but also social service centers (72.9%), residential homes
(72.1%) and home (54.6%). Lastly, the primary wish in the
last six months of life is found to be family-related. Nearly
one in five responded that having good memories with family
and friends was their first wish.
The findings suggest expansion of current care in time,
content, location and unit of care. Public education, bio-psy-
cho-social-spiritual model, hospital-community partnership
and family-centered care are all the possible future directions.
PHYSICIANS PERSPECTIVE: END-OF-LIFE CARE
TREATMENT FOR OLDER ADULTS IN ALLAHABAD,
INDIA
R.Gupta1, V.Pillai2, 1. San Francisco State University, San
Francisco, California, 2. University of Texas at Arlington,
Arlington, Texas
With globalization and shifts in cultural norms it becomes
increasingly important to examine physicians role at end-
of-life care of elderly (Marjolein, etal, 2012). The purpose
of this qualitative study was to examine the practices and
attitudes of physicians in Allahabad regarding Eol care. Eol
512
decision-making in India involves the mechanisms by which
family members and physicians make decisions about care
of elderly. Eol decision-making is challenging as it requires
understanding of technical information regarding the use
of life-sustaining treatments. Earlier research shows that in
Asian countries it is against the cultural norms to disclose life
threatening illness to the elderly, and this can cause conflict
between the norms prevailing in the medical profession on
the one hand and physicians and families actual practices
(Schaffer, 2007). Research is the US shows that a large number
of physicians were not adequately trained in Eol care. There
is dearth of research on Eol care in India. Thirty four in depth
interviews on physicians were conducted. Transcribed data
was translated from Hindi to English. Two researchers read
the transcripts and found four major themes. 1) Eol deci-
sions for elderly are made by family, along with physicians;
2) Prolonged unnecessary health care treatment for elderly
was found among higher income groups, while neglect was
common among lower class; 3)Few physicians in Allahabad
were trained in geriatric care; 4)Risk of elder abuse at EoL
is common, as elders wishes are not discussed. Hospice and
social workers need to be available for elderly in hospitals
and at home.
EXPLORING SURROGATES EXPERIENCES OF POLST
DISCUSSIONS FOR INDIVIDUALS WITH ADVANCED
DEMENTIA
H.Kim1, C.K.Bradway1, S.Hickman2, M.T.Ersek1, 1. compares to spending after hospice election. At present, no
University of Pennsylvania, Philadelphia, Pennsylvania, 2.
Indiana University-Purdue University, Indianapolis, Indiana
The Physician Orders for Life Sustaining treatment
(POLST) is a program to communicate and document
patient treatment preferences as medical orders. It is often
used for older adults with life-limiting illnesses including
dementia. For individuals with advanced dementia, POLST
is commonly discussed between surrogate decision makers
(SDMs) and providers. However, information about SDMs
experiences of POLST discussions is lacking. Semi-structured
interviews were conducted with family SDMs of older adults
with advanced dementia following POLST discussions with
providers. Interviews were analyzed using directed con-
tent analysis, and informed by three key concepts from the
Communication and Surrogate Decision Making framework.
Facilitators to effective communication and decision mak-
ing included: SDMs familiarity with end-of-life situations;
providers caring attitude and knowledge about the person
and SDMs; SDMs understanding of dementia as a terminal
illness and knowledge about the persons wishes. Challenges
included: unfamiliarity with medical terms and uncertainty
about the best decisions for the person. Findings suggest that
SDMs process information related to end-of-life care choices
based on their previous experiences with healthcare situa-
tions and appreciate healthcare providers attention to their
and their loved ones needs. SDMs understanding of demen-
tia influences the quality of medical decisions, and as a result,
may impact quality of life for older adults with advanced
dementia and their SDMs. Findings also highlight the impor-
tance of high quality communication between providers and
SDMs. Future studies should address improved education
for SDMs and clinicians to promote effective communica-
tion and improve end-of-life care planning.
Innovation in Aging, 2017, Vol. 1, No. S1
COMPARING MEDICARE UTILIZATION PRE- AND
POST-HOSPICE ADMISSION ACROSS PRIMARY
HOSPICE DIAGNOSES
T.Christian1, J.M.Teno3, P.Gozalo2, M.Plotzke1, 1. Abt
Associates, Cambridge, Massachusetts, 2. Brown University,
Providence, Rhode Island, 3. University of Washington,
Seattle, Washington
We compare daily estimates of total Medicare utilization
immediately prior to hospice admission with per diem pay-
ments during hospice election across common hospice prin-
ciple diagnoses. We used Medicare Part A, B, and D claims to
estimate average daily total Medicare utilization in the 180,
90, and 30days prior to hospice admission. In the 180days
prior to hospice admission, median daily estimates of total
Medicare utilization ranged from $66.84 (Alzheimers,
Dementia, and Parkinsons) to $217.46 (Chronic Kidney
Disease); national average $117.73. In the 30days prior to
hospice admission, median daily Medicare utilization ranged
from $105.24 (Alzheimers, Dementia, and Parkinsons)
to $466.25 (Chronic Kidney Disease); national average
$266.84. Among all diagnoses, the median daily estimates of
pre-hospice Medicare utilization for Alzheimers, Dementia,
and Parkinsons hospice admissions were consistently below
the 2013 routine home care per diem rate of $153.45. Average
lifetime hospice utilization ranged from 27.3days (Chronic
Kidney Disease) to 119.3days (Alzheimers, Dementia, and
Parkinsons); national average 73.8 days. Relatively little
was known about how pre-hospice Medicare utilization
case-mix system exists in the Medicare hospice benefit to dif-
ferentiate payments among patients. Additional analysis is
needed to understand if hospice patients with differing char-
acteristics (e.g., diagnoses) require different resource needs
and if hospice payments are appropriately aligned with those
requirements.
THE ROLE OF CARE HOMES IN PALLIATIVE AND
END-OF-LIFE CARE
M.L.Johnson, School for Policy Studies, University of
Bristol, Bristol, United Kingdom
Older people have been living and dying in Care Homes
for many decades. But as life expectancy has extended and
those who live longer lives do so largely in functional good
health for much longer, the demography and epidemiology of
dying and death have changed
dramatically. The latest available UK data for 2014 pro-
vide strong evidence of the rising numbers of old age deaths
in Care Homes and previously unavailable material on the
causes of those deaths. There emerges a new and important
picture, which should be brought to bear in discussions about
policies for end of life care. This presentation presents find-
ings from an enquiry commissiond by Public Health England.
It reveals distinctive patterns of multiple co-morbidities now
bundled together as frailty, which require revised patterns of
end of life care that rely more on sustained support rather
than elaborate palliation.
EVALUATING COMMUNITY END-OF-LIFE CARE
MODELS FOR OLDER PEOPLE WITH ADVANCED
ILLNESSES IN HONG KONG
K.Chan, A.Chow, C.Chan, V.Lou, The University of
Hong Kong, Hong Kong, Hong Kong
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
In Hong Kong, older non-cancer and cancer patients
found to have 2.3 and 1.6 comorbid diseases respectively.
Older patients, frequently suffer from chronic debilitating
diseases, multiple disabilities, and distressing symptoms,
need a holistic EoLC to meet the complex emerging needs.
A3-year project has been initiated by the Hong Kong Jockey
Club Charities Trust to increase community engagement in
EoLC by developing evidence-based community EoLC mod-
els for older adults in Hong Kong.
This presentation will describe five different models of
community EoLC programme introduced by non-profit
social service agencies in Hong Kong and the evaluation
of these models. All organizations collaborated with hospi-
tal partners to provide community-based EoLC to families
with older people with advance illnesses, with unique foci.
While emphasizing the partnerships with health care sys-
tem, these social care units strengthen the psychosocial care
in the community. Models include volunteer-based model,
assisted family-care model, non-cancer model, community-
care model and residential home care model. Astandardized
comprehensive outcome and impact evaluation are carried
out. Adopting mixed methods, assessments with older adults,
family caregivers, and volunteers are implemented through
pre-post-followup questionnaires as well as post-service
qualitative interviews. Changes in symptoms, mental health,
caregiving burden, quality of life, general health and com-
plicated grief are assessed. Volunteers changes in life satis-
faction and life meaning are also appraised. Clinical data
mining approach is adopted to analyze the impact as well.
NURSE-LED ADVANCE CARE PLANNING IN
PRIMARY CARE FOR OLDER ADULTS WITH
MULTIPLE CHRONIC CONDITIONS
D.E.Holland, C.Vanderboom, A.M.Dose, C.Ingram, difficulties in maintaining positive health-related changes
Mayo Clinic, Rochester, Minnesota
Advance care planning (ACP) can ensure people receive
the care they value and prefer when they cannot speak for
themselves, yet ACP participation is low. There is a need to
identify an approach to the ACP process that promotes par-
ticipation in high-quality ACP. Utilizing primary care nurses
is one ACP engagement approach. Our pilot study sought to
determine the feasibility and acceptability of ACP in primary
care by nurses with older adults with multiple chronic con-
ditions. The intervention involved two sessions between the
nurse and patient that lasted approximately one hour each.
Between the two sessions patients were requested to discuss
their values, life goals and treatment preferences with family
members. Patients completed the ACP Engagement Survey
before and after the intervention. Individual interviews were
also conducted with the patients and nurses. The majority
of patients invited to participate agreed (41/67; 61%). The
average participant was 66.2 years old with 9.6 diagnoses.
The majority (61%) were female and White/non-Hispanic
(98%). All but one of the 41 completed the intervention.
Both process and behavior scores on the ACP Engagement
Survey improved. Patients and nurse interviews indicated
that they were satisfied with the intervention. Thirty-six of
the 41 subjects (87.8%) completed an Advance Directive; all
41 identified a healthcare proxy decision maker. ACP conver-
sations between nurses and patients in primary care are fea-
sible and acceptable. Further study is warranted and would
IAGG 2017 World Congress
513
benefit by exploring the early impact of ACP conversations
on subsequent treatment decisions made by older adults with
multiple chronic conditions.
SESSION 995 (POSTER)
ENVIRONMENT AND COMMUNITY INTEGRATION
CAN SOCIAL PRESCRIBING HELP ADULTS WITH
LONG-TERM HEALTH PROBLEMS TO AGE WELL?
S.Moffatt, M.Steer, S.Lawson, L.Penn, Newcastle
University, Newcastle upon Tyne, United Kingdom
Social prescribing is the use of non-medical interventions
to achieve sustained lifestyle change and improved self-care
among people with long-term health conditions. Service
users are supported to live healthier and more fulfilling
lives, learn to manage their long term conditions and reduce
health care dependency. Ways to Wellness (WtW, http://way-
stowellness.org.uk/) is the first UK organisation to deliver
social prescribing at scale, serving an urban area with some
of the most socio-economically deprived constituencies in
England. The social prescribing model comprises referral to
a Link Worker trained in behaviour change methods who
offers a holistic and personalised service to identify meaning-
ful health and wellness goals, as well as connecting service
users to community and voluntary groups and resources.
Qualitative interviews were undertaken with 30 service users
aged 4074 with chronic and multiple long term conditions,
and repeated again at 6months. Service users reported many
positive changes: improved physical activity, weight loss,
reduced social isolation, improved mental health, and bet-
ter long term condition management. After six months many
were identified, yet largely overcome. Key elements of the
success of this programme were the ongoing and personal-
ised approach and the nature of the relationship with the
Link Worker in combination with actively engaging service
users with community organisations. This dual approach to
ageing well with long term conditions recognises the need
for individual change but through its community based
approach, also addresses many of the deep-rooted social
and economic barriers which compound long term health
problems.
COMMUNITY DIAGNOSIS WITH LOCAL
VOLUNTEERS AND CARE PROFESSIONALS IN AGE-
FRIENDLY CITY INITIATIVES
A.Kono1, N.Yoshiyuki1, Y.Kanaya1, T.Soga2, 1.
Department of Home Health Nursing,Osaka City
University, Osaka, Osaka, Japan, 2. Izumiotsu Community-
based Integrated Center, Izumiotsu, Osaka, Japan
Frail older adults can continue to live independently
at home in cities that are age-friendly. The purpose of the
present participatory action research is to identify the core
concerns for building an age friendly city through com-
munity diagnosis involving volunteers and professionals,
utilizing photovoice and surveys. The surveys were con-
ducted previously and investigated the care needs of 710
frail older adults living in Izumiotsu City, Japan. The study
514
participants were 39 local volunteers living in three dis-
tricts in the city including districts A(population=7,984;
% of adults 65 years = 21.0%), B (5,994; 18.5%), and
C (6,712; 24.3%), and 8 care professionals in a commu-
nity-based integrated center. We conducted four sessions of
focus group interviews with local volunteers and care pro-
fessionals, using 248 pictures from care professionals and
56 pictures from local volunteers, as well as survey data.
Through the focus group interviews, we identified the core
concerns from the community diagnosis of each district,
which included Older adults, at risk of social isolation, are
not participating in community activity groups (district A);
Older adults, who cannot ride a bicycle, find it difficult to
go shopping as shopping facilities are scattered (district B);
and Frail older adults living alone are more likely to be
isolated because they do not want contact with community
residents district C). These results suggest that a commu-
nity diagnosis, through focus group interviews with local
volunteers and care professionals utilizing photovoice and
surveys, could capture distinctive core concerns for devel-
oping age-friendly initiatives.
DEVELOPING INDICATORS OF AGEING-FRIENDLY
CITY IN TAIWAN: GUIDED BY THE PROCEDURES
PROPOSED BY WHO
C.Lin3, T.Li3, C.Liu2, C.Lin2, W.Lin2, C.Lung4, S.Chang- programs, and designing tools to make it easier for older
Lee1, 1. Asia University, Taichung, Taiwan, 2. China Medical
University Hospital, Taichung, Taiwan, 3. China Medical
University, Taichung, Taiwan, 4. Department of Social
Work, National Quemoy University, Kinmen County,
Taiwan
In the past ten years, many cities and counties in Taiwan
have improved their age-friendliness. However, the indica-
tors of ageing friendly city are inconsistent among cities
and counties. The purpose of this project is to establish a
consensus list of ageing friendly city indicators in Taiwan.
We applied World Health Organization (WHO) Global
Age-Friendly Cities Guide to develop a preliminary list of
eight dimensions of age-friendliness by literature review and
experts opinion. There are 38 candidates in the preliminary
list. Asurvey of 64 experts in the related fields and represent-
atives of elderly groups was conducted from Aug to October
in 2015. They were asked to evaluate the candidates based
on 5 technical criteria and 5 practical criteria Each candi-
date was calculated three average scores of all, technical, and
practical criteria, respectively. This project was funded by
Health Promotion Administration, Ministry of Health and
Welfare, Taiwan. Forty-seven questionnaires were completed
(response rate, 73.4%). Fifteen indicators were identified
in the top 50 percent of all, technical, and practical crite-
ria. Three indicators were selected in the top 50 percent of
each dimension. Furthermore, ten global age-friendly cities
indicators were essential for comparison with other global
cities. Finally, a total of 28 indicators, including 21 global
ones developed by WHO, was developed. A consensus of
indicators of ageing friendly city in Taiwan was produced.
For improvement the age-friendliness among cities and coun-
ties, to regularly report those indicators is needed.
Innovation in Aging, 2017, Vol. 1, No. S1
COMMUNITY MANAGEMENT OF CHRONIC
DISEASE: AN ALTERNATIVE MODEL FOR SENIORS
WITH MULTIPLE MORBIDITIES
M.Kloseck, S.A.Ali, R.Crilly, Western University, London,
Ontario, Canada
Managing the increasing prevalence of chronic diseases
(CD) has become a priority globally. However, the feasi-
bility of using a CD self-management approach with older
individuals with multiple morbidities, and reduced physical
and cognitive abilities to deal with the impact of these con-
ditions in their day-to-day lives, is increasingly being chal-
lenged. We propose CD management for older individuals
is best done in a collective community context using a com-
munity capacity building approach that actively engages
residents of the community as a whole in raising awareness,
identifying neighbours at risk and providing peer-led edu-
cation and ongoing mentoring to improve persistence with
positive lifestyle changes. Employing this approach has
shown a significant increase in screening for osteoporosis
in a naturally occurring retirement community (NORC) of
seniors in London, Ontario Canada (n=105; mean age=80.5
6.9; p<.001). We are now trialing this in a further study
of osteoarthritis prevention and management. Critical ele-
ments of our model include training community residents to
become CD advocates and coaches, building relationships
and sustained supportive networks and peer mentorship
community members to address key issues with their family
physicians. Our findings suggest guidance is more impor-
tant than knowledge to enable behavior change. Leveraging
knowledge from physician to community advocates to
peers/patients at a community level brings economies of
scale. This process is an essential link along the continuum
of RCT, to guideline development, to screening, assessment
and management of chronic diseases and offers a new evi-
dence-based approach.
SESSION 1000 (POSTER)
ENVIRONMENTAL AND NEIGHBORHOOD
CONDITIONS
THE BP OIL SPILL: RESILIENCE IN THE AFTERMATH
OF POST-DISASTER OLDER ADULT INTIMATE
PARTNER VIOLENCE
R.Ferreira1,2, F.Buttell1,3, 1. Tulane University, New
Orleans, Louisiana, 2. Disaster Resilience Leadership
Academy, New Orleans, Louisiana, 3. Wisner Center, New
Orleans, Louisiana
Little empirical research exists on the relationship
between disaster and IPV among older adults. Survivors of
non-disaster IPV are frequently able to recover, but clear
information is lacking on recovery mechanisms of older
adults. The extant literature on recovery mechanisms for
victims doesnt address the same issues for older IPV survi-
vors in the aftermath of disaster. Given the disruption caused
by disasters to every aspect of daily living, this study sought
to identify the resilience characteristics of survivors in the
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Innovation in Aging, 2017, Vol. 1, No. S1
aftermath of disaster and IPV. The risk and resilience eco-
logical framework guided the study (Corcoran and Nichols-
Casebolt, 2004).
Data was derived from Gulf States Population Survey.
The sample included 2,657 survivors of IPV. The design was
a comparative design, Individual resilience the outcome vari-
able, was operationalized using the Pearlin Mastery Scale
(Pearlin etal., 1981).
A hierarchical multiple regression analysis indicated that
risk factors explained 7% of variance in individual resilience,
(F (4,2657)=120.24, p < .0001).Protective factors explained
an additional 12% of variance in individual resilience (F (8,
2655)=138.24 p < .0001) above and beyond the variance
explained by and accounted for by risk factors.
This study identified predictors of resilience among older
adult survivors of IPV exposed to the Deepwater Horizon
disaster. Results suggest the importance of providing special-
ized training to practitioners involved in postdisaster IPV
victim assistance. Given the complexity of IPV within a post-
disaster context, attention should be directed at both identi-
fying and meeting the immediate postdisaster needs of older
adult IPV victims.
PREDICTORS OF INDIVIDUAL RESILIENCY AMONG
INDIVIDUALS AGE 65 AND OLDER IN POST-
DISASTER SETTINGS
J.Liddell, R.Ferreira, City Cultural and Community
Interdisciplinary PhD Program, Tulane University, New
Orleans, Louisiana
Older individuals are especially vulnerable following dis-
asters such as the BP Oil Spill, in large part due to social
vulnerability factors such as economic constraints, health
problems, and susceptibility to domestic violence. An inves-
tigation was undertaken to determine the unique resilience
predictors associated amongst older adults (65 years and
older) exposed to disaster. This research adapts disaster
resilience conceptual models to investigate resilience and
expands these models by investigating differences in age
and by exploring how equitable and inequitable variables
account for variation in resiliency scores.
Data was derived from the Gulf States Population Survey
(GSPS). The final sample included 5,713 residents from 4
gulf-coast states. Atotal of 25 communities exposed to the
BP Oil Spill were included. Resilience was defined by the
Pearlin Mastery Scale. The study was a multilevel, repeated
cross-sectional design with a three-level nested structure.
Anonlinear analysis was done using an ordered multinomial
response model with a log-link function and empirical Bayes
Markov chain Monte Carlo estimation.
The results of the model testing clearly indicated inequi-
table disaster mitigation, with the social resilience, individual
economic resilience and contextual economic resilience indi-
cators explaining most variance in individual resilience. In all
models, age was negatively associated with resiliency. Being
female was protective across all models. The results of the
model testing indicate inequitable disaster mitigation, with
social and health, indicators explaining the most variance
in individual resilience levels. An investment of resources is
needed for older adults in post-disaster contexts.
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515
A STUDY OF DISASTER SAFETY OF RESIDENTIAL
WELFARE FACILITIES FOR THE ELDERLY
J.Jang, Y.Song, Y.Choi, S.Kim, S.Kweon, B.Park, W.Lee,
Busan National University, Busan, Korea (the Republic of)
Design
In Korea, various kinds of residential welfare facilities
for the elderly started to spring up everywhere after the Act
on Long-term Care Insurance For Senior Citizens had been
newly enacted in July 2008. However, since the locations of
such kinds of residential welfare facilities for the elderly are
mostly located near the nature rather than places that can be
easily accessed by the elderly, there have been often the cases
that it is hard to respond to some kinds of disasters from
the beginning. Especially, there have been many times of fires
related to such facilities in Korea as well as with many num-
ber of the dead and the injured and huge amount of property
damage. However, a method for taking measures for some
disaster safety covering the whole area of such welfare facili-
ties which have been sprout up everywhere.
Regarding to the disaster safety of the housing welfare
facilities for the elderly, it is very important for preparing for
the safety measures for the relevant space. In addition, it is
necessary to consider the physical, psychological and social
characteristics of the elderly as well as the characteristics of
the relevant space when a disaster occurs. Therefore, in this
study, it is intended to analyze on what kinds of effects the
environment of the housing welfare facilities for the elderly
and the physical, psychological and social characteristics
of the elderly influence in case that a disaster occurs to the
housing welfare facilities for the elderly while analyzing the
elderly who live in various kinds of housing welfare facilities
for the elderly (Facilities for the Aged, Group Homes for the
Elderly and Welfare Housing for the Elderly) in Korea.
Method
The survey targets are 3kinds of facilities, such as, the
facilities for the elderly, Group Homes for the Elderly and
Welfare Housing for the Elderly and the aged who live in
such facilities. And the survey will be conducted for compre-
hending the physical, psychological and social characteris-
tics of the elderly and the levels of the environments of such
facilities compared to the accidents generated. The collected
data shall be used for conducting a regression analysis using
SPSS 22.0 in order to comprehend the relationship between
the characteristics and the environments and what kinds of
effects are influenced on the safety in case of a disaster.
EMERGENCY PREPAREDNESS IN COMMUNITY-
BASED LONG-TERM CARE IN SOUTH CAROLINA
AND ITS GLOBAL IMPLICATIONS
M.D.Bremseth1, R.K.Green1, S.Wright1, R.Smith2, 1.
Office of Human Services Research and Organizaitonal
Developement, Clemson University, Knoxville, Tennessee, 2.
South Carolina Department of Health & Human Services,
Columbia, South Carolina
The study examined the experiences of those served in
community based long term care in South Carolina and their
awareness of services available to them should they experi-
ence a critical incident, it explored to what extent are case
managers informed consumers about these services and com-
pleted a plan with the participant in the event that he/she
516
may encounter such a situation, it looked at the participants
responses compared to a 2012 study and then gathered qual-
itative data the experiences with the recent flooding in South
Carolina. Samples of 380 respondents in this population
were surveyed by telephone.
The results indicated in the case of the latest emergency
(major flooding) the majority were contacted by their case
managers as the emergency was developing. 98% had access
to TV, 77 % cell phone, 71% the internet, and 68% the radio.
60 % had an emergency safety plan in place, which included
having a go bag with copies of medical records and finan-
cial records. 70% had a transportation plan in place. For
those who are forced to stay in place 90% had extra medica-
tions, 80% extra food and 70% extra water. On the other
hand there were problems with lack of backup heat, and
battery power for communication devices. Comparing these
findings to the earlier survey there was evidence of some
major improvements in the preparedness of this popula-
tion but still indicated areas that needed to be worked on.
There may be well lessons to be learned that have global
implications.
RELATIONSHIPS WITH PLACES: AN ETHNOGRAPHIC
STUDY OF OLDER ADULTS IN DETROIT
NEIGHBORHOODS
W.D.Bartlo, Center on Health, Aging, and Disability,
University of Illinois, Champaign, Illinois
This seeks to extend psychosocial research that focuses
primarily on counting number of connections and relation-
ships with other people as a measure of well-being, through
the lens of non-biological kinship connections. Atheoretical
approach that utilizes anthropological considerations of kin-
ship is important to framing research on social isolation as
relationships are at the core of understanding the affiliations
and connections of individuals. Ifocus on the specific experi-
ences of older persons in a particular location to elucidate the
nature and practices of relationships in old age. The ethno-
graphic data in this study highlight relationships with both
others and spaces as key for shaping the experience of old
age in a specific environment. Participants emerge as having
negotiated a set of practices to pursue, maintain, and create
place based relationships and spaces are reconsidered as to
how they meet differing needs of an individual, both socially
and physically. Using in-depth interviews from a multi-year
ethnographic study in Detroit, Michigan with older current
and former residents (n=32), Ianalyzed interview transcripts
to identify key topics, themes, and patterns.
UNDERSTANDING PERSON-PLACE TRANSACTIONS
IN NEIGHBOURHOODS: AQUALITATIVE-
GEOSPATIAL APPROACH
C.Hand, D.L.Rudman, S.Huot, J.Gilliland, R.Pack, social environments, and aesthetics were associated with
School of Occupational Therapy, University of Western
Ontario, London, Ontario, Canada
Emerging research regarding aging in context reveals
much about neighbourhood characteristics that relate to
aging adults health, participation and inclusion; however,
in-depth information about the nature of person-place rela-
tionships is lacking. Shifting away from previous concep-
tualizations of place as static, a transactional perspective
considers place as inseparable from the person, each shaping
Innovation in Aging, 2017, Vol. 1, No. S1
the other through complex, ongoing transactions. The inter-
woven nature of person and place highlights the need to
use methods that can examine this relationship in situ and
explore meanings derived from places. Participatory geo-
spatial methods (i.e. methods that involve the participant in
collecting geospatial data) can capture situated details about
place that are not verbalized during interviews or otherwise
discerned, and qualitative methods can explore interpreta-
tions, both helping to generate deep understandings of the
relationships between person and place. This presentation
argues for applying qualitative-participatory geospatial
approaches to this area of study and describes an innovative
methodology. A study exploring how neighbourhood and
person transact to shape a sense of social connectedness in
older adults provided the basis from which we developed a
combined qualitative-participatory geospatial methodology.
Methods included global positioning system (GPS) track-
ing followed by map-based interviews, narrative interviews,
and go-along interviews, with attention to integrating spatial
and other forms of data during analysis. Findings indicate
the unique understandings that each method contributes,
the strengths and limitations of integrating geospatial with
qualitative data, and the potential for this methodology to
generate knowledge about person-place transactions that
can inform practice, policy and research to promote older
adults well-being.
PERCEIVED NEIGHBORHOOD ENVIRONMENT,
SOCIAL SUPPORT, AND PHYSICAL ACTIVITY
AMONG ELDERLY JAPANESE
K.Harada1, H.Sugisawa2, Y.Sugihara3, S.Yanagisawa4,
M.Shimmei5, 1. Jissen Womens University, Tokyo,
Japan, 2. J.F. Oberlin University, Tokyo, Japan, 3. Tokyo
Metropolitan University, Tokyo, Japan, 4. Tokushima
University, Tokushima, Japan, 5. Hosei University, Tokyo,
Japan
The effects of perceived neighborhood environment and
social support on the physical activity of young-old (65
74 years old) and old-old (75 years old) were examined.
Data were obtained from a probability sample survey of
739 participants (65years) living in two wards of Tokyo,
Japan. The dependent variable was physical activity divided
into active (engaged in 60min or more per week) and inac-
tive. The independent variables were the perceived neighbor-
hood environment, measured by the International Physical
Activity Questionnaire Environmental Module (IPAQ-E) and
the social support from kin, neighbors, and friends for going
out. Logistic regression analyses were conducted separately
for both age groups, controlling for sex, education, employ-
ment, living arrangement, and functional capacity. Results
demonstrated that access to shops and exercise facilities,
being physically active among the young-old. The interaction
between social environment and social support from kin was
statistically significant among the young-old. Social environ-
ments, aesthetics, and social support from neighbors and
friends were associated with being physically active among
the old-old. These findings suggest that improving access to
facilities might be effective for promoting physical activity
among the young-old. Social environment (e.g., seeing many
people walking) and aesthetics consistently correlated with
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Innovation in Aging, 2017, Vol. 1, No. S1
physical activity for both age groups. Findings also high-
lighted the importance of the social support from neighbors
and friends for promoting physical activity for the old-old
and the social support from kin as a modifier of the relation-
ship between neighborhood environment and physical activ-
ity for the young-old.
EVALUATING THE NURSING PRACTICE
ENVIRONMENT
I.Durosaiye, University of Central Lancashire, Preston,
United Kingdom
Background: Nursing is a crucial part of the healthcare
service delivery in the UK. However, an increasing number
of ward nurses are leaving the profession prematurely, due to
ill-designed hospital wards.
Objectives:
- Identify the typical ward elements in a hospital ward
setting;
- Establish the design features that have the greatest
impact on ward nurses in their job role; and
- Explore the personal constructs of nurses that should
be supported by these design features through their embodi-
ment in ward elements.
Methods: A focus group was conducted with six staff
nurses. This was followed by semi-structured interviews with
20 ward nurses. The study concluded by performing a post-
occupancy evaluation of three hospital wards where these
nurses worked. The results of the post-occupancy evaluation
were triangulated against those of the focus group and semi-
structured interviews.
Results: The findings of this study:
1) Established a case for the periodic post-occupancy
evaluation of hospital wards;
2 Identified the design features most essential for nurses in
hospital ward setting; and
3) Illuminated the personal constructs of nurses that
should be supported by these design features.
Conclusions: A supportive nursing practice environment
is essential for the therapeutic healing of patients in con-
temporary nursing. To ensure that ward nurses continue in
gainful employment for longer, there is a need for periodic
assessment of how the architectural design features of hospi-
tal wards support ward nurses in their job role.
BUILT ENVIRONMENT, ACTIVE LIVING, AND THE
COMPETITIVENESS OF ASENIOR-LIVING FACILITY
Z.Wang1,2, E.Rahardjo3, 1. Henan University, Kaifeng,
China, 2. Internationl Green, Chesterfield, Missouri, 3.
Moseley Architects, Moseley Architects, Virginia
Driven by a combination of facility competition and
customer preference, developing quality built environments
in a senior-living facility has become an important focus
for the service providers. Limited is known regarding spe-
cific environmental design principles significant to facility
competitiveness in the current state-of-art of development.
From providing environmental supports of active living
(including both physical and social activities), the benefits
include enhanced resident well-being and eventually pro-
moted facility competitiveness. This research investigates
the associations between environmental design principals,
IAGG 2017 World Congress
517
residents physical and social activities, and reported facility
competitiveness.
Case studies of 57 senior-living facilities in California
and Virginia are conducted through on-site observations,
face-face interviews, and an online questionnaire survey of
facility officers and coordinators. Key attributes of facility
design are summarized and measured at the site and build-
ing levels, including the factors of site planning, building
layout, vertical configuration, and interior decoration.
The Statistical Package for the Social Sciences are used
to analyze objective data and identify significant factors.
Content analyses are conducted to investigate partici-
pants suggestions and preferences. Keywords and themes
are identified. The presence of destinations for walking on
the property, a self-described building layout, good visual
and physical access to the outdoors, homey interior deco-
rations and amenities contribute to residents active living
and facility competitiveness. The results will be discussed
through the eyes of architects and academic researchers
working together to examine what it means to design for
facility competitiveness. Innovated design approaches are
emphasized. Creditable research findings and design expe-
riences are included.
EXPLORING CLIENT AND STAFF PERCEPTIONS OF
ENVIRONMENTS IN ADULT DAY SERVICES (ADS)
CENTERS IN TAIWAN
C.Liou1, S.E.Jarrott2, A.Kelly1, 1. Kent State University,
North Canton, Ohio, 2. Ohio State University, Columbus,
Ohio
Purpose of Study: Although several studies have
examined the impact of environments on quality of life
outcomes for long-term care residents, scholars have put
minimal emphasis on the environments of adult day ser-
vices (ADS). In the United States, ADS centers are per-
ceived as the place used by incompetent and impaired
elders who are labeled as dependents or children (Diaz
Moore, 2004; Salari & Rich, 2001). Little is known
about the perceptions of ADS in other countries with dif-
ferent cultural backgrounds. This study aimed to exam-
ine the role of physical-spatial conditions/dimensions and
social-interpersonal environments in two ADS facilities
in Taiwan from staff and client perspectives.
Design and Methods: Data were collected from 23 inter-
views with staff and clients and 270 hours of participant
observations. Authors triangulated field notes with interview
transcriptions and analyzed them with open, axial, and selec-
tive coding.
Results: For staff, (a) spacious well-designed physical
environments and supportive social and economic environ-
ments lead to good care interactions with clients and (b)
unsupportive environments make care work more challeng-
ing and create negative effects on clients lives. For clients,
(a) social environment was more important than physical
environment in affecting quality of life at centers and (b) dif-
ferent life experiences influenced their perceptions of and the
interactions with ADS environments.
Implications: Our study reveals the complex interrelation-
ships among ADS environments, staff perception, and cli-
ents quality of life reflecting Taiwanese culture. Results can
518
be translated into action research by implementing support-
ive environments for both staff and clients at ADS centers.
SESSION 1005 (POSTER)
EPIDEMIOLOGY AND HEALTH DEMOGRAPHY
EFFECTS OF DIETARY DIVERSITY ON
LONGITUDINAL CHANGES IN INFORMATION
PROCESSING SPEED AT 40S TO 70S
R.Otsuka-Ito1, Y.Nishita-Kodaira1, C.Tange1, M.Tomida1,
Y.Kato2,1, T.Imai1,3, F.Ando2,1, H.Shimokata4,1, 1. National
Center for Geriatrics and Gerontology, Obu, Aichi, Japan,
2. Aichi Shukutoku University, Nagakute, Aichi, Japan, 3.
Doshisha Womens College of Liberal Arts, Kyoto, Japan,
4. Nagoya University of Arts and Sciences, Nisshin, Aichi,
Japan
The present study assesses the effects of dietary diver-
sity on information processing speed among 1,766 men and
women aged 40 to 79years who participated in the first and
follow up (second to seventh) waves of the National Institute
for Longevity Sciences-Longitudinal Study of Aging at least
once. Information processing speed was assessed using a
component of the Wechsler Adult Intelligence Scale-Revised
at all waves. Dietary diversity was determined using the
Quantitative Index for Dietary Diversity based on a three-
day dietary record at the first wave. Sex- and age decade-
stratified, general linear, mixed models comprised fixed
effects of dietary diversity (high/low groups), age at the
first wave, years of follow-up, interactions, and covariates
(education, living alone, family income, smoking, body mass
index, energy intake, and medical history). The results indi-
cated that the effects of dietary diversity were marginally sig-
nificant for males aged in their 40s, 50s, and 70s (p < 0.06),
suggesting that more dietary diversity was associated with
better information processing speed. Regardless of dietary
diversity (high/low groups), information processing speed
increased with aging during the 40s and decreased in 60s
and 70s in both sexes (p < 0.05). Interaction between dietary
diversity and follow-up years revealed a significant interac-
tion effect only among females aged in their 70s (p=0.04),
and information processing speed decreased less in groups
with high than low diversity (-0.34 vs. -0.58 points/year). In
conclusion, daily intake of various foods might help to pro-
tect information processing speed decline in females aged in
their 70s.
TB TRANSMISSION IN OLDER POPULATIONS:
ARE-EXAMINATION OF RISK GROUPS
G.A.Noppert, Duke University, Durham, North Carolina
Background: Despite a low tuberculosis (TB) incidence
nationwide, stark disparities in TB incidence persist, par-
ticularly along lines of relative social disadvantage. While
TB incidence among older populations is typically driven
by reactivation of latent TB infection (LTBI), understanding
the extent to which recent transmission of TB is occurring
in older populations may move us closer to TB elimination.
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: We used Michigan surveillance data on 1,236
TB cases reported during 20042012 to examine the asso-
ciation between age and recent transmission of TB. We
used multivariable modified Poisson regression models to
examine the prevalence of recent transmission controlling
for demographic and clinical covariates at the individual
and neighborhood level (at the level of the census block
group).
Results: 310 (25%) of the 1,236 TB cases occurred among
adults aged 65 years and older. Of those 310 cases, 22%
resulted from recent transmission. Overall, those 65 years
and older had a prevalence of transmission 50% lower than
those aged 1864years a finding that was unchanged with
the addition of other individual- and neighborhood-level
covariates. However, in a model of only those aged 65years
and older, the U.S.-born had a prevalence of transmission
2.64 times that of the foreign-born and Asians had a preva-
lence of transmission 2.90 times that of Whites.
Conclusions: Policies aimed at screening older popula-
tions for LTBI may be effective in reducing incidence overall
among this population. However, increased efforts at reduc-
ing transmission are needed to address the racial disparities
apparent among older Asian adults.
THE IMPACT OF TOOTH LOSS ON COGNITIVE
DECLINE IN OLD AGE: APOPULATION-BASED
LONGITUDINAL STUDY
C.S.Dintica, W.Xu, D.Rizzuto, Department of
Neurobiology, Care Science and Society, Karolinska
Institute, Stockholm, Sweden
Poor dental health has been associated with cognitive
decline with some inconsistent result, and the role of cardio-
vascular disease (CVD) and chronic inflammation in such an
association remains unclear. We aimed to examine the asso-
ciation between tooth loss and cognitive decline over time,
and to explore whether CVD and inflammation may account
for this association.
Within the population-based Swedish National study
on Aging and CareKungsholmen, 2465 cognitively intact
participants aged 60 were identified at baseline, and fol-
lowed-up for 6years. Cognitive function was assessed with
the Mini-Mental State Examination (MMSE) at baseline and
at follow-ups. Information on dental status (no tooth loss,
partial and complete) and history of CVD was collected at
baseline. C-reactive protein (CRP) was measured in blood
samples and dichotomized (normal: 05 mmol/l and high:
>6mmol/l). Data were analysed using mixed-effects models
with adjustment for potential confounders.
Of all participants, 472 participants (19.2%) had tooth
loss including 339 (13.8%) with partial tooth loss and 133
(5.4%) with complete tooth loss. In mixed-effects models,
both partial tooth loss (: -0.8, 95% CI -1.40 to -0.2) and
complete tooth loss (: -2.89, 95% CI -3.89 to -0.51) were
associated with greater MMSE decline compared to no
tooth loss after adjustment for potential confounders includ-
ing CVD and inflammation. In stratified analyses by CVD
and CRP, the association between tooth loss and cognitive
decline remained statistically significant.
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Innovation in Aging, 2017, Vol. 1, No. S1
In conclusion, both partial and complete tooth loss are
associated with cognitive decline among the elderly people,
independently of CVD and inflammation.
THE RELATIONSHIP BETWEEN ALCOHOL
CONSUMPTION AND MORTALITY IN AN AGING
COHORT OF U.S. ADULTS
K.Keyes, Epidemiology, Columbia University, New York,
New York
Validity of the relation between moderate drinking
and mortality has been a subject of substantial contro-
versy. While epidemiological evidence has demonstrated a
J-shaped curve, extant literature has been criticized for not
separating recent abstainers from long-term abstainers and
not characterizing the dynamic nature of consumption. We
examined the relationship between drinking and mortality in
a nationally-representative sample of aging adults. Data were
drawn from 8,095 Health and Retirement Study respond-
ents, surveyed 9 times between 19962012. Respondents
were grouped into five categories: long-term abstainer, recent
abstainer, occasional drinker, moderate drinker, and heavy
drinker. We modeled mortality using Cox Proportional
Hazards models with time-varying measures of alcohol
consumption, wealth, depression, BMI, difficulties of daily
living, chronic conditions, as well as time-invariant demo-
graphics. Overall, 27.66% of the sample died during follow-
up. In unadjusted models, compared to long-term abstainers,
moderate drinkers had a hazard ratio (HR) of 0.51 (95% CI
0.440.58); occasional drinkers had an HR of 0.71 (95%
C.I. 0.620.82), and heavy drinkers had an HR of 0.74 (95%
C.I. 0.610.91). In a fully adjusted model, moderate drink-
ers had an HR of 0.53 (95% C.I. 0.380.74). Interactions
were observed by smoking status and race, and suggested
that smokers and racial minorities do not demonstrate mor-
tality benefits from moderate consumption. We observed
that moderate drinkers have lower hazard of mortality than
non-drinkers in a long-term follow-up study of older adults.
However, there is substantial variation in the mortality ben-
efit received, suggesting that social factors as well as biology
shape physiological responses to drinking.
INFLUENCE OF EDUCATION ON ASSOCIATION
BETWEEN MARRIAGE AND MORTALITY: ACROSS-
NATIONAL STUDY
T.Saito-Kokusho1, K.Shirai2, T.Oksanen3, J.Pentti3,
J.Vahtera4, 1. Department of Social Science, Natl Center for
Geriatrics and Gerontology (NCGG), Obu, Aichi, Japan,
2. University of the Ryukyus, Nishihara, Okinawa, Japan,
3. The Finnish Institute of Occupational Health, Turku,
Finland, 4. University of Turku, Turku, Finland
The association of marriage and mortality is well-estab-
lished, however, the role of education on the excess mortal-
ity of the unmarried remains unclear. This study examined
whether the effect of marriage on mortality differs by gender
and education in older individuals in Japan and Finland.
Data were obtained from the Japan Gerontological
Evaluation Study project (JAGES) and the Finnish Public
Sector study (FPS). In JAGES, 4832 men and 4720 women
aged 6574 were followed for 5.7years. In FPS, 3782 men
and 14253 women aged 6074 were followed for 4.4years.
A gender-wise Cox proportional hazards model estimated
IAGG 2017 World Congress
519
the effect of marriage and interaction effect of education on
the association of marriage and mortality in each country.
A total of 11.1% of men and 6.2% of women in JAGES
and 4.4% of men and 2.6% of women in FPS died during the
follow-up. Amultivariate analysis showed that being unmar-
ried was associated with excess mortality in both genders in
Finland but not in Japan. Astratified analysis by gender and
educational level showed that being unmarried with higher
education was associated with a higher risk of mortality
(HRs: 1.42.0) than with lower education compared to the
married in both countries except for Japanese women whose
marital status did not significantly affect mortality regardless
of educational level.
The findings suggest that a higher education may expand
marital health disparity rather than mitigate it. A support
system beyond familial relationships should be considered
for unmarried older individuals.
LOW NORMALIZED GRIP STRENGTH IS
ABIOMARKER FOR DIABETES AND PHYSICAL
DISABILITY IN AGING ADULTS
M.Peterson, K.Duchowny, Physical Medicine and
Rehabilitation, University of Michigan, Ann Arbor,
Michigan
Background: There is evidence to highlight the impor-
tance of muscular strength as a protective factor for meta-
bolic health and function across populations.
Objective: To examine the extent to which low normal-
ized grip strength (NGS) may serve as a biomarker for both
diabetes and physical disability in a population-representa-
tive sample of U.S.adults age 50 and older.
Methods: A sample of 5,267 individuals, aged
5085 years, was included from the combined 20112014
NHANES datasets. Strength was assessed using a hand-held
dynamometer, and was normalized to body mass. Alogistic
regression model was used to assess the association between
NGS and risk of diabetes (hemoglobin A1c (HbA1c) levels
(6.5% [48mmol/mol]), as well as physical disability status
(self-reported restrictions in ADLs/IADLs), while controlling
for age, sociodemographic characteristics, and daily televi-
sion viewing time.
Results: Every 0.05 lower NGS was independently associ-
ated with a 1.49 times increased odds for diabetes in men
and women; and a 1.45 times increased odds for disability.
Women were at lower odds of having both diabetes (OR:
0.30; 95% CI: 0.210.42) and disability (OR: 0.74; 95%
CI: 0.610.91), whereas only higher age (65 years vs
5064.9years; OR: 1.50; 95% CI: 1.181.91) and hours of
television viewing time (OR: 1.16; 95% CI: 1.021.31) were
associated with disability status.
Conclusions: NGS was robustly associated with both dia-
betes and physical disabilities in aging adults. This simple
screen may serve as a valuable tool to identify adults that
are at risk for negative health consequences, and that might
benefit from lifestyle interventions to reduce risk.
LOW INCOME OLDER SNAP PARTICIPANTS DO NOT
HAVE LARGER WAIST CIRCUMFERENCE THAN
NONPARTICIPANTS
L.Samuel, S.L.Szanton, Johns Hopkins University School
of Nursing, Baltimore, Maryland
520
Supplemental Nutrition Assistance Program (SNAP)
participants have been shown to have higher obesity rates
than their income-eligible nonparticipating peers. However,
recent studies using causal inference in adolescent and young
adult samples suggest that program self-selection may have
biased those results. To obtain unbiased estimates in adults
aged 65 years, we compared the average waist circumfer-
ence of prior-year SNAP participants to the average in a
propensity score matched group of nonparticipants, strati-
fied by gender. Probability of SNAP participation was esti-
mated based on age, race/ethnicity, socioeconomic status,
household size, employment status, lack of money for food
or other needs, and receipt of non-SNAP food assistance.
Community dwelling participants of the National Health
and Aging Trends Study with incomes <500% of the poverty
limit were included. Propensity score matching produced a
matched subset of the sample comprising SNAP participant
and nonparticipant groups that were similar on model covar-
iates; Rubins B, an estimate of standardized bias, reduced
from 155 in the unmatched sample to 21 in the matched
sample. In the unmatched sample, female SNAP participants
had a larger average waist circumference than nonpartici-
pants (40.7 vs. 38.3inches, t=5.49, n=1989), but there was
no statistically significant difference in the propensity score
matched subset (40.5 vs. 39.5inches, t=1.38, n=1719). Male
SNAP participants did not differ from nonparticipants in this
sample. These results suggest that economic and social fac-
tors may influence SNAP participation. Accounting for these
factors, there is no evidence of greater waist circumference in
low income older adults participating in SNAP.
USING GEOGRAPHICAL INFORMATION SYSTEMS
(GIS) FOR TARGETING RECRUITMENT IN
DEMENTIA STUDIES
D.L.Scerpella, K.A.Marx, K.Burke, L.N.Gitlin, Center
for Innovative Care in Aging, Johns Hopkins University,
Baltimore, Maryland
Recruiting sufficient numbers of individuals with demen-
tia and/or their family caregivers is critical for advancing
effective treatments and assuring generalizability and statis-
tical power in randomized trials. Recruitment is one of the
most expensive and time consuming aspects of dementia
trials. A tool that may assist in recruitment is Geographic
Information Systems (GIS). GIS applications provide a tech-
nology for connecting individuals data to their environment,
allowing researchers to visually inspect the distribution of
numerous variables across a location. Currently, there is no
robust location data for people with dementia or their car-
egivers, yet existing data sets may be useful. This paper pre-
sents results of a post hoc analysis of families recruited for
a randomized trial in the USA to demonstrate the power of
GIS and effective use of existing data sets. Using US Census
Bureau data, a grouping analysis of selected risk factors (age,
education, gender, income) for dementia was performed in
ArcGIS. Age alone was the most robust factor overlapping
with 48% (N=165) of enrolled trial participants. However,
the combination of risk factors predicted 52% of existing
locations of participants. We found that by increasing the
geographic area considered by one half-mile, we improved
the reach to 76% of enrolled participants. By utilizing gov-
ernment survey data and identifying specific demographic
Innovation in Aging, 2017, Vol. 1, No. S1
and health risk factors associated with dementia, GIS can be
used to identify localized areas in a community where these
attributes are concentrated. Using this information, a more
targeted recruitment approach may be possible, prospec-
tively resulting in potential cost savings.
DIFFERENT RISK PROFILES FOR INJURIOUS FALLS
IN OLDER ADULTS OVER 60: APOPULATION-BASED
STUDY
S.Ek1, D.Rizzuto1, L.Fratiglioni1,2, K.Johnell1, W.Xu1,3,
A.Welmer1,4, 1. Karolinska Institutet, Stockholm, Sweden,
2. Stockholm Gerontology Research Center, Stockholm,
Sweden, 3. Tianjin Medical University, Tianjin, China, 4.
Karolinska University Hospital, Stockholm, Sweden
Although falls in older adults usually have multiple causes,
falls risk factors have traditionally been studied one at the time.
The aim of this study is to identify different risk profiles for
injurious falls in people aged over 60 years by detecting dif-
ferent clusters of already established risk factors for falls and
quantify their impact on fall risk. Participants were 2556 peo-
ple (60 years) from the Swedish National Study on Aging
and Care in Kungsholmen (SNAC-K) study. Cluster analy-
sis was used to identify aggregation of possible risk factors.
Associations between the clusters and injurious falls over 3, 5
and 10years were analyzed by using flexible parametric sur-
vival models. The cluster analysis revealed five clusters. The
first cluster included mainly healthy individuals and was used
as the reference group. The second and third clusters included
people with high physical function but high disease burden,
FRIDs, depressive symptomology and unhealthy lifestyle. The
last two clusters included mainly people with cognitive impair-
ment, with or without FRIDs and physical impairment. The
risk of injurious falls for all groups were significantly higher
than for the comparison cluster. The hazard ratios ranged from
1.71 (95% confidence interval [CI]: 1.022.66) for the second
cluster to 12.67 (95% CI 7.3821.75) for the last cluster over
3 years of follow-up. Conclusion: The risk of experiencing
an injurious fall varied largely between the different groups.
Knowledge of the relationship between risk factors may help
clinicians to tailor interventions by identifying people at differ-
ent levels of risk of injurious falls.
SESSION 1010 (POSTER)
FALLS II
FEAR OF FALLING IN OLDER AFRICAN AMERICAN
HEMODIALYSIS PATIENTS
C.Liu1,2, D.Afezolli1, S.Janet1, A.Upadhyay 1, J.Bhatia1,
R.A.Fielding2, 1. Boston University, Boston, Massachusetts,
2. Jean Mayer Human Nutrition Research Center in Aging,
Boston, Massachusetts
Introduction: Older adults comprise the majority of inci-
dent hemodialysis patients. Falls are a tremendous threat for
older hemodialysis patients. Over a one year period, appox-
imiately half of these patients will suffer a fall, twice the rate
of falls among the general older adult population. Fear of
falling is known to increase fall risk. Yet little is known about
the fear of falling in this high risk population. Our objective
was to determine the impact of fear of falling in older hemo-
dialysis patients.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Methods: Aconvenience sample of 10 older hemodialysis
patients followed at an urban hemodialysis facility affiliated
with an academic medical center underwent key inform-
ant interviews in their homes between the period of June
1, 2015 through May 31, 2016. Inclusion criteria included:
aged 65 years or older, English-speaking, and willing to
allow interviewer into home. Questions included open-
ended and Likert-style questions regarding attitudes regard-
ing general physical function and falls; the Falls Efficacy
Scale-International was administered. All interviews were
audiotaped. Three research team members simultaneously
reviewed transcripts of interviews and dominant themes
determined by consensus discussion.
Results: Mean age of participants was 73.05.0years and However, adherence in prevention programs depends on
6 (60%) were women. All participants identified as African-
American. Mean time on hemodialysis was 4.84.5 years. study was to develop a questionnaire to assess older adults
Fifty percent of the sample agreed with the statement I am
afraid of falling. Mean Falls Efficacy Scale-International
Score was 22.39.0 points, which is consistent with a mod- was conducted through content analysis and quantitative
erate fear of falling. Dominant themes about contributors to
falls included hemodialysis side effects (Hemodialysis just
drains me out); and lack of physical activity (Dont like from senior groups in Porto Alegre (Brazil), and professors
laying around, bed makes you weak).
Conclusion: In older African-American hemodialysis
patients, fear of falling is a likely contributor to the occur-
rence of falls. Future studies should explore reducing the fear
of falling as a preventive measure for falls in older hemodi-
alysis patients.
DETERMINANT FACTORS IN THE RELATIONSHIP
BETWEEN URINARY INCONTINENCE AND FALLS IN
OLDER ADULTS
J.Rocha, L.Jorge, G.Guimaraes, B.Rauber, B.B.Neves, questions. According to preliminary results, the questionnaire
A.Bos, Catholic University of Rio Grande do Sul, Porto
Alegre, RS, Brazil
Studies had shown a strong relationship between falls and
urinary incontinence (UI) in the older-adult. However, this
relationship is complex and might involves intrinsic (organic)
and extrinsic factors. The aim of the study was to determine
whether there was a significant relationship between the fall
event and the presence of UI in the elderly, and what factors
could influence this correlation. The dependent variable was
reporting at least a fall in the last 6 months and the inde-
pendent variables were UI, sex, marital status, age, health
perception, cognition, and number of morbidities. A pop-
ulation-based survey interviewed 7315 older-adults (60 or
older) residents in 59 cities of the State of Rio Grande do
Sul, Brazil. Logistic regression models tested the odds of hav-
ing a fall. Two hundred three participants (3.9%) reported.
Prevalence of UI was statistically higher (p <0.001) among
those 693 older-adults reporting fall (14%). Urinary incon-
tinence increased 7 times the risk of falling (p <0.001) in the
simple analysis and 3.5 when controlling for co-variables.
Independent of UI, being male (confidence interval 0.63 to
0.91, p <0.05) and not having cognitive impairment (CI 0.59
to 0.77, p <0.001) were protective factors. Independent risk
factors were being widowed compared to married (CI 1.22
to 1.84, p <0.001), older (CI 1.04 to 1.06, p <0.001), worst
self-perceived health and number of morbidities (CI 1.16 to
1.28, p <0.001). We concluded that the relationship between
IAGG 2017 World Congress
521
the presence of UI and the history of falls is independent of
intrinsic and extrinsic factors.
DEVELOPING AQUESTIONNAIRE TO ASSESS OLDER
ADULTS PERCEPTIONS ABOUT FALLING
P.Morsch1, M.Myskiw2, J.Myskiw1, 1. Institute of
Geriatrics and Gerontology, Pontifical Catholic University
of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul,
Brazil, 2. Federal University of Rio Grande do Sul, Porto
Alegre, Rio Grande do Sul, Brazil
In Brazil, 28% to 35% of individuals over the age of
65 fall each year. Literature suggests that 30% to 40% of
falls are preventable through managment of risk factors.
older adults perceptions about falling. The objetive of this
perception about falls risk factors. It was developed through
qualitative and quantitative approach. Qualitative method
through analisys of content validity. Sample of qualitative
approach was 22 older adults, aged 60 or older, participants
from two local universities. Mean age was 70.27.1years.
Coding and interpretation of data resulted in two thematic
categories: falls problematization and the perception of risk
factors, which served as basis for the development of the
questionnaire. The proposed research tool, with 36 questions
was sent to content validity analisys through evaluation of
judges, in three aspects: clarity of language, importance
and theoretical relevance. With these results, it was possible
to calculate the Validity Coefficient (VC). All questions with
VC <0,7 were excluded. Final questionnaire consisted of 25
seems quite relevant to identify how older adults perceive
falling into a problem to be prevented and their perception
of the risk factors. This knowledge will help to develop more
effective methods considering for fall prevention.
FALLS IN BRAZILIAN OLDER PEOPLE: PREVALENCE,
ASSOCIATED FACTORS, CONSEQUENCES
W.Teixeira Pimentel1, S.Rizzato Stopa2, V.Pagotto3,
M.C.Hoffmann4, D.Carvalho Malta5, R.L.Menezes1, 1.
Universidade de Braslia -UnB, Brasilia, Distrito Federal,
Brazil, 2. Faculdade de Sade Pblica da Universidade de
So Paulo, Campinas, So Paulo, Brazil, 3. Faculdade de
Enfermagem. Universidade Federal de Gois, Goinia,
Gois, Brazil, 4. Ministrio da Sade, Brasilia, Distrito
Federal, Brazil, 5. Escola de Enfermagem da Universidade
Federal de Minas Gerais, Belo Horizonte, Minas Gerais,
Brazil
Background: Falls are considered a public health problem
because of their prevalence and consequences for health of
older people.
Objective: To estimate the prevalence of falls, associated
factors and consequences.
Methods: Data was obtained in the National Health Survey
(PNS,2013) a cross-sectional population-based study with
23.815 older people (>=60yrs), from all the States of Brazil.
The fall, dependent variable, was avaliated by the question:
in the last 12months, have you fallen and looked for health
services?. The independent variables were age, sex, marital
522
status, self-rated health and femur fractures. It was estimated
the prevalence of falls (IC95%). The statistic differences were
estimated by the qui-squared test, considering p<0,01.
Results: The prevalence of falls in the last 12months was
7,8%(n=1825; IC95%: 7,3-8,4). It was observed a higher
prevalence in women (9,6%), in people of 75 years old or
more(11,6%). According to the health characteristics, the
prevalence was higher in olders with bad self-related health
(14,8%). Among those who experienced falls, 8,3% had
femur fractures as a consequence, these 13.4% made without
surgery prosthesis placement.
Discussion/Conclusion: The prevalence of falls was low
comparing to previous studies performed in Brazil and other
countries. However, the associated factors and consequences
are similar to the related in literature before: fractures,
females, advanced age, bad self-related health, conditions
that may make old people, more susceptible to this harm.
Thus, one conclude that knowledge of these factors is impor-
tant to support the planning of preventive measures and poli-
cies to prevent falls and their consequences.
FACTORS RELATED TO FALLS AND FEAR OF
FALLING IN KOREAN OLDER ADULTS WITH
CHRONIC DISEASE
J.Lee1, M.Choi1, C.Kim2, 1. College of Nursing Yonsei
University, Seoul, Korea (the Republic of), 2. College of
Medicine Yonsei University, Seoul, Korea (the Republic of)
Elderly with previous fall experience perceives more fear
of falling and lead sedentary life style. Fear of falling as well
as falls in older adults are one of the most important health
problems that healthcare providers should pay attention to.
Nevertheless, there are limited evidence of falls and fear of
falling. This study was conducted to identify factors influenc-
ing falls and fear of falling among older adults with chronic
disease in Korea using a descriptive cross-sectional survey
design. A convenience sample of 108 patients was recruited
at a geriatric outpatient department of a tertiary hospital in
Seoul, Korea. Demographic characteristics, comorbidities,
medication use, falls history, level of physical activity, activi-
ties of daily living, mobility, muscular strength, and fear of
falling were investigated. Student t-tests, Chi-square tests, and
multiple linear regressions were utilized in statistical analy-
sis. The mean age of the participants was 80.255.1 years. implementation of evidence-based methods for communities
Hypertension was the most prevalent disease (67.6%), fol-
lowed by ophthalmologic disease (61.1%) and ischemic heart
disease (59.3%). Thirty six participants (33.3%) reported that
they had experienced one or more falls in the past year. Marital
status and use of antipsychotics was associated with falls,
while other factors did not show significant relationship with
falls. The number of comorbidities, level of physical activity,
activities of daily living, and mobility were predictors of fear
of falling in the regression model. In conclusion, increase of
physical activity, functional fitness, and physical independence
is important to decrease fear of falling and encourage active
and healthy life in older adults.
FALL RISK FACTORS IN MID-AGE WOMEN: RESULTS
FROM THE AUSTRALIAN LONGITUDINAL STUDY
ON WOMENS HEALTH
G.Peeters1,2, A.White2, L.Tooth2, 1. School of Public
Health and Preventive Medicine, Monash University,
Innovation in Aging, 2017, Vol. 1, No. S1
Melbourne, Victoria, Australia, 2. The University of
Queensland, Brisbane, Queensland, Australia
In contrast to older adults, little is known about risk fac-
tors of falls in adults aged 5064 despite a high prevalence
of falls in this age group. The aim was to identify risk fac-
tors of falls in mid-age women and explore how associa-
tions change with age. Data were from 11,226 participants
in the Australian Longitudinal Study on Womens Health
aged 5055years in 2001 (born 194651). Awide range of
health and lifestyle predictors were measured in the 2001,
2004, 2007 and 2010 surveys. Falls in the past 12 months
were measured in the 2004, 2007, 2010 and 2013 surveys.
Associations between predictors and reported falls 3 years
later were analysed using logistic regression. In surveys 2004
2013, 20.5%, 30.6%, 30.6% and 26.6% of women reported
a fall in the previous 12months, respectively. In the univari-
able models, most factors were associated with falls. In the
multivariable models, higher odds of falling were found for
overweight and obese women compared with healthy weight
women at all time points (OR=1.161.43). Impaired vision
(OR=1.241.35), poor physical functioning (OR=1.231.66)
and frequent severe tiredness (OR=1.271.49) were associ-
ated with falls at three time points. Depression (OR=1.31
1.42), leaking urine (OR=1.461.49), stiff/painful joints
(OR=1.341.63) and HRT use (OR=0.690.80) were asso-
ciated with falls at two time points. There was no obvious
age-related increase or decrease in the number of statistically
significant associations. Identified fall risk factors varied over
time, highlighting that falling involves a complex interplay of
risk factors in mid-age women.
KAATUMISSEULA: IMPLEMENTATION OF
EVIDENCE-BASED FALL PREVENTION FOR
COMMUNITIES
S.Karinkanta, T.Kulmala, P.Kannus, T.Vasankari,
H.Sievnen, The UKK Institute for Health Promotion
Research, Tampere, Finland
Compelling scientific evidence shows that every third fall
can be prevented. Effective measures need to be based on
knowledge of individual fall risk. This underscores impor-
tance of fall risk screening. In Finland, risk screening and
preventive measures are not used systematically. Thus,
is necessary. In the present economic situation, resources of
the voluntary and non-profit sector (NGOs) should also be
utilized.
The main objective of KaatumisSeula project is to create
local models for fall risk screening and implementing evi-
dence-based preventive measures. The models are based on
co-operation between local public sector and NGOs. Primary
risk screening is offered for older people by public sector and
NGOs. People with high fall risk are referred to comprehen-
sive assessment of individual fall risk and tailored implemen-
tation of fall prevention measures by educated health care
professional(s). This approach is based on the multifacto-
rial Chaos Falls Clinic Study. NGOs play a central role in
not only screening but also informing about fall prevention
measures and offering accessible balance and strength train-
ing - the most effective single intervention in fall prevention.
The models are now in operation in 2 municipalities.
NGOs are active and keen in their role. Two Falls Clinics
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
have started and almost 400 high risk older adults have
found their ways to the multifactorial assessment. Public sec-
tor and NGOs have received education. New exercise groups
have been established.
KaatumisSeula is a feasible approach to screen the fall
risk of older adults and implement preventive measures in
community.
THE EFFECTS OF NUTRITION ASSESSMENT BY
PREALBUMIN ON FIM SCORES IN PATIENTS WITH
FALL AND FRACTURE
S.Niyati, Nursing, University of Texas at Arlington, Allen,
Texas
Background: Fall is leading cause of injury in elderly
persons. Nutritional status is an important aspect of elderly
life that influences quality of life in patients with fall and
fractures.
Objectives: To evaluate the effects of nutritional assess-
ment by prealbumin level on Functional Independence
Measures (FIM) and Length of Stay (LOS)in elderly popula-
tion with fall and fracture in rehabilitation hospital.
Methods: This study design was a one group pretest-
posttest without a control group. Seventy one patients
(n=71) 65 years or older with a diagnosis of fall and frac-
ture recruited. Nutritional status was evaluated using the
pre-albumin levels. Nutritional intervention implemented
for participants who had prealbumin level of 18>mg/dl.
Outcomes measures were discharge FIM scores and LOS.
Results: Fifty four patients (76%) were required nutri-
tional interventions. Prealbumin levels, FIM scores, and food
intake were significantly improved from admission to the
discharge, for Prealbumin levels, t (71)=7.53, p<0.01; X=
14.97 versus 19.42, and for total FIM scores, t (71) =21.45,
p<0.01; X=1.82 versus 4.41. There was no significant cor-
relation found between prealbumin changes and improved
total FIM scores. Improved total FIM scores and self-care
has significant negative correlations with LOS (r= -0.46,
p<0.01) and (r=-0.47, p<0.01) respectively. Fifty six patients
(78.9%) gained prealbumin with a mean gain of 6.1mg/dl.
Prealbumin gain was associated with higher FIM scores and
lower LOS.
Conclusions: In patients who suffered a fall with result-
ing fracture, improving nutritional status is associated with
improvement of functional levels and a decreased length of
stay in rehabilitation hospital.
STAFF RESPOND POSITIVELY WHEN OLDER
PATIENTS ARE PROVIDED WITH FALLS
PREVENTION EDUCATION
A.Hill1, N.Waldron2, J.Francis-Coad3, T.P.Haines6, (75.4%), polypharmacy 107 (93.9%). The functionality of
C.Etherton-Beer4, L.Flicker4, K.Ingram2, S.McPhail5, activity of daily living scale was evaluated with the Katz scale,
1. School of Physiotherapy and Exercise Science, Curtin
University, Perth, Western Australia, Australia, 2. WA
Department of Health, Perth, Western Australia, Australia,
3. The University of Notre Dame Australia, Fremantle,
Western Australia, Australia, 4. University of Western
Australia, Perth, Western Australia, Australia, 5. Queensland
University of Technology, Brisbane, Queensland, Australia,
6. Monash University, Melbourne, Victoria, Australia
Providing older patients with individualized falls preven-
tion education was found to significantly reduce rates of falls
IAGG 2017 World Congress
523
and injurious falls on hospital rehabilitation wards. The aim
of this study was to understand how staff responded to the
education and how they perceived the program impacted
on falls prevention on their wards. Focus groups were con-
ducted. Participants were clinical staff who were recruited
from hospital aged care rehabilitation wards which had pre-
viously participated in a cluster randomized trial. During
the trial trained health professionals provided individualized
falls prevention education to (n=757) patients with good lev-
els of cognition (Mini-Mental State Examination > 23/30).
Staff were also provided with training to support the pro-
gram. Staff feedback was sought after the trial concluded.
Data were thematically analysed. Five focus groups were
conducted at different hospitals with (n=30) multidiscipli-
nary staff. Staff perceived that the education program gener-
ated a positive culture around falls prevention on the wards.
The program facilitated a team approach, whereby patients
and staff worked together to address falls prevention, with
the educator viewed as a valued member of the team. Staff
identified that providing patients with education increased
their own knowledge and awareness about creating a safe
ward environment. Patients being proactive and empow-
ered to engage in falls prevention strategies was viewed as
enhancing staff falls prevention efforts and motivation to
change practice. Providing individualized patient education
to patients with good levels of cognition can empower staff
and patients to work as a team to address falls prevention on
hospital rehabilitation wards
CHARACTERISTICS OF THE PATIENTS WITH FEAR
OF FALLING SYNDROME IN MEXICAN ELDERLY
N.Sandoval1,2, C.Moreno Cervantes1,2, H.De la Vega
Flores1,2, J.Torres Gutirrez1,2, S.Saldana Cruz1,2, M.Ramos
Rojas1,2, J.Viveros Garcia1,2, 1. Universidad de Guanajuato,
Leon, Guanajuato, Mexico, 2. ISSSTE, Len, Guanajuato,
Mexico
The Fear of Falling Syndrome (FoF) is the feeling that
a person has to be in constant risk of falling, without nec-
essarily be preceded by a fall. We conducted an analytical
observational study, with patients 65years old, from refer-
ence hospital of Institute of security and social services state
workers. Who meet criteria for fall syndrome. As socio-demo-
graphic variables, anthropometric, clinical and biochemical
data were collected. 114 patients were included, 39 of them
met FoF criteria, the mean age was 82.5years (SD + 7.46),
and 78 (68.4%) were women. The main geriatric syndromes
encountered were major depressive disorder 80 (70.2%),
frailty 54 (47.4%), sensory dysfunctions 98 (85.9%), uri-
nary incontinence 58 (50.9%), gait and balance disorder 86
founding 41 patients (36.8%) A, 24 (21.9%) B, 10 (9.6%)
C, and less functionality 36 (31.7%) patients. Instrumental
activity of daily living was evaluated using Lawton scale
founding > 5/8 18 (15.8%) patients. The FoF prevalence was
34%, and was associated to patients with lower albumin lev-
els (p=0.04), higher HbA1c levels (p=0.02) and we identified
urinary incontinence OR 1.32 (CI 95%: 1.011.72) p=0.03
and orthostatic hypotension OR 10.56 (95% CI 9.9711.17)
p < 0.01. Declining functionality for FoF leads the elderly
person to a loss of quality of life. Knowledge of this entity is
524
limited, the results of meta-analysis are inconclusive, know-
ing the associated factors could contribute to the prevention
and management of this syndrome.
REDUCING FALL RISKS IN THE HOME USING
SIMULATION EDUCATION FOR HOSPITALIZED
GERIATRIC PATIENTS
K.Starhorsky, N.DeWalt, L.Drobnich Sulak, Cleveland
Clinic - Hillcrest Hospital, Mayfield Heights, Ohio
Falls are the number one reason for hospital admissions
and the leading cause of injuries among older adults. Each
year, 2.5 million older individuals are treated in emergency
departments for fall injuries and over 700,000 are hospital-
ized. As our population ages, the $34 billion annual cost for
US hospitals to treat falls will skyrocket. One out of three
adults 65 and older and one out of two 80years and older
fall each year. Falls account for 25% of hospital admis-
sions, 40% of nursing home admissions40% admitted do
not return to independent living and 25% die within a year
(CDC, 2012).
Hospital-based fall prevention strategies focus less
on education and more on restricting movement to keep
patients safe while in the hospital. These strategies should
focus on applicability to the home setting and emphasize
education, creating safer environments, and prioritizing fall-
related research to reduce risk. Simulation-based education
can provide a unique learning experience to maximize recall
and retention, bridge the gap between hospital-based learn-
ing and post-discharge compliance, and stimulate a desire to
make sustainable changes in the home to reduce injury risk.
Aminimal risk falls study launched in 2015 randomizes par-
ticipants to an intervention group using a permuted-block
randomization scheme to study the benefits of utilizing
simulation versus traditional, written education. Preliminary
results show significant advantages to using simulation
education including, but not limited to, 54% fewer people
experienced a fall and 38% fewer fell at least once after dis-
charge, and 82% made sustainable changes to their home
environment.
THE OTAGO EXERCISE PROGRAMRESULTS FROM
5 YEARS OF DISSEMINATION IN THE UNITED
STATES
T.E.Shubert1,2,3, M.Smith4, M.Ory5, 1. University of
North Carolina, Chapel Hill, North Carolina, 2. Shubert
Consulting, Chapel Hill, North Carolina, 3. South College,
Knoxville, Tennessee, 4. University of Georgia, Athens,
Georgia, 5. Texas A&M, College Station, Texas
The Otago Exercise Program (OEP) is an evidence-based
fall prevention program designed to be delivered by physical
therapists and physical therapy assistants in 6 visits over a
year period. Though highly effective, the program has been
challenging to translate for implementation in the United
States (US) due to a myriad of regulatory and reimbursement
barriers. Innovative delivery models have been developed
and tested in the US which have proven to be highly effective
and lower cost than the traditional OEP. Three models will
be compared in this paper: 1)The OEP delivered over an 8
week period: 2) the OEP delivered by non-PT; and 3) The
OEP delivered virtually using a kinect camera and moni-
tored remotely by a physical therapist. All three models have
Innovation in Aging, 2017, Vol. 1, No. S1
demonstrated significant improvements in fall risk outcome
measures. These innovative delivery models will be compared
and contrasted for cost effectiveness and outcomes, and key
characteristics of effective delivery sites will be presented.
ETHNICITY AND SOCIOECONOMIC STATUS AS
PLAYERS IN COMMUNITY-DWELLING OLDER
ADULTS FALLS
T.V.Gonzalez-Cano1,2, M.Chung1, B.Flores1, M.Martinez1,
A.Murray1, J.Ross1,2, S.Lee 2,1, L.C.Arevalo-Flechas2,1, 1.
University of Texas Health Science Center at San Antonio,
San Antonio, Texas, 2. South Texas Veterans Health Care
System, San Antonio, Texas
The United States is becoming older and increasingly
diverse in cultures, languages and socioeconomic stand-
ing. However, providing culturally and linguistically ade-
quate health promotion programs for ethnically diverse
older adults remains a challenge. Research investigating
the relationships between ethnicity, socioeconomic status
and disease has been limited. This clinical demonstration
project explored the relationship between falls and eth-
nicity and socioeconomic status in a group of community
dwelling older adults in San Antonio, TX, using a culturally
and linguistically adapted clinical video novela on fall pre-
vention. The video, available in English and Spanish, was
designed using quality indicators from the Assessing Care
for Vulnerable Older Elders (ACOVE) criteria. Data were
collected using pre and post surveys asking general demo-
graphic information, fall risk factors, general knowledge of
falls and satisfaction with video. Zip codes were used as a
proxy for socioeconomic status. Data were managed with
REDCap and analyzed using the SAS V9.4 statistical soft-
ware. 172 individuals attending different senior community
centers and one clinic screened the video. 45.2% self-identi-
fied as Hispanic. 31 watched the video in Spanish. Significant
relationships were found between mean household income
and fear of falling (chi2=11.92, df=3, p<0.05), ethnicity and
fall history (chi2=8, df=1,p<0.005), ethnicity and fall injury
(chi2=8, df=1, p<0.005) and ethnicity and risk of falling
(chi2=11.15, df=1, p<0.001). In conclusion, there are signifi-
cant differences in attitude towards falling among Hispanic
vs. non-Hispanic individuals and those from different socio-
economic levels. These differences must be considered when
designing and implementing fall prevention education pro-
grams in the community.
IMPACT OF 25(OH)D AND FALLS ON OLDEST OLD
SURVIVAL
T.de Pontes, P.F.Moreira, L.M.Araujo, C.de Mello
Almada Filho, M.S.Cendoroglo, Federal University of So
Paulo, So Paulo, So Paulo, Brazil
Introduction: Some factors that contribute to active aging
can benefit the raising number of oldest old people. Vitamin
D and life style have shown impact on functionality and
mortality. Objective: Evaluating if 25(OH)D, outdoor activ-
ity time and falls are predictors of survival in independent
oldest old. Methods: We selected 258 community-dwelling
and independent elderly people with 80years old or more.
We evaluated the mortality through the death certificate
or register in medical records from April 2010 to March
2016. During the survival analysis, we have used the models
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of Kaplan-Meier and Cox. Results: Around 70.5% were
women between 80 to 89 years old (80.2%), 38.8% had
daily sunlight exposure superior to 15 minutes and 20.1%
were chronic fallers. Regarding 25(OH)D, 9.3% had serum
levels < 10ng/mL, while 76.4% between 1030ng/mL and
14.3% showed values > 30ng/mL. During the observational
period, 65.9% of the old oldest have stayed independent,
and 17.1% have deceased. The analysis of survival time
have shown that men (HR=2.7, p=0.003), over 90years old
(HR= 4.12, p<0.001), with levels of 25(OH)VitD inferior to
10ng/mL (HR=3.2, p=0.004) and chronic fallers (HR=1.97,
p=0.042) have shown a lower survival in comparison to the
other oldest old. Conclusion: This study has identified a pro-
file of oldest old more susceptible to a higher risk of death.
SESSION 1015 (POSTER)
FAMILY AND INTERGENERATIONAL
RELATIONSHIPS III
ENTERING OR EXITING GRANDCHILD CARE
DURING THE ECONOMIC CRISIS IN THE U.S.
Y.Lee, Syracuse University, Syracuse, New York
Family members experience role-based household rela-
tionships as sets of resources and demands, including time,
money, skills, and attention. Grandparents have resources;
and family members have demands. Balance between
resources and demands affect the care they are able to pro-
vide and the care that adult children and their grandchildren
would need. However, less is known about the predictors
of transitions entering into and exiting the roles as grand-
child care during the economic downturns such as the Great
Recession. Using the three waves from the Health and
Retirement Study 2006~2010, data is drawn from 12,753
respondents in 2008 (Wave 9)with at least one living grand-
child with a parent. Using the logistic regression, total 33,802
grandparent-parent relationships clustered within multigen-
erational families were examined in this study. Findings show
that entering childcare occurs in hard times especially when
adult-childrens demands exceed grandparents resources.
At the economic recession, grandparents are most likely to
enter the roles as grandchild caregivers because of adult chil-
dren and their families needs arise. Grandparents are valued
resources for adult children who are in needs of childcare
services and economic assistance.
CARING FOR AGEING PARENTSGENDER
INEQUALITIES IN AGENDER-EQUAL WELFARE
STATE?
K.Herlofson, M.Veenstra, H.Vagen Nordbo, Oslo &
Akershus University College, NOVA, Oslo, Norway
Norway, together with the rest of Scandinavia, is often
seen as a vanguard with regard to changing gender roles. In
the last decades, an important goal has been the dual earner/
dual carer model. However, politics have been targeted cou-
ples with young children Adult childrens care for older par-
ents has received limited attention, and recent Norwegian
research has documented substantial gender differences in
allocation of public help depending on both parents and
IAGG 2017 World Congress
525
their childrens gender. Here, we address provision of care to
parents among adult children in Norway, by taking account
of both parents and childrens gender. We ask to what extent
the degree of parental needs impact on sons and daughters
care provision, and whether there are signs of more care
involvement among more modern (gender equality oriented)
men compared to more traditional men. The analyses are
based on data from the Norwegian Life course, Ageing and
Generation Study (N=14,884). The results show that sons are
more inclined to help, but only as long as their parents are
not in need of care. When parents, and mothers in particular,
need help, daughters are more involved, and with increasing
needs, gender differences become more and more marked. So
far, there are no signs of a more caring son among modern
men. The findings indicate that the gender equality debate
needs to move beyond the early family years and care for
children, and address division of care provision among adult
children when ageing parents become in need of help.
RECONCILING INTERGENERATIONAL
AMBIVALENCE AND ONWARD TO INTIMATE
JAPANESE AND KOREAN FATHERING
A.Kim, Sociology, International Christian University,
Tokyo, Japan
This research analyzes the process by which intimate
fathering is established among Japanese and Korean men.
Due to globalization, new ideals of fatherhood are chal-
lenging traditional paternal roles in Japan and South Korea.
Contemporary fathers striving to emulate more engaged
parenting often wrestle with painful recollections of their
own fathers stern, distant, and patriarchal approach. How
do men reconcile their aspirations for their own develop-
ment as parents with their often-conflicted relationships with
their fathers? Motivated by the concept of intergenerational
ambivalence and social construction of masculinity, this
study analyzes how Japanese and Korean participants of an
international mens movement called Father School, craft a
new fatherhood less tethered to breadwinning and distant
patriarchy. With Father School guidance, men practice inti-
mate fathering and adopt a life course frame that allows them
to reconcile their mixed feelings toward their fathers. Based
on the ethnographic study of multi-week seminars in the US,
South Korea, and Japan, I illustrate the processual mecha-
nisms that enable adult men to reconcile their ambivalence
toward their adult fathers and practice a more contemporary
fathering approach in their families. My analysis points to
letter writing to adult fathers, affective family bonding prac-
tices, and small group confessional activities, as core pro-
cesses that structure reconciliation and paternal change.
FORMAL CARE USE IN OLDER AGE: THE ROLE OF
MARITAL TRANSITIONS
A.Ermer, C.Proulx, University of Missouri, Columbia,
Missouri
When individuals need care, spouses are only second to
adult children in care provided (AARP, 2015). Thus, marital
transitions in later life may prompt changes in formal care
use. But work that examines marital status and formal care
uses cross sectional data without examining marital transi-
tions as they unfold. We employed longitudinal data from
526
6 waves (20022012) of the HRS (N = 8,160) to examine DOES LIVING WITH UNMARRIED ADULT CHILDREN
whether changes in marital status (i.e., transitions to mar-
riage, widowhood, or divorce) occurring in later life are asso-
ciated with formal care use (i.e., home healthcare, hospital
visits, doctor visits). Multilevel analyses were conducted in
SAS. Level 1 variables (time-varying) included marital transi-
tions, income, and outcome variables. Level 2 (time invari-
ant) variables included race, gender, age, baseline marital
status, and number of divorces, marriages, and times wid-
owed at baseline. Only final models and primary IVs are
presented. Transitions into divorce were not associated with
immediate or longterm changes in outcomes. Respondents
who married over the course of the study had a decreased
likelihood of using home health care (OR= 0.74, p=.049)
and reported more hospital visits (=0.10, p=.049) these children will also be anticipated to extend. This study aims
effects occurred in the wave immediately following marrying.
Respondents who transitioned into widowhood experienced
increases in number of doctors visits (=0.48, p=0.002) ships for elderly parents in Korea. Using quota sampling in
this effect occurred over time, not immediately. These results
emerged while considering marital status and marital histo-
ries at baseline and provide evidence of the impact of marital
transitions on formal care use in later life.
WITHIN-FAMILY DIFFERENCES IN LIVING
PROXIMITY AND INTERGENERATIONAL SUPPORT:
IMPLICATIONS ON OLDER PARENTS HEALTH IN
CHINA
L.Bao, California State University, Los Angeles, Los
Angeles, California
Research on the impact of living proximity on childrens
provision of support in Chinese families has been based
on cross-family designs. Recent studies of western fami-
lies have shown significant within-family differences in
intergenerational support. Taking the within-family differ-
ences approach this paper uses data from the China Health
and Retirement Longitudinal Study (CHARLS, 2013) to
examine how childrens relative living proximity to older
parents compared to that of their siblings influences their
support to parents. Results suggest that sibling children
at different living distance to parents coordinate/cooper-
ate in elderly support. Children who live relatively farther
among siblings provide the highest level of economic sup-
port but have the least contact with parents. While living
closer to parents among siblings is associated with the
most frequency contact with parents and the lowest level
of economic support. These patterns differ between rural
and urban parent-noncoresident child dyads, and are also
moderated by parents living arrangement, the gendered
division of elderly support, and the reciprocity between
parents and children. The effect of non-coresident chil-
drens relative proximity on provision of economic support
is less prominent if urban parents live with sons. Rural
daughters provision of economic support is less affected
by their relative living proximity to parents than rural
sons and differences in intergenerational contact associ-
ated with childrens relative living proximity to parents are
smaller for all daughters than for sons. Furthermore, dif-
ferences in childrens provision of economic support asso-
ciated with their relative living proximity are larger if rural
parents have provided grandchild caregiving for children.
Innovation in Aging, 2017, Vol. 1, No. S1
THREATEN MARITAL RELATIONSHIPS OF ELDERLY
KOREAN COUPLES?
S.Choi1, M.Sung2, Y.Choi3, J.Lee4, 1. Home Economics
Education, Korea National University of Education, Seoul,
Korea (the Republic of), 2. Korea National Open University,
Seoul, Korea (the Republic of), 3. Sangmyung University,
Seoul, Korea (the Republic of), 4. Seoul National University,
Seoul, Korea (the Republic of)
Coinciding with the global economic crisis, the age at
first marriage in Korea has been delayed. Traditionally, the
independence of adult children away from parents has been
expectable mainly when they get married, thus, it would
mean that for the elderly parents to live with their adult
to investigate whether co-residence between adult children
and older parents disrupts the quality of marital relation-
terms of living arrangements (living together vs. living apart),
500 elderly parents, having at least one unmarried child aged
35years old or above, were selected in Seoul, Korea in June
2016. The quality of marital relationships as a dependent
variable was measured with four concepts: marital satis-
faction, marital intimacy, marital consensus, and marital
conflict. Co-residence of parents with adult children as an
independent variable was measured with a binary variable.
Regular financial support for adult children and socio-demo-
graphic variables were controlled. Findings from a series of
OLS regression models and the ordered logit model show
that parents living with adult children were less likely to
report satisfaction, intimacy, and consensus in their marital
relationships than those who living apart from their adult
children, holding financial dependency of the child fixed.
However, co-residence with unmarried adult children was
not positively associated with marital conflicts between the
elderly couples. The present study has implications for the
marital relationships of elderly Korean couples by boomer-
ang and/or failure-to-launch families.
DOES CLOSENESS MATTER?: PARENTS
EXPERIENCES WITH CHILDREN SUFFERING
PROBLEMS AND DAILY WELL-BEING
M.Huo1, K.Kim2, S.Zarit3, K.L.Fingerman1, 1. University
of Texas at Austin, Austin, Texas, 2. University of
Massachusetts Boston, Boston, Massachusetts, 3. The
Pennsylvania State University, University Park, Pennsylvania
Research has established associations between childrens
problems (e.g., divorce, major health problem, addiction)
and parents well-being. Yet, few studies have examined
whether parents closeness to a child with these problems
accentuates the effects. The current study assessed aging par-
ents everyday experiences with grown children who were
incurring life problems. We asked whether feelings of close-
ness to the child moderated effects of daily experiences on
the aging parents daily mood and physical symptoms. Data
were from The Family Exchanges Study wave 2 conducted
in 2013. The sample included 207 parents (Mage = 79.86)
who reported during seven days on experiences includ-
ing pleasant encounters, stressful encounters, and stressful
thoughts about the adult children. Parents also reported their
mood (positive and negative affect) and physical symptoms
each day. Multilevel logistic regression models showed that
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
parents were more likely to have pleasant encounters and
less likely to have stressful thoughts about problem children
with high closeness than problem children with low close-
ness. Yet, parents stressful encounters with problem children
who were closer to parents did not differ significantly from
the encounters with problem children who were less close.
Further, multilevel regression models revealed that pleasant
encounters and stressful thoughts about problem children
with high rather than low closeness were associated with
parents better mood and fewer physical symptoms. Overall,
findings suggest that lack of closeness may especially exacer-
bate the negative effects of offsprings problems on parents
well-being.
TRANSNATIONAL FAMILY SUPPORT EXCHANGES:
AN EXAMINATION OF STRESS AND HEALTH
STATUS
J.M.Kalavar, Penn State New Kensington, New Kensington,
Pennsylvania
Increasing longevity and rapid globalization have spawned
the emergence of transnational families. Over the past forty
years, aging research has repeatedly demonstrated that caring
for an older person may affect the health and well-being of
the provider. While providing support long-distance within
a country is itself stressful, transnational support involves
the additional challenges of distance, visa, travel expenses,
cultural expectations, different circumstances, and different
types of resources.
The challenges of providing transnational support carry
implications for the health and well-being of both the elderly
parents and adult children residing in two different nations;
however, migrants and their families are said to also expe-
rience care provision stress. Using data gathered from an
online survey of 129 Asian Indian adults living in the USA
who have an elderly mother living in India, a comparison
between maternal health status and adult offspring health
status as well as self-reported stress levels by the support
provider was examined. The correlation between maternal
health status and adult offspring was not statistically signifi-
cant. However, findings show that marital stress was the high-
est ranked stressor, followed by guilt experiences, and time
difference between the two nations. The risks to the physical
and mental health of immigrants who provide transnational
support to elders are varied and multifold. Results facilitate
our understanding of how health care provision strategies
are maintained, modified, and generated in transnational
exchanges. Examining these transnational support experi-
ences may help us generate policy to mitigate the health risks
and stressors that these immigrant adults may face.
CORESIDENCE, GEOGRAPHIC PROXIMITY, AND
SOCIALLY PRODUCTIVE ENGAGEMENT AMONG
OLDER KOREANS
P.Ko, National University of Singapore, Singapore,
Singapore
The study investigates the relationships between living
arrangement of older Koreans and the engagement in socially
productive activities (attending classes, social clubs, volun-
teering, joining NGOs and interest groups). Literature based
on western contexts emphasizes that the individual resources,
including education and socioeconomic status matter to the
engagement. We argue that such a framework needs to add
IAGG 2017 World Congress
527
the intergenerational solidarity into consideration in East
Asia where older adults social life is closely embedded with
intergenerational relationships. Two hypotheses are tested:
(1) Family norm hypothesis- older parents who live with
their children would be more likely to engage in socially pro-
ductive activities. The reason is that living with children is
the late-life ideal and hence they would be more likely to
develop their social circles in such living arrangement. (2)
Assistance hypothesis- older parents who live with children
are less likely to engage in socially productive activities than
those who do not because it means that older parents need
assistance due to health decline. The empirical examinations
are based on two waves of Korean Longitudinal Study of
Ageing (KLoSA) (n=7,869). The preliminary findings based
on Wave 1 show that older adults whose children stay nearby
are more likely to engage in activities than those who live
with children while controlling for education, marital sta-
tus, gender, mental health and disabilities, supporting the
second hypothesis. The next step is to apply random effect
estimations based on two waves in order to test whether
when changes of living arrangement affect the engagement
in activities.
THE CHANGING LANDSCAPE OF LATE-LIFE
INTIMACY IN MODERN SWEDENA NATIONAL
PORTRAIT
T.M.Bildtgrd1, P.berg2, 1. Social work, Stockholms
Universitet, Stockholm, Sweden, 2. University of Gvle,
Gvle, Sweden
This paper focuses on union form in cross-gender rela-
tionships in later life, against the background of the trans-
formation of intimacy in late modernity. Results are based
on a survey to 6090 year old Swedes (n=1225; response
rate 42%) and European census data. Sweden seems to be
the only country where there are more divorced than wid-
owed people in this age group. Almost 1/3 of Swedes, aged
6090, categorized as singles by official Swedish census data
on civil status, are in fact living as LATs or cohabitants. In
new romantic relationships initiated 60+ the dominant union
form is LAT (70%) followed by cohabitation (26%), while
marriage is rare (4%). Less than 2 in 10 singles think that is
important to be married and among marrieds less than 8 in
10. Relationship history data shows that although half of the
respondents have been married only once, one third (33%)
have had 2+ cohabiting unions (marital/non-marital), half
(46%) 2+ established relationships, and a majority (66%) 3+
sexual partners. The results indicate that the transformation
of intimacy includes older Swedes. Discussion: Should we see
older people as a vanguard in the exploration of late modern
intimacy, rather than carriers of cultural lag?
SESSION 1020 (POSTER)
GAIT
ANKLE STRENGTH AND GAIT DYSFUNCTION IN
AGING PATIENTS
T.L.Kauffman1,2, H.Jeffries3, 1. Kauffman Physical Therapy,
Lancaster, Pennsylvania, 2. Academy of Geriatric Physical
Therapy, Madison, Wisconsin, 3. Curtin University, Perth,
Western Australia, Australia
528
Gait dysfunction in aging patients is often multi-factorial
and unfortunately, ankle strength is infrequently measured.
In our Balance Center we evaluated 13 females and 15 males,
mean age 79.6years, range 6299. All had co-morbidities but
primarily balance dysfunction, unsteady gait and some falls.
Dysmobility and loss of balance can occur in any direction.
The ankle contacts the ground first and gives critical propri-
oceptive and kinesthetic sensory information. Dorsiflexion
(DF), Plantar Flexion (PF), Eversion (EV) and Inversion (IN)
muscle strength was measured with a hand-held dynamom-
eter and calculated as a percentage of body weight.
The purpose of this study was to compare ankle strength
in the patients with a control group without gait dysfunction
which included 6 females and 4 males, mean age 75.3years.
The percentage of DF/PF strength was statistically signifi-
cantly less in the patients, 13.4% versus 28.7%. The percent-
age of EV/IN was also statistically significantly less in the
patients 13.2% versus 4.5%. Our patients with gait dysfunc-
tion were slightly more than 2 times weaker for DF/PF and
almost 3 times weaker in EV/IN compared to controls.
For EV/IN, 29% of the patients, but no control subjects,
generated less than 5 pounds of force. Clinically, this medio-
lateral weakness appeared to be a motor control problem
because many of the patients did not know how to evert or
invert the ankle and they lacked the kinesthesia.
In conclusion, our results indicate ankle weakness espe-
cially in the medio-lateral directions may be a factor in gait/
balance dysfunction and falls.
GAIT SPEED AND MORTALITY IN OLDER ADULTS:
WHY TIMING MATTERS
S.Karunananthan, C.Wolfson, Epidemiology, Biostatistics
and Occupational Health, McGill University, Montreal,
Quebec, Canada
Recently, an emerging body of literature has indicated a
strong association between poor gait speed and mortality.
However, these studies have several methodological limita-
tions. Based on secondary analysis of data from existing lon-
gitudinal studies of aging, they generally measure gait speed
at a single time point and use this time point as the time origin
in assessing the association between gait speed and survival
over several years. The objective of this study is to estimate
the association between gait speed and mortality, using a
meaningful time axis, and accounting for the time-varying
effects of other health characteristics. The study is based on
data from the Cardiovascular Health Study, a study of 5,201
individuals aged 65 years and over, with annual measure-
ments of gait speed and several covariates over a period of
10 years. Using age rather than time-on-study as the time-
axis, Iapply a time-varying Cox model to estimate the inde-
pendent effects of gait speed on morality, while accounting
for the effects of health characteristics, including depression,
cognitive function, and chronic disease. For comparison,
Iprovide estimates of models where variables are treated as
time-fixed. Overall, Ifound that the time-varying measure of
gait speed yields a stronger association with mortality com-
pared to the time-fixed measure. Furthermore, the control
for health and lifestyle factors attenuates the association in
women, but not in men. Using time-varying measures of gait
speed and controlling for health and lifestyle confounders
Innovation in Aging, 2017, Vol. 1, No. S1
provides a more meaningful estimate of the association
between gait speed and mortality.
CURVED-PATH WALKING: WHEN VARIABILITY IS
GOOD
K.Bland1, A.Dahlhauser1, A.Krajek1, E.Johnson2,
T.Woods3, W.Farrington1, K.A.Lowry1, 1. Des Moines
University, Des Moines, Iowa, 2. Iowa State University,
Ames, Iowa, 3. Grand View University, Des Moines, Iowa
The Figure-of-8 Walk test (F8W), a measure of walking
skill, incorporates both straight and curved paths. While gait
variability during straight-path walking is associated with
adverse outcomes, variability during curved-path walking is
critical for efficient turning. We examined variability of step
length (SLV), step time (STV), and stride width (SWV) dur-
ing F8W and expected greater variability in those with better
motor skill.
Thirty-two older adults (mean age 72.1 9.3 yrs) com-
pleted the F8W (walking a figure-of-8 around two cones 5
feet apart) on an instrumented walkway. Gait measures were:
1)variability, standard deviations of SLV, STV, and SWV, 2)
F8W number of steps and time to complete, s. We examined
differences in variability by skill group using ANOVAs (F8W
time 8 seconds (F8H, high skill), F8W time > 8 seconds
(F8L, low skill)). Correlations (r) adjusted for speed were
used to examine associations between F8W and variability.
Motor skill groups differed for SLV (SLV: F8H = 22.2,
F8L= 18.2, p=.024) and SWV (F8H = 23, F8L = 17.2,
p<.001); no group differences for STV. Variability measures
related to curved-path walking ability, F8W time (SLV, r=
-.40, SWV r=-.70, STV r=-.51), and number of steps (SLV, r=
-.42, SWV r=-.80, STV r=-.60).
Better motor skill in walking is associated with greater
spatial variability. Individuals with better curved path
walking ability (F8W time) are able to actively adjust spa-
tial parameters for the walking task. Rehabilitation should
include practice of curved paths and experience in active
adjustments of step length and width.
LOW TEST-RETEST RELIABILITY OF GAIT
VARIABILITY: AN INDICATOR OF POOR MOBILITY
AND BALANCE?
M.Almarwani1,2, J.Brach2, 1. King Saud University, Riyadh,
Saudi Arabia, 2. University of Pittsburgh, Pittsburgh,
Pennsylvania
Test retest reliability of gait variability is less than ideal,
i.e. ICC <0.70. Low test-retest reliability or inconsistency
of gait variability may be an indicator of impaired mobility,
balance and overall health of the older adult. Our purpose
was to examine the association of inconsistency of step time
variability to mobility, balance and health in older adults.
Participants included 46 community dwelling older adults
who could ambulate independently (mean age=78.09years,
SD= 6.2). Gait characteristics were measured twice, one
week apart, using a computerized walkway. Step time vari-
ability (STV) was the standard deviation of the step times for
all steps recorded during one session. Mobility, balance and
health were measured during the first session using gait speed
and global questions of mobility, balance, health and vigor.
Using the difference of the STV measures from sessions 1 and
2 two groups were created: 1)inconsistent (IN, n=14), STV
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Innovation in Aging, 2017, Vol. 1, No. S1
difference from session to session > 0.013s, 2) consistent
(CN, n=32) STV difference from session to session < 0.013s.
Differences between groups were determined by independent
t-tests and Chi-square. IN compared to CN, walked slower
(0.83 vs 1.01 m/s) and was less likely to report good or better
mobility (36% vs 78%) and balance (21% vs 63%), all ps <
0.05. Overall health and vigor were similar between groups.
Inconsistency in step time variability from week to week in
older adults may not be due to measurement error, but may
actually be an indicator of impaired mobility and balance.
INHIBITION, PROPRIOCEPTION AND STEPPING
PERFORMANCE: IS THERE ASPECIFIC RELATION IN
OLDER ADULTS?
J.Magnard1, C.Cornu1, G.Berrut2, T.Deschamps1, 1. WRo = 0.03, WR1 = 0.03, WR2 = .04; SLV: WRo = 3.4,
Laboratory Movement, Interactions, Performance (E.A.
4334), University of Nantes, France, Nantes, France, 2.
Investigation Clinical Center of Gerontology Department,
Teaching Nantes Hospital, France, Nantes, France
The perceptual inhibitory process has been suggested to
be specifically involved in the integration of proprioceptive
information that is necessary for an efficient postural per-
formance in older adults. This ongoing study aimed to inves-
tigate the perceptual and motor inhibition requirements of
planning and executing a choice step initiation task in young
and older adults following experimental perturbation of
proprioceptive information using bilateral Achilles tendon
vibrations. Two groups (n~50 each) of young adults (range
age 1830years), and healthy older adults (>65years of age)
were asked to perform an inhibitory stepping reaction time
(RT) task in which the participants had to step as quickly as
possible in response to visual arrows that manipulated spe-
cific perceptual or motor inhibition, in two conditions: with
or without vibrations. The preliminary results (up-to-date
n~10) showed that the vibrations induced higher RT per-
formances irrespective of the perceptual or motor inhibition
demands. Any specific role of the perceptual inhibition into
the processing of proprioceptive inputs needs to be confirmed
in healthy older adults. Compared to younger adults, older
adults have greater variability in step behaviour, with longer
total stepping time, when using localized vibrations in condi-
tions requiring inhibition. More participants continue to be
included to determine robustly whether modulating afferent
proprioceptive inputs and inhibition are two processes that
share, at least in part, the same cognitive resources in older
adults, while executing a choice step. But the current results
validate the view that inhibitory process is a core executive
function of dynamic postural control.
NEUROMOTOR CONTROL, AGING AND EVERYDAY
WALKING
K.A.Lowry1, J.M.Van Swearingen2, 1. Physical Therapy,
Des Moines University, Des Moines, Iowa, 2. University of
Pittsburgh, Pittsburgh, Pennsylvania
Neuromotor control and efficiency of walking is repre-
sented in the optimal relationship between step length and
cadence (walk ratio, WR). Aging results in suboptimal WRs
and inefficient walking. In older adults, we explored the neu-
romotor control of usual walking, WR, and motor skill in
usual (gait variability) and curved path walking (Figure-of-8
walk, F8W). Older adults (n=82, mean age 74.9 yrs. 7.5)
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529
participated. Walking measures derived from an instrumented
walkway: 1)WR, step length (m)/cadence (steps/min), 2)gait
speed, cm/s, 3)gait variability, standard deviations of stance
time (STV, s), step length (SLV, cm), and 4)F8W time, s, and
number of steps to complete. WR categories were defined by
distance from optimal range (WRo=optimal, WR1=sub-
optimal, WR2 = most suboptimal). ANOVAs were used to
compare mean variability and F8W time and steps across
WR categories, with test for trend (ptrend). The F8W time and
steps increased, and usual speed decreased across WR cat-
egories (F8W time, s: WRo=7.7, WR1=9.2, WR2=10.7;
F8W steps: WRo=13.7, WR1=15.2, WR2=18.1; speed,
cm/s: WRo=116, WR1=106, WR2=90; all ptrend <.001).
Variability did not differ across WR categories (STV, s:
WR1 = 3.0, WR2 = 3.6, ptrend = .145, ptrend = .400, respec-
tively). Neuromotor control in walking is important for the
adaptability needed to switch between straight- and curved-
paths, typical of everyday walking.
INCREASED DIFFICULTY OF DUAL-MOTOR TASKS
EFFECTS STEP LENGTH IN YOUNG AND OLDER
HEALTHY ADULTS
K.Watson, J.A.Blaskewicz Boron, S.Myers, J.Yentes,
Biomechanics, University of Nebraska at Omaha, Omaha,
Nebraska
Many adults have difficulty doing two things at once,
especially walking and completing another motor task. In
older adults, this could lead to a fall. Further, falls during
walking have been associated with changes in gait variability
or the natural stride-to-stride fluctuations while walking. The
aging process contributes to a more variable gait cycle, which
contributes to falls, and has been used to predict falls occur-
rence. This project investigated the effect of task difficulty
during dual-motor tasking on gait variability in young and
older healthy adults. Fifteen young adults (20.62 years,
167.46.5cm, 65.05kg), and five older adults (723years,
169.213.3cm, 68.710.9kg) completed of a series of dual-
task conditions, 3 minutes each, where the opaqueness of
the tray and/or the amount of water in glasses on top of the
tray (task difficulty) varied while walking on a self-paced
treadmill. For each condition: sample entropy was calcu-
lated on step length, step time and step width. Older adults
showed significantly less repetitive step length values than
young adults (p=0.04). Step length was less repetitive during
baseline walking as compared to conditions in which vision
or task difficulty was altered (ps=0.005, 0.021, 0.006, <.001
respectively). Larger sample size may help increase the signif-
icant differences between groups: trends suggest that a sec-
ondary motor task impacts step length in both populations.
Older adults were impacted to a greater extent suggesting a
more variable, less repetitive gait, consistent with previous
literature in prediction of falls.
ROAD NETWORK HILLINESS AND DEVELOPMENT
OF WALKING DIFFICULTIES AMONG COMMUNITY-
DWELLING OLDER PEOPLE
K.Keskinen, M.Rantakokko, T.Rantanen, E.Portegijs,
Gerontology Research Center and Faculty of Sport and
Health Sciences, University of Jyvskyl, Finland
530
Aims: To study associations between objective road net-
work hilliness and development of walking difficulties (WD)
within two years, and to examine how hilliness as a perceived
barrier and frequency of moving through the neighborhood
affect to this.
Methods: Prospective analyses of community-dwelling
75-90-year-old people without any WD at baseline and living
at the same address throughout the 2-year follow-up (n=546,
59% women). The average slope in the road network within
500m distance from home was defined using GIS (range
2.711.2%). Self-reports of hilliness as perceived barrier for
outdoor mobility (yes/no) and frequency of moving through
the neighborhood (03 / 4 times a week) were collected at
baseline, and WD over 500m (yes/no) at baseline and follow-
up. Logistic regression analyses were adjusted for age, gen-
der, number of chronic conditions, years of education, years
in current address, and length of road network.
Findings: Of the participants 18% perceived hilliness as
a barrier, 15% moved through the neighborhood 03 times
a week, and 15% developed WD over the 2-year follow-up.
Higher road network slope increased the risk for develop-
ing WD (OR=1.22,CI 1.011.48). Hilliness perceived as a
barrier (OR=1.51,CI 0.842.74) and frequency of moving
through the neighborhood (OR=3.41,CI 1.946.02) attenu-
ated the association between the road network slope and
WD (OR=1.21,CI 0.9951.47).
Conclusions: Hilliness perceived as a barrier and fre-
quency of moving through the neighborhood partly medi-
ate the association between objective road network slope
and WD. Further study is needed to determine how hilliness
affects behavior and consequently the development of WD.
EFFECTS OF VIRTUAL UPHILL WALKING ON
ENERGY EXPENDITURE AND LOCOMOTOR-
RESPIRATORY COUPLING
W.Denton, M.Mukherjee, N.Stergiou, J.Yentes,
Biomechanics, University of Nebraska at Omaha, Omaha,
Nebraska
Uphill walking becomes more difficult with age due to
physiological changes. Aerobic respiration which increases
to meet the increased energy demand becomes limited. The
link between our movements and breathing that maximizes
economy is termed locomotor-respiratory coupling (LRC).
This project expands on previous LRC research using incline
as the independent variable instead of walking speed. Virtual
reality also provided level or uphill environments to see if
vision could alter energy expenditure and LRC. Participants,
4 older adults (693.6years, 16012.4cm, 61.311.6kg) INTERVENTIONS
and 10 younger adults (22.51.2 years, 175.28.0cm,
77.99.0kg), walked on a treadmill that was either level
(0%-grade) or inclined (10%-grade) while paired with level
or inclined virtual reality. Abaseline condition (level walk-
ing with no virtual reality) and an oscillating condition (level
walking with sinusoidal level-uphill virtual reality) were also
included. Average energy expenditure was used to quantify
the energy requirement and cross recurrence quantification
analysis (cRQA) was used to quantify LRC. Although not
significant, energy expenditure decreased with the addition
of virtual reality for the older group, while it increased for
the younger group and while energy expenditure was similar
Innovation in Aging, 2017, Vol. 1, No. S1
for all level conditions, the older group used less energy for
inclined walking. Additionally, older adults always required
a larger radius for cRQA (p=0.032) and cRQAs max line,
mean line, and entropy may become significant with a larger
sample size as they were always lower for the older group.
Older adults exhibited less coupling, yet required less energy
during uphill walking than younger adults.
EFFECT OF MOTOR-COGNITIVE TRAINING ON
POSTURAL CONTROL OF ELDERLY: SYSTEMATIC
REVIEW
E.M.Varise, J.R.Bacha, G.Gomes, J.Pompeu, University
of So Paulo, So Paulo, So Paulo, Brazil
Objective: To analyze the effectiveness of motor-cognitive
training on postural control of elderly people. Methods: We
conducted a search in the databases PubMed and Web of
Science, considering the period of 2011 to 2016,using the
strategy: (aged OR elderly OR older adult OR older
people OR older person OR geriatric AND dual task
OR dual-task OR dual task training OR dual tasking
OR dual task elderly OR dual-task training OR cogni-
tive engine OR cognitive-motor OR dual task cognitive
engine OR motor cognitive dual task OR multi tasking
OR multi-task). We selected randomized clinical trials
(RCTs) that used motor-cognitive training to improve pos-
tural control of elderly people. Papers not available in full in
the collection of on-line journals USP Library, duplicates and
studies that did not assess the static or dynamic postural con-
trol were excluded. Results: The search strategy result in 15
studies (122 in PubMed and 93 in the Web of Science). It was
selected 12studies. Most articles demonstrated superiority of
different types of cognitive-motor training (CMT) compared
to isolated training to improve postural balance and tem-
poral gait parameters, with and without dual task. Training
once a week demonstrated positive effects on the march, but
long-term training attenuated the decline in physical func-
tion of older people in many ways. Adherence for cognitive
training improves executive function, especially when man-
agement tasks. The incidence of falls and fractures reduced
one year after training. Conclusions: The motor-cognitive
training improves postural control, cognition, quality of life
and reduces falls of elderly people.
SESSION 1025 (POSTER)
HEALTH AND SOCIAL SERVICE ASSESSMENTS AND
PROMOTING THE HEALTH OF RURAL CAREGIVERS
THROUGH THE CAREGIVER LITERACY SERIES
E.T.Jurkowski, Southern Illinois University at Carbondale,
Carbondale, Illinois
Repeatedly as multidisciplinary professionals we are con-
cerned about the individual patient we serve especially
as we consider their cognitive and neurological needs. The
Caregiver Literacy Series, is a series of ten specific modules
designed to enhance the coping of the caregiver and fam-
ily members through scientific and educational resources.
Four specific therapeutic workbooks and accompanying
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Innovation in Aging, 2017, Vol. 1, No. S1
CDs provides an overview of information about the specific
neurological and biological aspects of the dementia disorder
and how these aspects affect the individuals behavior. The
series designed through the use of the Self Efficacy Model
(Bandura, 1968)and Prochaska and DiClementes Stages of
Change (1988) theoretical frameworks has demonstrated
some positive impact in improving ones understanding
of the illness, decreasing caregiver burnout and improv-
ing depression levels for users. The efficacy of these educa-
tional tools was measured by various psychometric scales
including the Care giving Burden scale, Compassion Fatigue
and Satisfaction Scale and Center for Epidemiologic Study
Depression Inventory. Some of the educational module top-
ics include Understanding the Care giving Role; Care giving
and Depression; Care giving and People with Alzheimers
Disease; Care giving and People with Behavioral Issues. This
presentation will showcase the specific modules of the series
related to Alzheimers Disease, and showcase data on the
efficacy of this intervention in a rural population of caregiv-
ers meeting the needs of their loved ones advancing in age.
Qualitative and qualitative results suggest that these tools
provide both information and respite to the potentially iso-
lated caregiver and aids in the coping process.
FROM PASSIVE CARE TO ACTIVE CARE:
PROMOTING SENIORS HEALTH WITH HOME CARE
AIDES
N.Muramatsu1, L.Yin1, M.L.Berbaum1, D.Marquez1, among older adults can be identified and seniors referred to
D.A.Jurivich2, J.P.Zanoni1, S.M.Walton1, K.Y.Cruz appropriate services and supports to enhance positive health
Madrid1, 1. University of Illinois at Chicago, Chicago,
Illinois, 2. University of North Dakota, Grand Forks, North
Dakota
As aging societies strive to strengthen home and commu-
nity-based services systems, home care aides (HCAs), also
called personal care assistants, play increasingly important
roles for frail older adults. In the current home care para-
digm of passive care, HCAs provide prescribed help with
daily activities, rather than actively stimulate older clients
reserves to maintain independence. To innovate home care
practice, we piloted a safe, low-cost physical activity pro-
gram delivered by HCAs for older adults in a Medicaid-
funded home care setting in the United States. HCAs were
trained to deliver a brief motivational enhancement and
three chair-bound movements to motivate their clients to do
physical activity daily and help maintain their independence.
Mixed methods were used to evaluate the 4-month interven-
tion. Survey data showed significant improvement in clients
function to perform daily activities targeted by the interven-
tion (p<.01) as well as in clients physical performance tests
and other outcomes such as reduced interference with daily
activities due to pain and fear of falling. The program was
well-received by home care clients (N=54) and their HCAs
(N=46) as indicated by the high retention rates and by
remarks provided by clients and their HCAs. Building physi-
cal activity into the everyday care of older adults and the
routine job of HCAs is feasible. The promising results urge a
cultural shift in home care towards an active service model
in which home care aides and their clients work together
on a safe, simple physical activity program to maintain or
improve function to remain in the community.
IAGG 2017 World Congress
531
SCREENING OLDER ADULTS FOR FOOD
INSECURITY DURING CHECK-UPS: WHAT DO
HEALTH PROFESSIONALS THINK?
J.Pooler, V.Hoffman, F.Karva, Health Services, IMPAQ
International, Windham, Maine
Food security screening is becoming increasingly com-
mon at well-child visits in the U.S. Systematic screening of
older adults for food insecurity is much less common, despite
increasing rates of food insecurity among seniors and the sig-
nificant impact of food insecurity on health outcomes and
chronic disease. Our study sought to understand health pro-
fessionals attitudes and beliefs about food security screening
and referrals for older adults and barriers to implementation.
We conducted 20-minute telephone interviews with a diverse
group of health professionals (n=16) who are currently
seeing older patients and do not currently screen for food
insecurity in routine practice. Overall, those interviewed
recognized the importance of good nutrition and food secu-
rity for older patients and did not think a 2-item screener
would be difficult to administer in routine practice. Three
major challenges were identified: limited time available to
meet with patients, a lack of resources available to address
food insecurity when it is identified, and prioritizing food
insecurity at both the health system and the patient levels,
when competing interests such as billing and required screen-
ings or chronic conditions and other social needs are present.
Primary care practice may be one place where food insecurity
outcomes and encourage management of chronic diseases.
While community services are a critical piece in the referral
process, health systems and insurers may consider ways to
seamlessly integrate screening and discussions with patients
around food insecurity.
EFFECTS OF EMPATHY CLUBS ON HEALTH CARE
AMONG HIV-AFFECTED GRANDPARENT-HEADED
HOUSEHOLDS IN VIETNAM
L.M.Harris1, J.Wilfong1, V.Schmidt1, N.Thang2, 1. Kent
School of Social Work, University of Louisville, Louisville,
Kentucky, 2. Cooperation and Development (CESVI), Hai
Phong, Viet Nam
In areas of Vietnam with high rates of HIV/AIDS, Empathy
Clubs (ECs) have become interventions for grandparents rais-
ing grandchildren. ECs offer psychosocial care and knowl-
edge of community resources, such as healthcare events. This
mixed methods study aimed to 1)explore the factors influ-
encing health care for grandparents and grandchildren and
2)understand the differences in health care access between
grandparents in ECs and those who are not. The research
team interviewed 30 grandparents raising grandchildren in
urban and rural areas of Hai Phong, Vietnam. Fifteen of the
grandparents were involved in ECs and fifteen were not. The
grandparents completed the Access to Healthcare Scale and
a qualitative interview. The results showed a statistically
significant difference between the two groups t (2)=6.53,
p=0.04 and indicated that EC membership contributed to
free healthcare for grandchildren. 73% of the EC group had
free healthcare for their grandchildren compared to 26.6%
of the non-EC group. The study found that ECs were most
successful in terms of HIV testing for grandchildren. 100%
532
of the grandparents in the EC group had their grandchildren
tested, whereas only 40% in the non-EC group had their
grandchildren tested. Qualitative findings indicated that both
groups of grandparents were not accessing healthcare ser-
vices to address their significant health needs. The majority
of the grandparents experienced barriers such as limited or
no health insurance, physical health problems, poverty, and
stress. Attributes that improved health among the grandpar-
ents included access to community health events, HIV test-
ing, social support through ECs, resilience, and sacrifice.
COMMUNITY COMPREHENSIVE GERIATRICS
ASSESSMENT WITH SERVICE DEVELOPMENT IN
CAMBODIA
H.C.Cooper, S.Hean, B.Cordory, Grace House discussion on finitude. It is concluded that the Community
Community Centre, Siem Reap, Cambodia
Cambodia is a health poor country with health expendi-
ture 5.68% of GDP in 2014 according to the WHO, with an
ageing population. In the 2008 census, 6.34% of the popu-
lation were over 60, rising to 11.1% predicted by 2030. At
present there are no focused services existing in the country
to care for the complex and specific health needs of older
people and very little in terms of expertise.
A consultant geriatrician from the UK and a Cambodian
social worker, undertook comprehensive geriatrics assess-
ment (CGA) in the community, identifying and assessing
older people for their health, financial and social needs. We
studied 38 older people age 59 to 92 over a 4month period
in 3 semi-rural villages in Siem Reap province.
Many of the health needs in older people in Cambodia are
very similar to those recognised in developed countries, such
as cardiovascular disease, diabetes, incontinence, dementia
and poor mobility. For example, of the 38 surveyed 29%
suffered from severe incontinence affecting quality of life,
34% had difficulty using their squat toilet, 68% had prob-
lems with their vision and it was considered that 37% would
benefit from a physiotherapist.
The service that was developed involved a trained social
worker co-ordinating access and transport to health services
that already exist, provision of equipment, expertise in physi-
otherapy, nutritional support and financial assistance when
required.
We produced a simple, reproducible, cost-effective model
to deliver basic health and social care support to older people
in a developing country with an ageing population.
QUALITY ASSESSMENT OF ELDERLY LIFE OF
COMMUNITY DWELLING PROJECT IN RIO DE
JANEIRO, BRAZIL
C.Brasil1, A.Brando2, C.Chaves2, H.L.Furtado3,1, 1. health information and make appropriate decisions regard-
Commission of the Elderly, Chamber of Deputies - Brazil,
Brasilia - DF, Brazil, 2. Municipal Secretariat of Active
Ageing, Resilience and Care, Rio de Janeiro, Brazil, 3.
Castelo Branco University, Rio de Janeiro, Brazil
Currently, Brazil has 23% of its population consisting of
elderly. Seeking better health conditions and quality of life,
the participation and social support networks are the focus of
gerontology. The Community Dwelling Project for the Elderly
of the Municipal Secretariat of Active Ageing, Resilience and
Care (SEMEARC) of Rio de Janeiro City Government gives
users a space of coexistence and social integration through
Innovation in Aging, 2017, Vol. 1, No. S1
various activities. The objective was to evaluate the quality
of life of elders in the program. We conducted an explora-
tory, transversal and descriptive quantitative research. The
sample consisted of 113 women aged 73.057.50. To meas-
ure the quality of life, WHOQOL Bref and WHOQOL
Old were used. The results for the WHOQOL-BREF point
to Global Life Quality with 71.8%, the highest score in the
psychological domain with 74.7% and the lowest score in
the environmental domain with 66.3%. As for the results of
the WHOQOL-OLD, they indicate a total average score of
73.95%. The sensorimotor functioning facet had the highest
average score 81.58%, showing good sensory performance.
However, the death or die facet obtained the lowest aver-
age 67.48%, showing that there is a need to broaden the
Dwelling Program helps to raise self-esteem and improve the
quality of life of elderly, demonstrating itself to be an efficient
public policy for the elderly population of Rio de Janeiro.
MERGING HEALTH CARE WITH SENIOR HOUSING:
APROCESS EVALUATION
T.Barry, Arcadia University, Glenside, Pennsylvania
This paper reports the results of a case study on a success-
ful partnership between a large health care organization and
housing for seniors that resulted in lower emergency room
visits and hospitalizations. The program provides on-site,
primary care visits by a physician and a nurse in addition to
intensive social services to residents in an affordable senior
housing apartment building located in Pennsylvania. Using
Avedis Donabedians Structure-Process-Outcome model as
a theoretical framework, this study sought to provide guid-
ance for replication in similar settings.
With program structures in place and outcomes meas-
ured, this case study collected and analyzed qualitative infor-
mation taken from program documents and key informant
interviews on care processes involved in the program.
Qualitative analysis identified common processes across
respondents; however, the nuanced processes that lead to
successful outcomes suggest that defined structures and pro-
cesses may not be sufficient to produce similar outcomes in
other settings. Further research is needed to determine the
programs replicability and policy implications.
HEALTH LITERACY AMONG KOREAN ADULTS AND
KOREAN IMMIGRANTS IN THE U.S.
S.Chung1, H.Lee2, M.Lee1, S.Chung1, 1. Ewha Womans
University, Seoul, Seoul, Korea (the Republic of), 2.
University of Minnesota, Twin Cities, Minnesota
Background: Health literacy is necessary to understand
ing ones health. Largely influenced by cultural setting as well
as age, to date no study has compared age-specific health
literacy between immigrants and people from their home
country.
Objective: This study aims to investigate (1) the health
literacy level of Korean citizens and Korean immigrants in
the United States (U.S.) and (2) factors that influence health
literacy across three age groups (2044, 4564, and 65 and
older).
Methods: Aquota sampling method was used to collect
cross-sectional survey data from 404 Korean participants
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Innovation in Aging, 2017, Vol. 1, No. S1
and 404 Korean immigrants. The Korean Participatns data
were collected from Februrary to March 2014 and data of
Korean immigrants in U.S.were collected in 2009. Andersens
behavioral model, with its three components of predisposing,
enabling, and need factors, was used as the theoretical frame-
work for this study.
Results: Korean participants had a higher mean score on
health literacy than did the Korean immigrants. Only one of
predisposing (gender) and enabling factors (education) were
significant variables influencing health literacy in Korean
immigrants, while several predisposing (gender, employment,
religion, and economic status), enabling (education and fre-
quency of doctor visit) and need (frequency of doctor visit)
factors were significantly associated with health literacy in
Korean adults. These results were different from the three
age groups.
Conclusion: Our findings indicate that Korean adults in
both countries need to have a community-based health liter-
acy educational program that is tailored to the needs of each
age group. This age-specific and geographically competent
intervention program will eventually reduce the health dis-
parity disproportionally experienced by these at-risk popula-
tions with low health literacy.
WHATS PAST IS PROLOGUE: FINDINGS FROM
WIGL PROJECT WAVE 1 ON BEING AWOMAN
GERONTOLOGIST
D.B.Bradley1, P.P.Brown2, C.Bennett3, C.L.Estes4, 1. various actors with diverse roles and intentions.
Center for Gerontology, Western Kentucky University,
Bowling Green, Kentucky, 2. Winston-Salem State
University, Winston Salem, North Carolina, 3. University
of Maryland Baltimore County, Baltimore, Maryland,
4. University of California San Francisco, San Francisco,
California
WIGL (Women in Gerontology Legacy) Project emanates
from the Gerontological Society of Americas Task Force
(now Committee) on Women, and captures the life course
trajectories of older female gerontologists via audio, video,
and written interviews. Over 36months, WIGL researchers
interviewed 53 women gerontologists who have been active
in research, education, and/or applied work for between
2540 years. Professional association recognition of study
participants academic and applied achievements qualified
them for study inclusion. One aspect of these interviews
focused on examining how participants own experiences
with aging influenced their professional growth and contri-
butions. After qualitative analysis, two predominant themes
emerged: interconnectedness and personal gerontologist,
based on professional expertise. Within interconnectedness,
interviewees demonstrated a great range in how their own
aging experiences had impacted their research agendas.
Brody (2010) who stated, my future perspective is informed
by my past and present perspectives, best captures this
interconnectedness between professional and personal lives.
The second theme, personal gerontologist, revealed the myr-
iad ways in which individuals responded to older women
gerontologists. While family and friends who were dealing
with aging-related issues accessed many for advice, a number
of interviewees confirmed that this was not the case, despite
their many years in the aging field. Since WIGL participants
are well-known for their contributions to theoretical and
IAGG 2017 World Congress
533
applied gerontology, their experiences as women gerontolo-
gists adds depth to our understanding of what it means to
balance personal and professional identities, and roles.
IMPLEMENTING INTEGRATED SERVICES AT
THE NATIONAL LEVEL: AVIEW OF 25 YEARS OF
INNOVATIONS IN QUEBEC
Y.Couturier, University of Sherbrooke, Sherbrooke,
Quebec, Canada
For 25years, Quebec has been very innovative in the inte-
gration of services. Integrated service models are innovations
involving various operational components (Case manage-
ment, etc.), that can be implemented in various ways: let it
happen, help it happen or make it happen, and applied to
different essential works for change management. Cloutier
and collaborators (2015), describe four of such works:
1. A conceptual work, which involves the creation and
communication of stable representations, which are helpful
in guiding the action of the various actors.
2. A structural work, which consists of the consolidation
of the regulatory aspects of the system, that is, the redistri-
bution of formal action capacities of actors involved in the
intended change.
3. An operational work, which involves the creation of
conditions such that the actors who are targeted by the inno-
vation actually experiment new ways of doing things.
4. A relational work, which involves the accompanying of
This presentation summarizes the evolution of this move-
ment of integration of services from the early 1990s until
today through an analysis of the speech of 130 key witnesses
of these transformations. Though we observe a strong con-
ceptual continuity between successive reforms, it is clear
that the movement seems to be moving on a conceptual
standardization of the integration of services. Is the inte-
gration of services project inherently technocratic? Given
the Quebec experience, it seems that yes, although this fact
is less the result of conceptual models as of their empirical
implementation.
GARMENTS AS TRANSITIONAL OBJECTS:
NEW POSSIBILITIES IN RE-EVALUATING THE
SUBORDINATE SENSE OF TOUCH
E.Mbonu, University for the Creative Arts, Epsom, Surrey,
United Kingdom
Universally the hierarchy of the senses predicates visual
dominance. Hearing is largely perceived as second in line, in
the West, followed by, the subordinate senses of touch, taste
and smell (Roque S L etal 2015). This paper will argue the
efficacy found in the transitional object for persons living
with dementia who have moved from their familiar home to
the unfamiliar environment of a care-home is largely due to
the surface of the object the tactile quality, perhaps even
more than the physicality and presence of the object itself.
Using garments as transitional objects and focusing on the
key component, cloth, this paper aims to explore new pos-
sibilities in how people living with dementia experience the
world they live in.
This study gathered information from residents living
with dementia (from moderate decline to moderately severe
decline) in a care home setting. Avariety of meaningful and
534
engaging sensory activities involving cloth, garments and
accessories formed the basis of the study. Semi-structured
interviews were also conducted to gather qualitative data.
The types and textures of fabrics that have elicited a
measurable positive response amongst the participants will
be described. The implications of their responses to these fab-
rics within the context of comfort, sensation, memory and
familiarity will be discussed.
The sense of (meaningful) touch is under-rated and needs
to be re-evaluated for the positive benefits that it can bring
to persons living with dementia within a care-home setting.
HEALTH BEHAVIORS AND HEALTH OUTCOMES:
COMPARISON AMONG THREE OLDER AGE
COHORTS
Y.Su, H.Obhi, E.Beck, J.A.Margrett, Iowa State
University, Ames, Iowa
Previous research found differences in social involvement,
aging perception and health status among different older age
cohorts (Field & Minkler, 1988; Garfein & Herzog, 1995;
Seccombe & Ishii-Kuntz, 1991). In the current study, we
aim to examine differences in both health-related behaviors
and health outcomes among the three age groups: young
old (6574), the old (7584), and the oldest old (85 +). To
investigate this, we collected data from older adults residing
in one Midwest county (N=433), among which 76% were
female and 28.2% were young-old (n= 122), 42.3% were old
(n=183) and 29.6% were the oldest old (n=128). Aseries
of analysis of variance tests and chi-square tests were con-
ducted. The results showed no significant difference in self-
reported chronic diseases [x2 (2, N=433)=4.25, p=.12],
self-reported depression [x2 (2, N = 433) = 1.63, p = .44],
exercise duration every time they exercise [F (2,430)=1, p
=.37], nor in exercise frequency [F (2,430)=2.79, p =.06].
However, the old had significantly higher social participation
frequency than young old [x2 (1, N=305)=6.51, p=.01]
and the oldest old [x2 (1, N = 311) = 4.86, p = .03]. Our
results showed no significant differences in health outcomes
but differences in health behaviors (social participation) were
apparent. Thus, our study implied the compensatory effect of
social participation in health and the fact that more attention
may need to be paid to young-old.
HOW CAN WE HELP?: ABIO-PSYCHO-SOCIAL
RISK SCREENER FOR COMMUNITY DETECTION OF
VULNERABLE ELDERS
Z.J.Hildon1, C.Tan1, F.Shiraz1, W.Ng2, X.Deng1,
G.C.Koh1, K.Tan3, H.J.Vrijhoef1, 1. Saw Swee Hock
School of Public Health, Singapore, Singapore, 2. Tsao
Foundation, Singapore, Singapore, 3. Ministry of Health,
Singapore, Singapore
We examine additive effects of BioPyschoSocial (BPS)
health to help identify vulnerable elders, and link them to
appropriate care. Objectives are, to (1) outline a theoreti-
cal basis for measure (2) report BPS Risk Screeners items
and test its structure, and (3) discuss the tools application
to interventions, both as a stratified care-planning tool and
as an outcome for evaluation. Aquantitative cross-sectional,
psychometric study was conducted using face-to-face survey
Innovation in Aging, 2017, Vol. 1, No. S1
interviews with n=1,325 Singaporean elders, aged over 60
carried out in their homes. Standardized questionnaires
(Easy-Care standard 2010 and Lubben Social network
Scale) were included to help determine BPS domains using
factor analysis. Three individual B(io),P(sycho) and S(ocial)
domains were derived, then a combined BPS managing score
was tested against: self-reported general health; number
of falls; cognitive impairment; longstanding diseases; and
linked data on utilisation of tertiary care. Results showed
52 questionnaire items were reduced to 35 (factor loadings
over 0.5), which were in three distinct BPS clusters. These
were independently associated with self-reported health: B:
1.99 (1.64 to 2.41), P: 1.59 (1.28 to 1.98), S: 1.33 (1.10 to
1.60), and the fit improved when combined into an additive
BPS score 2.33 (1.92 to 2.83, <0.01). The score predicted
mounting risk, particularly between lower and higher lev-
els (score of 4 or over) for service usage outcomes. The BPS
Risk screeners greatest attribute is that it renders the clients
domain needs transparent, and can inform future care plan-
ning for elders. The use of the tool will also depend on the
intervention goals.
DEMENTIA CARE MAPPING (DCM): ODDS OF ITS
USE AS AN OBSERVATORY TOOL TO MEASURE
QUALITY OF CARE
A.Dilara1,2, A.J.Astell1,2,3, 1. Research and Academics,
Ontario Shores Center for Mental Health, Whitby, Ontario,
Canada, 2. University of Toronto, Toronto, Ontario,
Canada, 3. University of Sheffield, Sheffield, United
Kingdom
A literature review was performed to present critique
and to understand use of Dementia Care Mapping (DCM)
in different patient situations. The review aimed to help in
decision making for choosing DCM as an assessment tool
to measure care-quality based on patients optimal needs.
Keywords and thesaurus searches were performed in Ovid
interdisciplinary databases to find articles those specifi-
cally used DCM to measure quality and published between
1992 and 2016. Medical Subject Headings (MeSH) search
terms dementia care mapping AND quality of life was
used. Other keywords were well-being, quality of care,
wellbeing, quality-of-life, quality-of-care, QOL and
DCM. Out of sixty one yielded results, seventeen articles
met inclusion criteria and were examined in this review. The
critiques included inadequate sample size, sampling bias,
short evaluation periods and a lack of consideration of the
confounding variables commonly associated with dementia.
Methods used to validate the use of DCM in different stud-
ies were highlighted. The review identified DCM has good
validity and inter-rater reliability. However, content validity
remains less convincing and it can only be considered as a
moderately valid instrument for patients suffering from mod-
erate to severe dementia. Although DCM is a very useful and
one-of-a kind tool for staffs who wish to improve the qual-
ity of their care, but it is a very time-consuming method and
requires considerable training and attention of responders to
complete the forms. It is recommended that this tool should
be amended and used side-by-side of other tools to compare
correlations of outcome measures.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
DEVELOPMENT AND PILOT OF AN INDEPENDENT
CARE ASSESSMENT FRAMEWORK IN SINGAPORE
R.Choo, D.Chia, P.Chow, I.Chung, W.Loong Mun, reflections on the screener administration; 4) stakeholder
S.Ho, Z.Sum, Care Integration Division, Agency for
Integrated Care, Singapore, Singapore, Singapore
In Singapore there is currently no consistent assess-
ment tool or process which can identify a patients cogni-
tive, functional and social needs to determine what services
would enable ageing in place. For this reason, Singapore has
embarked on an Independent Care Assessment Framework
(ICAF) pilot to standardise how patients are referred into
long term care services and to build a consistent language of
assessment for continuity of care.
The pilot encompasses (1) the development of an eligi-
bility assessment tool to capture the essential parameters
to determine a clients care needs and (2) the creation of an
algorithm which can generate a hierarchical care needs level
score to guide service recommendations.
The ICAF pilot began in January 2016 and will be car-
ried out over two years in all public hospitals and selected
long-term care services in Singapore.This process will be car-
ried out in consultation with an appointed Clinical Advisory
Panel.An iterative approach will be applied where continual
enhancements to the algorithm and assessment will be made
upon analysis of data collected.The agreement between care
needs assigned by experienced assessors and the algorithm
will be studied and used to inform improvements to the
framework.
Based on the data collected thus far (N=200), 41% of cli-
ents are male while 58% are female. Their average age is
76years old. Seventy-one percent are cognitively impaired,
63% have functional impairment and 42% are socially at-
risk. These parameters will continue to be monitored during
the on-going ICAF pilot study.
RECOMMENDATIONS FOR IMPLEMENTING
ABIO-PSYCHO-SOCIAL RISK SCREENER FOR
STRATIFIED CARE AT OLDER AGES
Z.Z.Lim1,2, F.Shiraz2, W.Ng1, H.J.Vrijhoef2,3,4, tive tools available.
Z.J.Hildon2,5, 1. Tsao Foundation, Singapore, Singapore,
2. Saw Swee Hock School of Public Health, National
University of Singapore, Singapore, Singapore, 3. National
University Health System, Singapore, Singapore, 4.
Department of Patient & Care, Maastricht University
Medical Center, Maastricht, Netherlands, 5. London
School of Hygiene and Tropical Medicine, London, United
Kingdom
Background: Successful translation of evidence-based
innovations to real-world settings is dependent on inno-
vation attributes, implementation context and strategies.
This study was conducted to explore translational issues,
at a pre-adoption phase, for a novel BioPsychoSocial (BPS)
risk screener developed to inform stratified care at older
ages. Methods: qualitative mixed methods were conducted
with elders themselves, policy makers, community service
providers and clinical referral teams: 1)administration of
the screener to the elders (n=40) and managing scores
IAGG 2017 World Congress
535
generated; 2)in-depth interviews to explore the elders views
on suitability of survey and their scores; 3) researchers
focus groups (n=6) on strategies to improve implementa-
tion. Results: Three key translational approaches and two
key strategies (i.e., adaptation and integration) were iden-
tified. First, screener attributes (in terms of its relevance,
compatibility and simplicity) can be improved through
cultural adaptation of the screener and integration of risk
screening with interventions. Second, survey methodology
can be adapted to better engage with the elders, who exhib-
ited varying degrees of interest, ability and truthfulness.
Third, existing workflow in home visits conducted by com-
munity workers can be adapted to incorporate the screener.
New screener administrators should also be identified care-
fully and trained on both administration skills and cultural
competency in engaging the elders. Conclusion: The BPS
risk screener had demonstrated favourable attributes for
its translation to a context of multiethnic community-
dwelling elders. Adaptation strategies would connect the
screener to the elders; whereas integration strategies would
connect the screener to the existing delivery system.
DEVELOPMENT OF APERSON-CENTRED
COGNITIVE TOOL: HOW TO PROVIDE STRENGTH-
BASED MEMORY CARE
M.DSouza, L.Venturato, M.Gil, University of Calgary,
Calgary, Alberta, Canada
As the aging population grows, there is an increasing
focus on interventions that support person-centred and
wellness-based approaches to care for older adults. This is
particularly evident for those in supported living (SL) cen-
tres and the community, where the focus is on maximizing
strengths, and reducing the need for admission to long-term
or acute settings for more advanced care. Despite this, cur-
rent cognitive assessment tools focus primarily on diagnosis
or functional deficits in order to determine care needs, while
there are limited strength-based and person-centered cogni-
Our research challenges this practice gap through under-
standing the gold standard of person-centered care, in order
to develop a tool that supports a wellness-focused approach
to meet residents everyday lifestyle goals and health support
needs. This participatory action research study is a partner-
ship between the Geriatric Research Unit at the University
of Calgary and United Active Living, a SL facility in Calgary.
In this study, researchers work alongside Memory Care staff
and cognitive residents in developing an assessment approach
that incorporates resident goals, memory care programming
considerations, and cognitive support to maximize resident
well-being.
This presentation will argue for critical engagement with
a person-centred care philosophy that moves from the rheto-
ric of the approach to the application of the philosophy in
relation to assessment. We will overview the process involved
in developing the tool and present the draft assessment tool
for discussion.
536
SESSION 1030 (POSTER)
HEALTH CARE NEEDS AND UTILIZATION
OLDEST-OLD PATIENTS IN ACUTE CARE
HOSPITALS: APORTUGUESE NATIONWIDE 15-YEAR
RETROSPECTIVE STUDY
D.Brandao1,2,3, A.Freitas2,3, O.Ribeiro1,3, M.Paul1,3, among extremely long-lived individuals, which is in line with
1. UNIFAI / ICBAS.UP, Porto, Portugal, 2. Faculty of
Medicine, University of Porto (FMUP), Porto, Portugal, 3.
CINTESIS, Porto, Portugal
The oldest old is one of the fastest growing segments of
the population in most developed countries. This exponential
growth is expected to place a heavy demand on healthcare
systems worldwide, since the oldest old are intensive users
of healthcare services. This study aims to analyze inpatient
hospitalizations by persons aged 80+ between 2000 and
2014 in Portugal. Administrative data from all public acute
care hospitals in the Portuguese National Health Service was
considered (national hospitalization database). Exploratory
descriptive analyses regarding the number and nature of the
episodes and discharge diagnoses were performed. A total
of 1.837,613 inpatient episodes (number that doubled from
80590 in 2000 to 166210 in 2014) were analyzed. The
majority were unplanned admissions (85.9%), of which
73% were medical (without any surgical intervention) and
12.9% were surgical. The most frequent diagnoses (clas-
sified in Major Diagnostic Categories) were Diseases and
Disorders of the Respiratory System (22.2%), Diseases and
Disorders of the Circulatory System (17.1%), and Diseases
and Disorders of the Nervous System (10.8%). This study
pointed to an increasing importance of oldest old patients in
acute care hospitals, and provides insights into the clinical
characteristics of these patients. The demand for hospital ser-
vices by the oldest old should be a major concern for policy
agents and healthcare professionals. Further studies should
focus on variables associated with adverse outcomes, namely
in-hospital mortality rates.
TRENDS IN HOSPITAL ADMISSIONS BY
PORTUGUESE CENTENARIANS
D.Brandao2,1,3, O.Ribeiro2,3, A.Freitas1,3, M.Paul2,3, 1. parts. Among older adults with opioid abuse, gender, mental
Faculty of Medicine, University of Porto (FMUP), Porto,
Portugal, 2. UNIFAI / ICBAS.UP, Porto, Portugal, 3.
CINTESIS, Porto, Portugal
The number of centenarians worldwide is projected to
increase rapidly from 441,000 in 2013 to 3.4 million in 2050.
In Portugal, centenarians almost tripled over the last decade
from 589 in 2001, to 1526 in 2011. The aim of this study is to
examine hospitalisations between 2000 and 2014 by patients
aged 100+ years using administrative data from all public hos-
pitals in the Portuguese National Health Service located in the
continent. ICD-9-CM codes associated to secondary diagnoses
and the Charlson Comorbidity Index were considered to assess
comorbidities. Exploratory descriptive analyses of data regard-
ing the number of episodes, discharge diagnoses and comor-
bidities were performed. During the 15-years period, a total of
6,410 episodes of hospital admissions occurred, most of which
were inpatient episodes (94.7%). The number of admissions
more than doubled from 311 in 2000, to 688 in 2014. Most
Innovation in Aging, 2017, Vol. 1, No. S1
frequent discharge diagnoses (grouped by CCS) were pneumo-
nia (19.9%), fracture of neck of femur (hip) (7.8%), acute cer-
ebrovascular disease (5.6%), and non-hypertensive congestive
heart failure (4.7%). Most frequent comorbidities in inpatient
episodes were congestive heart failure (16.4%) and renal dis-
ease (10.2%). Our findings document the importance of respir-
atory and cardiovascular diseases as reasons for hospitalization
the main causes of mortality in Portugal. Further studies should
be conducted in order to identify the impacts of increased hos-
pital admission rates among this population, in order to better
manage their care needs and improve service delivery.
HEALTHCARE UTILIZATION AND BEHAVIORAL
HEALTH IN OLDER ADULTS WITH OPIOID ABUSE
Y.Chang, S.Casucci, Y.Xue, S.Hewner, University at
Buffalo, Buffalo, New York
Opioid abusers, particularly those that are middle-aged
adults and older, often suffer from co-occurring mental
health, chronic pain, and other substance use problems. Yet,
little is known about the utilization of hospital and commu-
nity based care services for this group. This study compared
differences in healthcare utilization among middle-aged
and older adults with opioid abuse to age-matched indi-
viduals without opioid abuse; and (2) identified predictors
of healthcare utilization in older adults with opioid abuse
diagnoses. Our study sample (N=58,934) included Western
New York Medicaid recipients aged 50 and above during the
June 2014-June 2015 period. Using data mining methods,
risk factors influencing healthcare utilization were identi-
fied, and included mental health, chronic pain, smoking, and
other substance abuse diagnoses. Healthcare utilization was
categorized by the number of in-patient, out-patient, and
emergency department encounters during the study period.
Correlational statistics were used to compare utilization dif-
ferences between opioid abusers and people without opioid
abuse. A generalized linear model with Poisson error and
log link was used to identify predictors of healthcare utiliza-
tions for opioid abusers. Results indicate that opioid abusers
had significantly higher utilization across different types of
healthcare services compared to their age-matched counter-
health comorbidities, smoking, other substance use disor-
ders, and chronic pain were significant predictors of health-
care utilization. These results will enable future opioid abuse
treatment research to modify treatment plans based upon the
unique care needs of this population.
HEALTH ECONOMIC EVALUATION OF CASE
MANAGEMENT FOR FRAIL OLDER PEOPLE:
EFFECTS OF AN RCT
M.Sandberg1, U.Jakobsson2, P.Midlv2, J.Kristensson1,
1. Department of Health Sciences, Lund University, Lund,
Sweden, 2. Department of Clinical Sciences Malmo, Lund
University, Lund, Sweden
The aim of this study was to evaluate the effects of a case
management intervention for frail older people (aged 65+
years) by cost and utility. In total 153 frail older people living
at home were randomly assigned to either an intervention
(n=80) or a control group (n=73). The 1-year intervention
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
was carried out by nurses and physiotherapists working as
case managers, who undertook home visits at least once a
month. Differences in costs, EQ-5D and EQ-VAS based
quality-adjusted life years (QALYs), and incremental cost-
effectiveness ratio were investigated. All analyses used the
intention-to-treat principle. For the 1-year study, no signifi-
cant differences between the intervention and control groups
for total costs, EQ-5D-based QALY or EQ-VAS-based QALY
were found. Incremental cost-effectiveness ratio analysis
was not conducted because no significant differences were
found for QALYs or total costs. However, the intervention
group had significantly lower levels of informal care in terms
of help with instrumental activities of daily living both as
costs (3,927 vs. 6,550, p = 0.037) and provided hours FG) used a semi-structured format with open-ended ques-
(200 vs. 333 hours per year, p=0.037). The conclusions are
that the intervention was cost neutral and does not seem to
have affected health-related quality of life. One reason may
be a too short follow-up period. The intervention reduced
informal care in hours and cost of help with instrumental
activities of daily living. This suggests that the intervention
provides relief to informal caregivers.
IMPACT OF HEALTHY AGING ON MEDICAL AND
LONG-TERM CARE EXPENDITURES IN THE LAST
YEAR OF LIFE
H.Yoshida1, T.Furuna2, H.Makizako3, T.Akanuma4, lation, caregiver issues, and interventions to improve care.
K.Yokoyama4, T.Suzuki5,3, 1. Tohoku Bunka Gakuen
University, Sendai, Japan, 2. Sapporo Medical University,
Sapporo, Japan, 3. National Center for Geriatrics and
Gerontology, Obu, Japan, 4. Bibai City Office, Bibai, Japan,
5. Institute for Aging and Development of J.F.Oberlin
University, Machida, Japan
This study examined the impact of healthy aging on medi-
cal and long-term care expenditures in the last year of life in
Japanese older adults. The subjects were those aged 65years
(n=326) who died in fiscal 2013 in Bibai, Hokkaido, Japan
and used public medical and long-term care insurance ser-
vices at least one time in fiscal 2013. We classified the sub-
jects into three groups: < 80years old (n=76), 8089years
old (n=155), and 90 years old (n=95). We compared the
mean medical and long-term care expenditures per capita
among the three groups during the last year, and deter-
mined whether aging affected these expenditures. The larg-
est expenditure were that for those with <80years old (4.45
million yen), followed in turn by those with 8089years old
(4.09 million yen) and those with 90years old (3.78 million
yen). Also only in women (n=169), the largest expenditure
were that for those with <80 years old (5.41 million yen),
followed in turn by those with 8089years old (4.57 million
yen) and those with 90years old (3.84 million yen), and, in
addition, using general linear models and post-hoc test, those
with <80 years old were significantly larger for those with
90years old (p=0.015). In conclusion, healthy aging could
reduce terminal care cost in Japanese older adults.
BEHAVIORAL HEALTH CARE NEEDS AMONG AGING
VETERANS IN RURAL OUTPATIENT CLINICS:
PROVIDERS VIEWPOINTS
M.K.Luptak1, B.Hicken2, L.Greenberg3, M.Grant2, eastern Germany. The study population comprises all those
R.Mabe3, K.Parry2, R.Rupper4,1, 1. University of Utah, reaching the age of 100 or older on December 31, 2013
Salt Lake City, Utah, 2. Veterans Rural Health Resource
IAGG 2017 World Congress
537
Center - Western Region, Salt Lake City, Utah, 3. George
E.Wahlen Department of Veterans Affairs Medical Center,
Salt Lake City, Utah, 4. VA Geriatric Research, Education,
and Clinical Center, Salt Lake City, Utah
Aging Veterans frequently have cognitive and behavioral
health problems in addition to physical health issues. Meeting
these complex needs is challenging, particularly in rural areas
with scarce resources. This project utilized an exploratory
qualitative data collection method to better understand and
address these needs.
Focus groups (FG) of rural providers (N=62) were con-
ducted on site at eight VHA Community Based Outpatient
Clinics (CBOCs) in three western states. Facilitators (2 per
tions to prompt conversations among participants about
patients complex behavioral health and physical health
issues, family/caregiver concerns, clinic workflow, internal/
external referrals, and desired services/resources. FG ses-
sions were digitally recorded and transcribed verbatim with
participant consent. Observation notes were also completed.
Analysis began with an a priori set of coding categories (FG
questions). We employed team coding to identify and refine
codes and categories as new themes and patterns surfaced.
Three major themes (with multiple subthemes) emerged
from the discussions: challenges working with this popu-
Subthemes include provider burden, remoteness from urban
medical center, difficulties coordinating specialty services,
barriers to providing family and caregiver support; and dif-
ficulty navigating resource networks.
Rural providers from VHA CBOCs in the western
U.S. identified numerous challenges that complicate care
for aging Veterans with co-morbid cognitive and behavio-
ral health issues in rural settings and also offered practical
suggestions to improve care. Findings are informing develop-
ment of an evidence-informed intervention to improve access
to specialty behavioral health care for these Veterans.
GENDER-SPECIFIC PREVALENCE OF
COMORBIDITIES AND USE OF HEALTH CARE
SERVICES IN GERMAN CENTENARIANS
D.Draeger1, T.Zahn2, P.v.Berenberg-Goler1, G.Paul1,
J.Neuwirth2, A.Kuhlmey1, 1. Charite - Universittsmedizin
Berlin, Berlin, Germany, 2. GeWINO Institut der AOK
Nordost, Berlin, Germany
Centenarians are the fastest growing segment of the pop-
ulation in many industrial nations; most of them are women.
However, research on gender differences in terms of demo-
graphic characteristics, chronic conditions, and use of medi-
cal, pharmacological, and nursing care services is sparse.
To draw on to describe the socio-demographic character-
istics of the centenarian population and patterns of use of
medical, pharmacological, and nursing care services in this
population separately for men and women.
This descriptive analysis will be based on master data
from 1.8 million persons insured with a German statutory
health insurance fund who were resident in Berlin or north
(N=1,121).
538
The number of centenarians increased between 2006 and
2013 by 25% in Berlin and by 59% in north eastern Germany.
In terms of gender differences, the vast majority of centenar-
ians are female (91%). Men accounted for only 9.2% of the
100+ year olds, and for none of those aged 107109. The
half of the centenarians were in long-term care. Women were
more often in long-term care and less often without any care
compared with men. Further findings on the gender-specific
use of health care services will be discussed.
The study provides insights into health service use
in centenarians against the background of their existing
health conditions. The findings contribute to the gender-
specific development of needs-based care structures for this
population.
GERIATRIC CARE POSTMEGA EARTHQUAKE 2015
NEPAL
B.Pant1,2,3, S.Banjade1, 1. Geriatric Society of Nepal,
Kathmandu, Nepal, 2. POSSIBLE, Kathmandu, Nepal, 3.
Grande International Hospital, Kathmandu, Nepal
Nepal was hit by a devastating earthquake of 7.8 magni-
tudes on 25 April 2015 followed by a strong aftershock on
12 May. Over 8 million people are affected in 39 out of 75
districts, 11 of which are most critically hit. This caused over
8,670 deaths, injured 21,422. As a consequence 2.8 million
people have been displaced. The most affected from this dis-
aster are the Children and Geriatrics.
The consequences of earthquakes on elderly population
are not limited to physical injuries but also results in an
increase in adverse consequences of chronic illness because
of lack of regular checkup-followup facilities and shortage of
medicines. The affected people are neither able to travel for
medical services nor can get access at their local levels. Lack
of attention of the family members, absence of social security,
non-availability of hospital care and financial dependency on
children or relative are the prominent factors which worsen
the life of Geriatrics.
Considering this fact, the Geriatric Society of Nepal
(GSN) ran Health Camps with special focuses for Geriatrics
to protect them from health issues and impact of earthquake.
These GSN Health Camps concentrated on Health Check-up
for earthquake affected patients, Psychosocial counseling for
traumatized and stressed people, Referral and follow up ser-
vices for elderly, Health care education for patients and their
family members.
This type of targeted Health Camps post Disaster helps
in understanding the needs of Geriatrics and solves them
locally. The vulnerable group of elderly population should be
taken well care post any disaster.
PREVENTION OF CATHETER-ASSOCIATED URINARY
TRACT INFECTION IN ACOMMUNITY HOSPITAL
IN SINGAPORE
J.Koh, S.Agustinus, R.Bte Abu Hassan, Y.Phyu Thinn, sexual throughout their lives, considered physical intimacy
B.Ng, Ang Mo Kio-Thye Hua Kwan Hospital, Singapore,
Singapore
Background: Catheter-associated urinary tract infection
(CAUTI) is a common hospital acquired infection which can
lead to prolonged hospitalisation and mortality. Ang Mo
Innovation in Aging, 2017, Vol. 1, No. S1
Kio-Thye Hua Kwan Hospital is a 360-bedded Community
Hospital in Singapore, providing inpatient rehabilitation
and subacute care. The majority of patients are geriatric and
referred from tertiary hospitals.
A multidisciplinary Quality Improvement team was
formed in March 2015 to reduce CAUTI.
Aim
The median CAUTI rate was 5.3 per 1000 catheter days
in 2014. We aim to reduce CAUTI rate by 30% in 3years.
Methods: Analysis of CAUTI cases showed majority
had an indwelling catheter (IDC) on admission and devel-
oped CAUTI with the same IDC. The identified gaps were:
Inefficient CAUTI data collection, lapses in IDC care and no
IDC removal protocol.
Changes tested and implemented in stages at a pilot ward:
- Improved CAUTI data collection method
- IDC reminder system
- Nurse-led protocol to empower nurses to remove
catheters
- Using S hook to lower urine bag during ambulation
- Daily audit of IDC care
Frontline staffs were engaged regularly for feedback. The
changes were modified, tested and improved after PDSA
cycles.
Results: CAUTI cases in the pilot ward reduced from 13
to 6 from 2014 to 2015, with 2 cases detected in the first
5months of 2016. Results on compliance to IDC care have
also been encouraging.
Conclusion: We plan to test and spread the changes to
other wards to reduce CAUTI rate in the hospital. Getting
feedback and buy-in from the ground helps in designing sus-
tainable changes.
SESSION 1035 (POSTER)
LONG-TERM CARE AND ASSISTED LIVING I
BEDTIME: PARTNERED BABY BOOMERS PRIVACY
EXPECTATIONS IN RESIDENTIAL CARE
A.Rahn, University of New England, Armidale, New South
Wales, Australia
Many couples in Australian residential care facilities
experience institutional interference in their sexual relation-
ships. Duty of care usually takes precedence over privacy.
Some institutions separate couples, residents doors may be
kept open at all times, staff enter without knocking, ignore
do not disturb signs, or gossip about residents. In this pres-
entation I report on findings of a phenomenological study
using a self-administered online survey of partnered Baby
Boomers (born 194665) conducted in 2016, which reveals
their attitudes to these intrusions and their expectations of
privacy. The majority of respondents expected to remain
with their partners essential to their wellbeing, and required
a high degree of privacy to maintain their relationships in
care settings. Many expressed it was their business, and no-
one elses, what happened in their rooms. Recommendations
for providers include (1) clear written policies in relation to
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
residents privacy; (2) individual privacy assessments of resi-
dents upon admission; (3) inclusion of privacy needs in resi-
dent care plans; and (4) creation of a culture that allows staff
and residents to develop understanding and rapport with
each other. Enabling new residents and their families to make
informed decisions when choosing a facility has the potential
to improve the experiences of both residents and staff.
PERCEIVED BARRIERS AND FACILITATORS TO
HOME AND COMMUNITY-BASED PLACEMENT IN
THE VETERANS HEALTH ADMINISTRATION
E.A.Miller2,4,6, E.Gadbois4,6, S.Gidmark6, O.Intrator3,4,5, Ageing and Retirement in Europe, combined with national
J.L.Rudolph4,6, 2. University of Massachusetts Boston,
Boston, Massachusetts, 3. Canandaigua VA Medical Center,
Canandaigua, New York, 4. Brown University, Providence,
Rhode Island, 5. University of Rochester, Rochester, New
York, 6. Providence VA Medical Center, Providence, Rhode
Island
The U.S. Department of Veterans Affairs (VA) administers
the largest integrated health care system within the United
States with more than 1,700 sites of care serving close to
8.8 million Veterans annually. The demand for VA funded
long-term services and supports have risen concomitantly
with the aging of the Veterans population. Because national
VA policy has been to rebalance the provision of long-term
care away from nursing homes and towards home- and
community-based services (HCBS) options, lessons from the
VAs experience in promoting greater use of non-institutional
services and supports may prove informative for other initia-
tives seeking to shift the locus of care internationally. The
purpose of this study is to identify factors that promote or
impede the diversion of long-term care recipients from insti-
tutional nursing home care to non-institutional HCBS dur-
ing the long-term care referral process, a heretofore limited
area of study. Data derives from analysis of thirty-five semi-
structured interviews performed with key informants from
12 VA Medical Centers (VAMCs). Results indicate that care
teams recommend whether or not to refer Veterans for an
HCBS or nursing home consult. Veterans care needs and
preferences and social and financial resources influence these
recommendations; so too does the perspectives of care team
members. Lack of staffing and failure to offer the specific
types of services needed limits the use of HCBS. Distance
and crime/safety concerns pose further barriers in rural
and urban jurisdictions, respectively. Budgetary imperatives
influence the relative availability of HCBS across VAMCs.
Findings highlight the impact of provider-level practices and
system-level constraints in impeding the successful diversion
of long-term care recipients from nursing homes to alterna-
tive settings in the home and community.
THE RELATIONSHIP BETWEEN CHANGES IN HOME
CARE EXPENDITURE AND USE OF INFORMAL CARE
D.Verbeek-Oudijk, I.Woittiez, Labour and Public Services,
Netherlands Institute for Social Research, The Hague,
Netherlands
In light of population ageing combined with cuts in gov-
ernment spending the financial sustainability of long-term
care is high on the political agenda in many countries. In this
paper we examine the relationship between rising home care
expenditure and use of informal care among independent
IAGG 2017 World Congress
539
community-dwelling persons aged over 50 in eight European
countries. We use data from 2004 to 2013 a period charac-
terised by rising expenditure and investments in home care.
The eight countries studied are Austria, Belgium, Denmark,
France, Germany, the Netherlands, Spain and Switzerland.
Unlike other studies we include expenditure on home care
in our analysis as a characteristic of the care system next to
individual factors such as need, predisposing factors and ena-
bling factors. We analyse the effect of a change in home care
expenditure using multinomial logistic regression with fixed
effects on the longitudinal data from the Survey of Health,
data on home care expenditure from the OECD (Organisation
for Economic Co-operation and Development).
We find that, when home care expenditure in a country
rises, fewer over-50s receive informal care. Consequently, the
average informal care use in the European countries studied
was lower in 2013 than nine years earlier. The changes in
home care expenditure mainly affected people with milder
care needs, who have several options open to them for meet-
ing those needs.
CHALLENGES TO SUCCESSFUL TRANSITIONS FROM
INSTITUTIONS TO LIVING IN THE COMMUNITY
N.A.Shugrue1, M.Porter1, D.Lambert2, J.T.Robison1, 1.
University of Connecticut, Farmington, Connecticut, 2. CT
Department of Social Services, Hartford, Connecticut
The Money Follows the Person Rebalancing
Demonstration (MFP) is a U.S.initiative helping states tran-
sition people needing long-term services and supports from
institutional settings to the community in order to honor
individual preferences and rebalance Medicaid expenditures.
In Connecticut, MFP transition coordinators complete a
standardized checklist of transition challenges for each indi-
vidual during the transition process. Twelve challenge cate-
gories are recorded cumulatively until the person transitions,
or if not transitioning, until the case closes. Quality of life
surveys are completed at baseline, 6, 12, and 24months after
transition. This study examined transition challenges as pre-
dictors of successful transitions, including length of time to
transition, risk of post-transition reinstitutionalization, and
post-transition community integration. Analysis of challenge
checklists (n=7021) indicates that persons whose cases closed
without transitioning had significantly greater challenges
relating to physical (OR=1.2) or mental health (OR=1.3),
consumer engagement (OR=1.8), other involved individuals
(OR=1.7), and home and community-based services (HCBS)
programs (OR=1.5). For persons who transitioned, five chal-
lenges significantly (p<.05) and independently predicted
longer transition times: consumer engagement, housing,
legal issues, HCBS programs, and other involved individu-
als. Challenges with mental health and engagement prior
to transition significantly predicted reinstitutionalization
twelve months following transition. Participants with mental
health and nursing facility challenges had lower community
engagement at 6 months after transition, while those with
physical health and services challenges had less community
engagement across all three follow-up times. Knowledge of
pre-transition challenges enables program managers to make
540
policy and programmatic changes to enhance the probability
of timely, successful transitions.
DEVELOPMENT OF AUNIVERSAL SATISFACTION
SCORE FOR LONG-TERM CARE FACILITIES
N.G.Castle1, L.Schwartz2, 1. University of Pittsburgh,
Allison Park, Pennsylvania, 2. AHCA, Washington, District
of Columbia
Collecting satisfaction information from long-term care
residents is important. We have seen a philosophical change
in healthcare that now includes the patient and their prefer-
ences, as an integral part of the system of care. However,
numerous satisfaction surveys exist and no uniform satisfac-
tion measure or score can be used to compare facilities. This
would be useful for both benchmarking and report cards.
Aparsimonious satisfaction measure was recently developed
by the American Health Care Association (AHCA). This
measure is the CoreQ. This research will detail the develop-
ment and underlying basis of the CoreQ. The CoreQ consists
of a limited number of satisfaction items that were used to
create an overall satisfaction score. Information from more
than 20,000 seniors was used to develop and test 5 CoreQ
instruments. These CoreQ instruments include nursing home
short-stay residents, long-stay residents, and family; and
assisted living residents and family. The process of develop-
ing and choosing the items included in the CoreQ will be
described. The testing of the CoreQ will be described (e.g.,
reliability, validity, exclusions, risk adjustment). The reliabil-
ity of the measure at the data element level; the person/ques-
tionnaire level; and, at the measure (i.e., facility) level will
be presented. The CoreQ is currently in use by over 1000
facilities. We will also present the experience and current uses
of the information collected to date. This will include the
distribution of scores and the correlation with other quality
measures.
SERVICE USE AND HEALTH OUTCOMES AMONG
LOW-INCOME OLDER ADULTS WITH UNMET NEEDS
R.H.Weaver2, K.A.Roberto1, 1. Human Development,
Virginia Polytechnic Institute & State University,
Blacksburg, Virginia, 2. Washington State University,
Pullman, Washington
When older individuals fail to receive any or sufficient
assistance for daily self-care and functional activities, a situa-
tion of unmet need is created. Prevalence of unmet need in the
United States ranges from 20% to 58% of older adults with
disabilities. Functional criteria for receiving assistance from
federal and state programs vary. This study investigated pat-
terns of service use among 1,040 low-income older Virginians
seeking assistance from a Medicaid waiver program during
the 2014 and 2015 fiscal year. Over the 2-year study dura-
tion, 660 clients met both financial and functional need eligi-
bility requirement for Medicaid; 380 clients were not eligible
because they did not meet Virginias stringent functional
need requirement (limitations in 4+ instrumental or basic
activities of daily living). Of non-eligible clients, 222 received
minimal and 158 received no Medicaid-supportive services.
Non-eligible clients were more likely than eligible clients to
live in rural areas (X2=23.139, p<0.001) and access Older
Americans Act funded services (F=16.650, p<.001). Non-
eligible clients receiving no services were significantly more
Innovation in Aging, 2017, Vol. 1, No. S1
likely to have died (F=11.686, p<.001), compared to non-eli-
gible clients receiving minimal services (p<.001) and eligible
clients receiving waiver services (p<.001). Hospitalizations
were infrequent, but were more likely among non-eligible
clients (F=7.374, p=.007). Trends suggest that individuals
receiving 2 or fewer services (F=1.948, p=.102) had greater
hospitalization risk. Based on these findings, policy provi-
sions need to consider the long-term health implications
experienced by older adults not eligible for waiver programs
and develop targeted service delivery initiatives to reduce the
likelihood of individuals living with unmet needs.
SYSTEMATIC REVIEW OF MEASUREMENT OF
NURSING HOME CULTURE CHANGE
D.Sturdevant1, C.A.Mueller2, K.C.Buckwalter1, 1. College
of Nursing, University of Oklahoma, McAlester, Oklahoma,
2. University of Minnesota, Minneapolis, Minnesota
Nursing home culture change (NHCC) aims to change
the way care is provided in nursing homes. Valid and reli-
able measures are needed to evaluate the impact of NHCC
on outcomes. A systematic review of available instruments
provides an overview of current instruments designed to
measure NHCC and provide criteria for others to evaluate
and choose instruments according to their own purpose.
The purpose of this review is to identify instruments used
to measure NHCC at the organizational level, describe the
psychometric properties, and to examine to what extent the
instruments have been used empirically to assess resident,
staff, or organizational outcomes. Method: A systematic
review was conducted using Medline, Embase, CINAHL,
PsycINFO, ProQuest, and Web of Science databases, limited
to articles published between January 1995 and December
2014. Citations were included if they reported: (1) the devel-
opment and/or vialidation of an instrument; (2) evaluation
of NHCC on an organizational level; and (3) quantitative
results following administration of an instrument. Results:
Ten instruments to measure NHCC on an organizational
level were identified. A common limitation of the instru-
ments reviewed was the lack of psychometric testing; thus,
their validity and reliablity needs further exploration. Three
of the 10 instruments reported Cronbach;s alpha and one
reported construct validity. Implications: The systematic
review demonstrated a number of tools available for meas-
urement of NHCC on an organizational level. Lack of devel-
opment description hindered their assessment and studies
examining the relationship between NHCC and outcomes
are rare. Further psychometric testing of the instruments is
also needed.
NATIONAL TRENDS IN OMBUDSMAN RESIDENT
ADVOCACY IN LONG-TERM CARE FACILITIES
(20062015)
K.Nguyen2, L.Ryan1, E.White2, S.Downie2, 1. US
Department of Health and Human Services Administration
for Community Living, Washington, District of Columbia,
2. NORC at the University of Chicago, Bethesda, Maryland
Since its inception in 1972, the Long-Term Care
Ombudsman Program (LTCOP) has played a critical role
in protecting and promoting the health, safety, welfare and
rights of long-term care residents by maintaining a regu-
lar presence in facilities nationwide. Dramatic changes in
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Innovation in Aging, 2017, Vol. 1, No. S1
the long-term care landscape, however, including the rapid
aging of the U.S.population and the tremendous growth of
non-institutional residential options, have placed increas-
ing demands on programs. Based on data from the National
Ombudsman Reporting System, we describe national trends
in ombudsman staffing and volunteer capacity in serving
long-term care residents. While nursing homes and beds
have been steadily declining as the field moves toward more
board and care type facilities, the overall number of facilities
and residents requiring ombudsman services has increased
by nearly 11% from 2006 to 2014. During this period, the
number of paid staff has remained fairly stable but the num-
ber of volunteer ombudsmen (who serve as key advocates
for residents) has decreased by 11%. From 2006 to 2014,
quarterly visits to nursing homes and board and care facili-
ties have declined by 10% and 14%, respectively. While the
increase in facilities overall presents challenges to maintain-
ing regular visits, the loss of volunteers may have exasperated
these challenges. As the elderly population and the number
of long-term care facilities continue to grow, the LTCOP will
increasingly be a vital resource for residents, particularly for
vulnerable elders. Understanding the programs ability to
advocate on their behalf is critical to ensure that all residents
receive quality care.
CHANGING CHAIN OWNERSHIP IN THE NURSING
HOME SECTOR AND ITS IMPACT ON SPECIALTY
SERVICE PROVISION
J.C.Banaszak-Holl1, Q.Zheng1, O.Intrator2,
D.G.Stevenson3, D.C.Grabowski4, R.Hirth1, J.Blackburn5, and of their job demands) and valued (i.e., appreciated for
1. University of Michigan, Ann Arbor, Michigan, 2.
University of Rochester, Rochester, New York, 3. Vanderbilt
University, Nashville, Tennessee, 4. Harvard University,
Cambridge, Massachusetts, 5. University of Alabama-
Birmingham, Birmingham, Alabama
Nursing homes offer an array of specialty services, includ-
ing the most prevalent types of dementia care, post-acute
rehabilitative services, and hospice. Corporate ownership
may support specialty care services in a number of ways,
by making possible the sharing of costs across facilities or
providing connections for sharing best practices. This paper
explores whether changes in chain ownership of nursing
homes impact provision of specialty care. The Online Survey
Certification and Reporting (OSCAR) data were used to iden-
tify chain ownership and specialty care provision from 1993
to 2010. Nursing homes report the provision of nine types
of specialty care, including care for those with Alzheimers,
AIDS, dialysis, head trauma, hospice, Huntingtons, rehabili-
tative, ventilator, and disabled child services. Annual chain
characteristics were coded from self-reported membership.
Contemporaneous market and state data were added from
other sources. We dropped the more rare forms of specialty
care that did not change in prevalence over time. The remain-
ing forms of specialty care, including Alzheimers, rehabilita-
tive, hospice and ventilator units, have shown dramatically
different trends in prevalence although facilities change little
in their reporting of all forms of specialty care. Most changes
in prevalence occurred when nursing homes enter or exit the
data. The availability of Alzheimers beds peaked in 2004
despite continued growth since then in the prevalence of
dementia among residents. Larger chains, with more than
IAGG 2017 World Congress
541
30 facilities, acquired facilities with a higher prevalence of
Alzheimers care but there is no evidence that these chains
convert beds post acquisition. Overall, chains do not appear
to convert beds to specialty care but do seek acquisition tar-
gets with services to fit with the chain strategy.
RESIDENTIAL CARE AIDES EXPERIENCES OF
PERSONHOOD IN DEMENTIA CARE SETTINGS
H.Cooke, University of British Columbia, Vancouver,
British Columbia, Canada
Conceptually, person-centred care entails fostering
the personhood of residents and the residential care aides
(RCAs) who provide much of their hands-on care. Yet, to
date, staff personhood has been overlooked in the empiri-
cal literature. Drawing on data from a larger ethnographic
study examining the influence of the organizational and
physical care environment on dementia care provision, this
paper explores RCAs experiences of personhood. In-depth
interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers),
and more than 230 hours of participant observation, were
conducted in two Canadian nursing homes with special-
ized dementia units. Two overarching themes, personhood
undermined management-staff relations and personhood
undermined workplace policies and practices illustrate
how, despite exposure to features believed beneficial to their
working environment (e.g., smaller staffing ratios, relatively
good remuneration, manageable workloads), RCAs encoun-
tered repeated affronts to their personhood. The first theme
encompasses the importance of being known (i.e., as persons
their work in non-monetary terms). The second highlights
the salience of work-life balance, full staffing coverage, sup-
portive human resource practices, and information shar-
ing. RCAs experiences reveal how the ongoing search for
cost-efficiencies, cost-containment, and cost-accountability
overshadows their individuality, indicating a key discon-
nect between conceptual ideals and workplace realities.
Organizations seeking to provide quality dementia care are
encouraged to focus on the creation of person-centred man-
agement and workplace practices thereby providing tangible
evidence that RCAs, and their work, matter.
DEPRESSION AMONG OLDER RESIDENTS IN
LONG-TERM CARE: AN ILL UNDERSTOOD AND
UNDERTREATED PROBLEM
A.Milne, School of Social Policy, Sociology & Social
Research, University of Kent, Chatham Maritime, Kent,
United Kingdom
420,000 older people live in care homes in the UK.
Residents tend to be frail and many have dementia. Evidence
suggests that between 4 and 25% have major depression
and 29 to 82% have depressive symptoms. The factors
that appear correlated with depression include: functional
impairment, physical health problems, loneliness, loss and
the depressogenic effects of living in an institutionalised
environment. Depression is linked to increased mortality,
suicide, and reduced quality of life. Barriers to recognition
and treatment include: limited staff awareness of depressive
symptomology, challenges in assessing its presence espe-
cially in people with dementia and variable access to health
services. Antidepressants are the most common treatment
542
although they are often prescribed in sub-therapeutic doses.
Behavioural and cognitive therapies are also effective although
rarely available. In terms of management, in reach provision
by primary care services appears effective. Improvements in
the management and treatment of depression has a number
of evidenced strands: supporting the older persons transition
into the home; staff training to increase detection; a com-
mitment to person centred care; education of GPs about the
particular needs of residents; consistent access to health care;
and an inspection regime committed to driving up quality.
Clinical guidelines are also helpful. Although some research
has been done in this area little is known about the nature
and course of depression amongst care home residents nor
their subjective experiences. Much more attention needs to
be paid to this hidden issue as depression is common, pro-
foundly undermining of well-being, and significantly under
treated.
NURSING HOME SATISFACTION MEASURES: WHAT
IS THEIR RELATIONSHIP TO QUALITY?
P.Nadash, J.Hefele, J.Wang, A.Barooah, University of ily retrospective orientation demonstrating compliance, to a
Massachusetts Boston, Boston, Massachusetts
Consumers and their families need information to help
choose nursing homes (NHs) that best suit them. Government,
too, needs good information to perform its oversight and
program management functions, incentivize better per-
formance, and respond to consumers information needs.
Incorporating consumer perspectives could improve public
reporting of NH quality. Little is known, however, about the
relationship between resident/family satisfaction, and qual-
ity of life (QoL) and/or other quality measures and whether
they supplement existing quality measures. This study inves-
tigates these relationships, and explores how different factors
predict satisfaction. Using resident/family satisfaction survey
data from 2887 NHs in all 50 states, along with data on NH
characteristics and performance (using CASPER, LTCFocus,
and NH Compare data), we found that, in 2013, overall sat-
isfaction was high, averaging 3.3 for both residents and fam-
ily members (on a scale of 1 to 4). Satisfaction was highest
for families regarding nursing care quality, and for residents
in feeling safe; it was lowest for families in staffing adequacy
and for residents in meal quality. Overall satisfaction had
near-zero or very low Pearson correlations with staffing vari-
ables. Nor was the link to quality measures strong: correla-
tions with CMS NH star ratings were low (0.24 for residents
and 0.31 for families), and with NH deficiencies near-zero.
These results suggest that resident/family perspectives indeed
add a unique component to the assessment of overall NH
quality, and support the call to add satisfaction and experi-
ence ratings to public reports of NH quality.
QUALITY OF LIFE IN NURSING HOMES: ELEVATING
THE STATUS OF RECORDING TO ARELATIONAL
PRACTICE
K.Barrie, Institute of Healthcare Policy and Practice,
University of West of Scotlan, Edinburgh, United Kingdom
Internationally, nursing home care provision demands
radical change. Lack of honesty about the complexity of so-
called basic care together with performance cultures have
created a more transactional and confused environment,
Innovation in Aging, 2017, Vol. 1, No. S1
detracting from authentic care work grounded in human
relationships. A personal outcomes approach, comprising
three inter-related components of engaging, recording and
using information, can result in more effective, inclusive,
enabling and relational ways of working, but raises particu-
lar challenges in collective living settings for older people
with complex and often fluctuating needs and priorities.
This session presents results from an action research study
conducted in collaboration with multi-disciplinary staff from
six nursing homes in Scotland to facilitate a focus on per-
sonal outcomes. Grounded in the philosophy of relationship-
centred care, the study recognised the importance of everyday
acts of noticing alongside scheduled care planning processes,
including being attentive to, and properly valuing, the life
stories and more embodied stories of people with commu-
nication or cognitive impairments. Building upon the ways
staff already come to understand and negotiate what matters
to a person and to family members, and thinking about how
such insights might be used by others, the study facilitated
a shift from recording as a bureaucratic task with a primar-
practice foregrounding information useful for maintaining
the identity of the older person, building relationships and
shaping future care. It also highlighted the practical and ethi-
cal dilemmas encountered daily, and the necessity of success-
ful negotiation amongst everyone involved in individual and
collective decision making processes.
CHANGE OVER TIME IN THE USE OF CARE IN THE
LAST 5 YEARS AMONG PEOPLE WITH DEMENTIA
M.Aaltonen1,2, J.Raitanen2,3, L.Forma2, J.Pulkki2,
P.Rissanen2, M.K.Jylha2, 1. Institute for Advanced Social
Research, University of Tampere, Tampere, Finland,
2. Faculty of Social Sciences (Health Sciences) and
Gerontology Research Center, University of Tampere,
Tampere, Finland, 3. UKK-Institute for Health Promotion
Research, Tampere, Finland, Tampere, Finland
Advanced age and dementia are important contributors
to care use, especially long-term care (LTC). We studied the
impact of age on use of LTC and hospital care (HC) in last
five years of life in those who died from dementia in three
time periods.
Data were drawn from Finnish National Registers. The
outcome variables, (1) use of LTC and (2) use of HC, were
followed for the last five years of life for all those who died
in 2001, 2007, or 2013 at the age of 7079, 8089, or 90+.
Generalized Estimated Equations were used to estimate the
impact of age and year of death, taking into account other
major diagnoses and gender.
Between years 2001, 2007 and 2013, age at death and the
use of LTC increased. Use of LTC was highest in the oldest
old and HC in the youngest old, but the differences between
age groups decreased during the study period. Among those
aged 7079, use of LTC increased. In the oldest age group,
use of LTC increased until 2007 after which it decreased. Use
of HC decreased among younger age groups. In the oldest,
use of HC increased slightly.
Advanced age is an important driver of LTC in those with
dementia. Longer lives and increased age at death likely lead
to higher need for LTC. Yet the effect of age on use of LTC
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Innovation in Aging, 2017, Vol. 1, No. S1
and HC decreased between the study years. Causes behind
the increase in LTC use in the youngest group should be stud-
ied further.
CONVINCING THE LEADERS: PERCEIVED BARRIERS
TO THE IMPLEMENTATION OF NURSING HOME
CULTURE CHANGE
N.Kusmaul, Social Work, University of Maryland,
Baltimore County, Baltimore, Maryland
Nursing home culture change has been around since the
emergence of the Eden Alternative in the early 1990s, yet
few long term care communities use its practices. Culture
change practices radically change nursing home operations
and organizational structures in ways that flatten the organi-
zational hierarchy and share decision making power with
elders and direct care workers. Implementation studies have
shown that organizational change is challenging and requires
sustained engagement from leadership. The aim of this trans-
lational research study was to identify what keeps nursing
home leaders from adopting culture change so that barri-
ers could be addressed, resulting in more living communities
adopting person-centered culture change practices.
The Maryland Culture Change Coalition conducted a
culture change training series across the state in the Summer
of 2015 aimed at nursing home administrators and assisted
living managers. Exit surveys were given to all participants.
Ninety eight participants completed the survey. The most
common barriers identified were about regulations and their
enforcement, and about the effectiveness of culture change
practices.
Together these indicate ongoing concerns with regula-
tions and the application thereof. If administrators are not
convinced that culture change practices improve outcomes
for older adults then they are less likely to consider making
changes that they perceive as threatening to the health of
the organization. This suggests a need for more outcomes
research, clearer policies, and education for administrators
and surveyors.
THE STATUS OF QUALITY CONTROL OF GERIATRIC
CARE INSTITUTIONS IN SHANGHAI: ASURVEY
L.Gu1, L.Zhang1, Y.Weng1, D.Li2, 1. Department of
Nursing, Changhai Hospital affiliated to Second Military
Medical University, Duhram, North Carolina, 2. Shanghai
Donghai Geriatric Caring Hospital, Shanghai, China
To investigate the situation of quality control in geriatric
care institutions (GCI) and identify the existing problems and
propose management strategies, a questionnaire survey and
field survey was conducted in 270 GCIs in Shanghai in 2014,
including facilities, human resources, characteristics of elder
patients, distribution of adverse events and quality of geri-
atric care. Descriptive methods were used for data analysis.
Totally 25 geriatric care hospitals (GCH) and 245 commu-
nity health service centers (CHSC) responded to the survey.
There were 6140 beds for elderly care in GCHs where mean
length stay of elder patients were 140 days, while 10265
beds in CHSCs where mean length stay of elder patients
were 119days. The proportions of nursing assistants, nurses,
medical physicians and technicians in GCHs were 37.91%,
IAGG 2017 World Congress
543
29.11%, 19.62% and 13.35%, while those in CHSCs were
14.14%, 34.59%, 36.47% and 14.80%. The top five most
frequent adverse events in GCHs were fall, medication,
catheter, diet and transfusion related events, while those in
CHSCs were medication, fall, catheter, transfusion and hurt
related events. During field survey, public GCHs were found
better in quality of elderly care than private ones after expert
assessments. Our results indicate that administrators in
GCIs should improve medical and nursing facilities, increase
human resource, optimize geriatric nurse training system,
implement risk analysis and quality management to promote
quality of care for the elderly.
SELF-RATED HEALTH AND THE COMBINATIONS OF
SELF-CARE DISABILITIES AMONG DISABLED ELDERS
IN TAIWAN
H.Tung, H.Hsu, S.Chuang, S.Hsu, J.Wang, Asia
University --Taiwan, Taichung, Taiwan, Taiwan
Introduction: Self-rated Health (SRH) is a commonly
measured concept in gerontological studies. The single item
measures peoples subjective rating of their current health
status. Agreat majority of Long-term Care users are physi-
cally disabled elders with a poorer rating of SRH. Yet, few
studies have examined the associations betweem different
combinations of self-care disabilities (e.g. Activity of Daily
Living, ADL) and SRH. In this study, combinations of 6 ADL
disabilities among a group of disabled elders were identified
to correlate with their ratings of subjective global health.
Methods: Data were taken from a face-to-face interview
survey (N=514) of disabled elders, aged 60 or over in 2008,
who were users of long-term care services in central Taiwan.
Self-rated Health was measured with a single item, regard-
ing your state of health, would you say it is excellent (=5),
good, average, poor, or very poor (=1).The 6 items in the
ADL scale, tapping to the performance on 6 self-care tasks,
were toileting, bathing, eating, dressing, transferting, and
walking. The coding for each of the tasks was: no difficul-
ties=0, somewhat difficult =1, very difficult=2, and
cannot do it at all=3. Both the total number of the 6 tasks
with difficulties and the summing score of the 6 items were
calculated.
Results: The correlation between the number of ADL
disability items and SRH was -.022 (p<.001).Walking
appeared in all of the frequently identified combinations of
ADL disabilities, implying that it was often the first self-care
disability a disabled elders would develop over the disable-
ment process. The combination of ADL disabilities with
highest mean SRH rating was not from the participants who
were free of any ADL disabilities (N=57, mean SRH=3.07),
instead the participants with the combination of walking
and bathing (N=37, mean SRH = 3.35) and the partici-
pants with the combination of walking, bathing, and
toileting (N=26, mean SRH=3.27) had the highest SRH
ratings.
Conclusion: For the long-term care services users with
ADL disabilities, some of them still show resilience and were
able to find a way to interpret their health as adequate, as
long as the provided services could meet some of their care
needs.
544
SESSION 1040 (POSTER)
MENTAL AND COGNITIVE DISORDERS:
ASSESSMENT AND INTERVENTION
OFF-LABEL USE OF ANTIPSYCHOTIC MEDICATIONS
ACROSS LONG-TERM CARE SETTINGS IN KOREA
Y.Jung, H.Kim, Graduate School of Public Health Seoul
National University, Seoul, Korea (the Republic of)
Introduction: Off-label use of antipsychotic medications
refers to the utilization of drugs for an unapproved indica-
tion. Mitigating psychiatric conditions are often a reason for
off-label use, which can cause unintended safety issues. The
purpose of this study is to examine the prevalence and vari-
ations of off-label use of antipsychotics among older people
with long-term care needs in nursing home (NH) and long-
term care hospital (LTCH) settings.
Method: We conducted a nationally representative sam-
ple survey of 2,542 older people in 91 NHs (n=1,275) and 52
LTCHs (n=1,267) in South Korea in 2013, including compre-
hensive geriatric assessments and medication order reviews.
Off-label use of antipsychotics was defined by applying
the FDAs 2005black box warning. We calculated at the decade. Admission records from residents at two U.S.long-
organizational level the prevalence of off-label use of antip-
sychotics and the interquartile range of the prevalence.
Results: The overall percentage of older people receiv-
ing antipsychotics for unapproved indications was 16.9%,
and the prevalence was similar at NHs (16.4%) and LTCHs
(17.3%). The variance in mean prevalence of off-label use of
antipsychotics in both settings was large, and it was larger
at NHs than LTCHs even after adjusting for individual
characteristics.
Conclusion: Preliminary evidence suggests that organiza-
tional characteristics affect antipsychotic prescribing independ-
ent of resident case-mix. Additional research on off-label use of
antipsychotics in LTC settings is needed.
REDUCING ANTIPSYCHOTIC USE IN NURSING
HOME RESIDENTS WITH DEMENTIA
W.J.Spurlock1, F.Epps2, S.B.Anthony3, 1. Nursing, nitive impairment and mental illness. This increase in both
Southern University and A&M College, School of Nursing,
Baton Rouge, Louisiana, 2. Georgia State University,
Atlanta, Georgia, 3. SBAFA, Inc., St. Francisville, Louisiana
Inappropriate use of antipsychotics in elderly nursing
home (NH) residents with dementia has gained national
attention. Adverse effects from the use of these drugs can
result in poor health outcomes, as well as increased mortality
rates. The overarching aim of this study was to determine
the perception of NH employees of symptoms and situations
that prompt the initiation or continuance of antipsychotics
in dementia residents and to identify perceptions of major
challenges to reduction in antipsychotic use. A survey was
administered to 319 NH employees (i.e., directors of nurs-
ing, administrators, staff nurses, social service, and activity
personnel) from Louisiana. Participants were asked to rank
order their perception of the importance of the role that nine
symptoms or situations have played in the initiation or use
of antipsychotics in dementia residents. In conjunction with
descriptive statistics to analyze survey results, content analy-
sis of participants comments from open-ended questions was
Innovation in Aging, 2017, Vol. 1, No. S1
performed. Findings (ranked in the order from most to least
important) were: combativeness; psychosis; resident placed
on antipsychotic during treatment in acute care behavioral/
mental health facility; agitation; admitted to NH on antipsy-
chotic; severe sleep pattern disruption; wandering; resistance
to care; and family requested. Responses overwhelmingly
highlighted the need and interest for educational opportu-
nities about evidence-based, non-pharmacological interven-
tions and potential adverse effects of antipsychotics. Findings
from this survey were used to tailor a statewide educational
intervention targeting NH staff. Recommendations that
emerged from survey findings can also be used by interested
stakeholders from other geographical regions to reduce the
use of antipsychotics.
THE RISE IN OCCURRENCE IN MENTAL HEALTH
ISSUES AMONG LONG-TERM CARE RESIDENTS
A.E.Kris, C.Zembrzuski, Fairfield University, Westport,
Connecticut
The purpose of this study is to document the trends in the
incidence, prevalence and demography of long-term care res-
idents with complex psychological needs over the previous
term care institutions were selected for review. Data from
2016 were collected and compared with records from 2006.
In addition to demographic characteristics, information was
collected about a) the presence of mental illness b) the type
mental health diagnosis, c) the presence, type and level of
cognitive impairment and d) the number and types of medi-
cations used. Results indicated that between 2006 and 2016,
there was a statistically significant rise in the number of resi-
dents with documented co-morbid mental health problems
over time (n=250, p<0.05). This rise in the number of resi-
dents with diagnosed mental health issues upon admission
was associated with a statistically significant rise in the use
of both anxiolytic and anti-psychotic medications. In addi-
tion to the general trend towards increases in diagnosed
mental health problems, there were also substantial increases
in the number of residents dually diagnosed with both cog-
the prevalence and complexity of resident mental health
problems has serious implications for both family members
and healthcare providers. Increased education, staffing and
services may be needed to address the complex medical and
mental health needs of this vulnerable population.
SENSORY LOSS AND DEMENTIA: INSIGHTS INTO
LONG-TERM CARE NURSES EXPERIENCES OF CARE
AND ASSESSMENT
F.Hbler1,2, A.Escrig Pinol1,2, M.Rodrguez Monforte3,
X.Argueta-Warden2, K.McGilton1,2, 1. Toronto
Rehabilitation Institute-University Health Network,
Toronto, Ontario, Canada, 2. University of Toronto,
Toronto, Ontario, Canada, 3. FCS Blanquerna-Universitat
Ramon Llull, Barcelona, Spain
More than half of long-term care (LTC) residents are
reported to be living with dementia, affecting their ability
to understand and express information, thereby having pro-
found implications for effective interactions. This is further
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
compounded by hearing and vision loss which also affects
two thirds of residents. Persons living with dementia have
identified the assessment of such sensory impairment, along
with its treatment and care, as a key research priority. As
part of a larger project aiming to develop a package of effec-
tive sensory screening tools to identify LTC residents with
dementia in need of specialist referral, an environmental scan
was conducted to capture the tools and strategies currently
being used by front line staff in this setting. Apurposive sam-
ple of 20 registered nurses and registered practical nurses
was interviewed across 2 facilities in Ontario, Canada, and
asked about: their experiences of working with persons who
have dementia and sensory loss; how they identify which
residents have sensory impairment; ways in which current
screening procedures could be improved; and, key elements
to include in a sensory screening package. Using a strength-
based analytical framework, we highlight pockets of excel-
lence in nurses practices of care and assessment. Results
from a two-step qualitative content analysis reveal diverging
institutional frameworks of practice, along with shared bar-
riers and enablers to the care and identification of sensory
loss in this population. We also discuss examples of effective
and creative strategies used by nurses to conduct informal
assessments and enable communication with older adults
who have dementia.
A NATIONAL APPROACH TO IMPROVING
DEMENTIA CARE: THE DEMENTIA DYNAMICS
TOOLKIT
S.Davis, A.Campbell, R.Capp, Applied Gerontology,
Flinders University, Bamawm, Victoria, Australia
Under the Encouraging Better Practice Initiative, the
Australian Commonwealth Department of Health and
Aged Care funded a team from Flinders University to
develop and disseminate the Dementia Dynamics Toolkit
to all residential aged care homes in the country with the
aim of building capacity in person-centred dementia care.
The DD Toolkit comprises a manual, eLearning and micro-
training DVDs, and a website which provides access to
technical and implementation support. Anational sample
of aged care staff and management were surveyed pre/post
the dissemination of the toolkit. Data was also collected
during the project via workshop evaluations, pop-up sur-
veys online, email surveys and telephone interviews. Of
the 2768 residential aged care homes in Australia, 60%
have staff and management completing the eLearning. This
paper provides an overview of the project and presents
data collected specific to examining staff-based measures
of individualised care (ICI), work practices, person-centred
leadership and responsive behaviour in relation to comple-
tion of the eLearning. Data analysis indicates that in care
homes where a critical mass of staff have completed the
eLearning the general institutional climate has shifted, with
a consequential decrease in responsive behaviour expressed
by residents with dementia. Overall, staff and management
who have completed the eLearning have higher individual-
ised care scores, report more person-centred work practices
and feel more empowered in their workplace. The flexibil-
ity of the toolkit is highlighted through descriptions of the
different ways care homes have made use of the resources.
IAGG 2017 World Congress
545
COMMUNICATION LEADING TO SHARED
MEANING IN THE NURSING HOME
A.S.Ashcraft, D.C.Owen, School of Nursing, Texas Tech
University Health Sciences Center, Lubbock, Texas
Patterns of communication between nurses and physicians
directly impact nursing home (NH) resident quality of care.
Nurses not fully explaining clinical change and physicians
not eliciting needed information has compromised effective
communication. This qualitative study used a Sensemaking
model of communication between NH nurse/physician to
understand shared meaning informed by oral and written
strategies.
Sample-19 nurses, 22 MDs. 33 communication events
were the focus of 16 interviews, 17 nurse notes, 22 MD
orders, and 16 MD notes. Using grounded theory and eth-
nographic interviewing (1st & 2nd cycle coding, constant
comparative analysis, analytic memos) with a Sensemaking-
based semi-structured interview guide and examination of
related medical records, communication events were ana-
lyzed. Cases were created to illustrate communication pro-
cesses. Trustworthiness was addressed through an audit trail
of decision-making memos, triangulation of prolonged inter-
views with medical records, and using Sensemaking to guide
interpreting codes and developing theory.
Nurses established relationships by intentionally
approaching MDs at monthly NH visits, creating individual-
ized communication exchange, contact lists, and MD infor-
mation sharing. MDs noted nurses availability or phone
contacts directed their coming to know the nurse and their
capabilities. Case analysis yielded contrasting views by nurse
and MD of the same event. Nurses described symptoms, and
MD orders or transfer requests. MDs noted importance of
crafting resident information for decision-making.
Nurses and physicians sought agreement about next steps
or decisions. Education should emphasize how to reach
shared meaning. Research should examine impact of nurse/
MD communication on resident outcomes.
RELIABILITY AND VALIDITY OF THE RESISTIVENESS
TO CARE SCALE AMONG COGNITIVELY IMPAIRED
OLDER ADULTS
E.Galik1, B.Resnick1, S.D.Holmes2, V.Nalls1, 1. University
of Maryland School of Nursing, Ellicott City, Maryland,
2. University of Maryland Baltimore County, Catonsville,
Maryland
Resistiveness to care generally occurs when an individual
with cognitive impairment interferes with caregivers attempts
to provide care, and commonly occurs during personal care
interactions such as bathing, toileting, and oral care. The pur-
pose of this study was to test the reliability and validity of the
Resistiveness to Care Scale (Mahoney et al., 1999) using a
Rasch Measurement Model among a larger group of nursing
home residents with moderate to severe dementia. This was a
descriptive study using baseline data from 261 residents par-
ticipating in an ongoing trial testing a Function and Behavior
Focused Care intervention for cognitively impaired nursing
home residents (FBFC). The average age of the residents was
84.64 (SD=9.60) and the majority were female (N=198,
74%), white (N=161, 61%), and not married (N=185, 69%).
The mean MMSE was 7.23 (SD=5.10). There was sufficient
evidence of internal consistency with findings similar to the
546
original scale development which was done with a non-
independent sample of 68 residents younger residents (mean
age of 72) providing 232 observations in which the alpha
coefficient was .82. Psychometric testing using Rasch analy-
sis supported the validity of the measure. The findings from
this study provide new support for the reliability and validity
of the Resistiveness to Care Scale for use with older adults
with dementia in nursing home settings. Future work with
the measure may benefit, however, from the addition of items
that are easier to endorse or express with regard to resistive-
ness to care.
INTRODUCING MONTESSORI-BASED VISITING IN
ACANADIAN LONG-TERM CARE HOME: RESULTS
AND RECOMMENDATIONS
P.V.Hunter1, L.Thorpe1, W.Landen1, L.Pickard1,
C.Hounjet2, 1. St. Thomas More College, University
of Saskatchewan, Saskatoon, Saskatchewan, Canada,
2. University of British Columbia, Vancouver, British
Columbia, Canada
Enhancing quality of life for residents with advancing
dementia remains one of the most significant problems of
residential care. Nevertheless, there is growing recognition
that when activities are appropriately adapted to individual
interests and abilities, residents with dementia can enjoy
sustained participation. One method that has seen con-
siderable success in this regard is the Montessori method,
introduced by Cameron Camp, and based on the work of
Italian physician and educator Maria Montessori (1870
1952). We recruited and trained 18 community volunteers
to use a Montessori-based approach to visit residents in a
secure dementia care unit. In this presentation, we describe
the design and implementation of this volunteer visiting pro-
gram and provide brief data-driven summaries of resident,
volunteer, family, and staff input. We offer specific recom-
mendations from our experience to those interested in devel-
oping similar Montessori-based initiatives in dementia care
settings.
COSTS OF ASTAFF COMMUNICATION
INTERVENTION TO REDUCE DEMENTIA
BEHAVIORS IN NURSING HOME CARE
K.N.Williams1, P.Ayyagari1, Y.Perhounkova1, M.Bott3,
R.Herman2, A.L.Bossen1, 1. The University of Iowa, Iowa
City, Iowa, 2. University of Kansas, Lawrence, Kansas, 3.
University of Kansas Medical Center, Kansas City, Kansas
Background: Persons with Alzheimers disease and other
dementias experience behavioral symptoms that frequently
result in nursing home (NH) placement. Managing behavio-
ral symptoms in the NH increases time required to complete
care, adds to staff stress and turnover, and increases costs of
care. The Changing Talk (CHAT) intervention improves staff
communication by reducing elderspeak and led to reduced
resident resistiveness to care (RTC). We evaluated the cost
effectiveness of CHAT in reducing elderpeak and RTC.
Methods: Costs to provide CHAT were determined for
each NH (N=11) using process based costing.
Analysis: Based on the number and type of staff attending
the CHAT training, and materials and interventionist time,
an average cost per participant was calculated for each NH.
Innovation in Aging, 2017, Vol. 1, No. S1
Regression estimates from the parent study were applied to
determine costs per unit reductions in staff elderspeak and
resident RTC.
Results: Aone percentage point decrease in elderspeakwas
associated with an average 0.43 reduction in RTC. CHAT led
to a 12.9% average drop in elderspeak use by NH staff. The
average 12.9% reduction in staff elderspeak use predicted
a 5.59% decrease in RTC per resident. Assuming that each
staff cares for 2 residents with RTC, the cost effectiveness
ratio for each 1% RTC reduction per resident is $7.13.
Conclusions: Cost variations to reduce elderspeak and
RTC were based on the number of factors such as baseline
elderspeak and the number of residents with RTC. Overall,
the 3-session CHAT program is a cost-effective intervention
for reducing RTC in dementia care.
THE EFFECT OF AROMATHERAPY ON AGITATION
AND CAREGIVER BURDEN IN PATIENTS WITH
DEMENTIA
T.Turten Kaymaz, L.Ozdemir, Hacettepe University,
Ankara, Turkey
Introduction: In dementia, psychiatric and behavioral
symptoms develop over time. One of the most frequently
observed behavioral symptoms is agitation. The caregivers of
dementia patients with agitation have an increased burden.
Therefore, studies are needed to examine the effect of aroma-
therapy on agitation in dementia. The aim of this study was to
examine the effects of aromatherapy on agitation in patients
with moderate to severe dementia and caregiver burden.
Method: The study was carried out in patients with demen-
tia and their caregivers at two university hospitals in Turkey.
The study sample comprised a randomly selected aromather-
apy (n=14) and control group (n=14). Patients in the study
were stratified by dementia phase and taking antipsychotic
medication. The intervention group was given aromatherapy
via hand massage and inhalation for 4 weeks in their home.
The control group received no intervention during the study.
The data were collected using Neuropsychiatric Inventory
(NPI), CohenMansfield Agitation Inventory (CMAI) and
Zarit Burden Interview (ZBI). Results: The NPI scores of
intervention-group significantly decreased at weeks 2 and 4
compared with control patients (p<0.05). In addition, CMAI
and ZBI scores were significantly lower in the intervention
group compared with the control group at week 4 (p<0.05).
Conclusion: After aromatherapy, agitation, neuropsychiatric
symptoms and caregiver burden in the intervention group
had significantly decreased compared with the control group.
THE EFFECTS OF WEB-BASED PHYSICAL
RESTRAINT-REDUCTION EDUCATIONAL PROGRAM
E.Kong1, S.Kim2, M.Kim3, S.Yu4, D.Shin5, 1. Gachon
University, College of Nursing, Seongnam, Korea (the
Republic of), 2. Chungbuk National University, Department
of Nursing, Cheongju-si, Korea (the Republic of), 3.
Sungshin Womens University, College of Nursing, Seoul,
Korea (the Republic of), 4. Sangji University, Department
of Nursing, Wonju-si, Korea (the Republic of), 5. Hallym
University, Division of Nursing, ChunCheon, Korea (the
Republic of)
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Physical restraints have been frequently used in Korean
nursing homes. This study was conducted to evaluate the
effects of web-based physical restraint-reduction educational
programs on Korean nursing students. A randomized, sin-
gle-blind, control-group pretest-posttest design was used to
evaluate the effects of web-based physical restraint-reduc-
tion educational programs (six session-educations for 54.33
minutes). Atotal of 169 nursing students (85 in experimen-
tal group and 84 in control group) in four Korean nurs-
ing schools completed this study. The experimental group
received the web-based physical restraint-reduction educa-
tional programs and the control group did not receive the
program. Data were collected immediately before and after
the intervention (between December in 2015 and January
in 2016). Three instruments were used to measure nursing
students knowledge, perception, and attitudes regarding use
of physical restraints in nursing homes. There were statis-
tically significant effects of the web-based educational pro-
grams on nursing students knowledge (t= 5.97, p < .001)
and perception (t= -9.67, p< .001) regarding the use of physi-
cal restraints. There was no significant effects of the web-
based educational program on nursing students attitudes
(t= 1.72, p < .087) regarding the use of physical restraints.
The results show that web-based physical restraint-reduction
educational program is an effective intervention to improve
nursing students knowledge and perception regarding the
use of physical restraints in nursing homes. More interven-
tion studies to improve students attitudes toward physical
restraint-reduction are required using more rigorous research
methods. Also, restraint measurements targeting nursing stu-
dents need to be developed and evaluated.
CLINICAL AUDIT: QUALITY OF PALLIATIVE CARE
IN LONG TERM-CARE FACILITIES IN WESTERN
FRANCE, 2015
J.Prudhomm1,2, V.Morin-Chouarbi1, M.Bechac1,
E.Menand1,2, A.Corvol1,3, D.Somme1,2,3, 1. Centre
Hospitalier Universitaire CHU de Rennes, Rennes, France,
2. Universit Rennes 1, Facult de Mdecine, Rennes,
France, 3. Centre de recherche sur laction politique en
Europe, UMR 6051, Rennes, France
Most of the erlderly patients hospitalized in Long-term
care (LTC) facilities are under palliative care. However, lit-
tle is known about the quality of the care they receive in
this setting. French health care Information system do not
give precise information on their end-of-life. We conducted a
study to assess families satisfaction with care after the death
of their relative in LTC.
We asked 40 families of all patients deceased during one
month (October 2015)in 13 LTC facilities of Western France,
to respond the Family Perception of Care Scale. Respondents
indicate their agreement with 25 items, rated on a seven-
point Likert scale. Items are gathered in 4 sub-scales: resident
care, family support, communication and rooming. Finally,
respondents were invited to include written comments.
First results indicate the existence of a polarization of
families satisfaction, without any nuances: either they con-
sider the care received by their love one as perfect, eather
they consider it as clearly inadequate. Most of the commen-
taries concern resident care and communication with the
IAGG 2017 World Congress
547
staff. The survey is still in process, complete results will be
presented. The difficulties faced will be discussed.
Our studyPalliative care; Long-term care; Long-term care
facilities; Geriatric department
ASSOCIATION OF DIABETES AND ITS
COMPLICATIONS WITH DEPRESSION IN OLDER
PEOPLE OF INDIA
R.Bansal, H.Indani, P.Chatterjee, A.Chakrawarty,
S.Dwivedi, A.B.Dey, AIIMS, New Delhi, India
Diabetes is a known risk factor for mental health disor-
ders but studies on elderly diabetic in developing countries
are limited. Each country should assess its own burden on
mental health due to chronic diseases like diabetes. Across
sectional comparative study (180 diabetic cases, 180 age-
sex matched non-diabetic controls; aged 60 years) were
recruited from Geriatric Medicine OPD between November,
2014 to June, 2016. Depression was assessed using Geriatric
depression scale (GDS). There was significantly higher preva-
lence of depression in diabetic (35.6%) as compared to non-
diabetic (16.7%) (p-value <0.01). On subgroup analysis,
Diabetic neuropathy was more associated with depression
(49.3%) than those without diabetic neuropathy (27%)
(p-value 0.002) among diabetic group. Diabetes is associated
with increased risk of depression, while diabetic neuropa-
thy is associated with even more risk of depression. So, all
diabetic patient (especially those with diabetic neuropathy)
should be assessed for depression at each health care visit.
PREVALENCE OF MENTAL DISORDERS AND ITS
ASOCIATED FACTORS AMONG CHINESE ELDERLY
PEOPLE
N.Li1, Q.Zhou3, G.Xu2, 1. Peking Univeristy, Beijing,
China, 2. Tianjin Mental Health Center, Tianjin, China,
3. University of International Business and Economics,
Beijing, China
Elderly people were at high risk for mental disorders.
Most studies in China on geriatric mental health were
focused on single mental disorder such as depression and
dementia. Besides, screening scales on mental disorder symp-
toms were used and the results could be biased. In this study,
using data with diagnosis information based on the Chinese
version of the Structured Clinical Interview for Diagnostic
and Statistical Manual (DSM-IV) Axis Idisorders (SCID) by
trained psychiatrists, we aimed to explore the prevalence rate
of mental disorders and its associated factors among Chinese
elderly people.
Data for this study was derived from the 2012 Tianjin
Mental Health Survey, which employed a multistage strati-
fied and probability proportionate to size sampling method.
Participants were firstly screened with Chinese version
General Health Questionnaire and 8 additional items that
assessed other risk factors for mental disorders, and divided
into 3 risk groups. All subjects from high risk group, 44.5%
from moderate risk group, and 10.4% from low risk group
were selected for diagnosis of mental disorders with SCID.
Of the 15,538 people selected for interview, 128,99 peo-
ple were investigated and 3,450 aged 60years or older. The
adjusted 1-month prevalence rate of mental disorders among
Chinese elderly people was 13.0%. Factors associated with
548
mental disorders included female gender, older age, being
currently unmarried, and low educational attainment.
The results revealed a high prevalence rate of mental dis-
orders among Chinese elderly people. Targeted intervention
programs should be conducted to improve the mental health
status among Chinese elderly people.
PROMOTING ACTIVE AGEING IN OLDER PEOPLE
WITH MENTAL DISORDERS: DEVELOPMENT AND
TESTING OF ATOOL
K.Kenbubpha, I.Higgins, S.Chan, A.Wilson, The cial approach that predicts potential problems, and care
University of Newcastle, Newcastle, New South Wales,
Australia
This study was carried out in Thailand. Asurvey instru-
ment was developed based on the mixed methods research.
The first phase, a qualitative study with two focus groups
was used to initially develop the instrument. The second
phase, a quantitative study was used to develop and test
a draft of the survey instrument which included two main
steps. The instrument development consisted of item genera-
tion, content validity, face validity, and a pilot study. Then,
a cross-sectional study of 575 primary care providers was
surveyed with a response rate of 72%. Psychometric prop-
erties were tested for internal reliability using Cronbachs
alpha, and construct validity using exploratory factor analy-
sis. The survey instrument was categorised as; participants,
education, health, leisure, and security for conceptual and
theoretical meaningfulness. A5 point Likert scale was used
ranged from 0(never) to 4(always). The initial content valid-
ity index was 0.82 and the final of survey instrument was
revised into 54 items. The total Cronbachs Alpha from the
pilot study was 0.975. Three items were removed because
corrected item-total correlation coefficient was lower than
0.30. Test-retest reliability was a significant correlation with
total score 0.97(P<0.01). Factorability of all items was con-
firmed with correlations greater than 0.30. Significant results
obtained on Barletts test of sphericity [c2 (1431)=18737.05,
P<0.001] and the Kaiser-Meyer-Oklin measure of sampling
adequacy was 0.95. This paper reports preliminary evidence
of the psychometric properties of a new survey instrument.
Five factors identified assessment of promotion in active age-
ing for older people with mental disorders in communities.
CORRELATIONS OF NURSING PRACTICES FOR
ELDERLY WITH COGNITIVE IMPAIRMENT AND
COMPETENCE IN HOSPITALS
M.Suzuki1, H.Yoshimura3, Y.Ito2, M.Kanamori4, 1. (using the 18-item Mini Nutritional Assessment (MNA)
Faculty of Nursing, Hamamatsu University School of
Medicine, Hamamatsu, Shizuoka, Japan, 2. Hamamatsu
Rosai Hospital, Hamamatsu, Shizuoka, Japan, 3. Seirei
Mikatahara Hospital, Hamamatsu, Shizuoka, Japan, 4.
Ritsumeikan University, Shiga, Kusatsu, Japan
In Japan, the proportion of elderly people in the popula-
tion increased to 25% in 2013, and will increase to 38%
by 2055. The number of elderly people with dementia in
Japan has been increasing due to the increasing propor-
tion of very old people among the elderly. In this context,
many elderly people with dementia require physical treat-
ment and admission to acute care hospitals. The Self-
Assessment Scale of Nursing Practice for Elderly Patients
with Cognitive Impairment (NPCI) was developed to
Innovation in Aging, 2017, Vol. 1, No. S1
evaluate person-centered care practices for elderly people
with dementia; the Clinical Nursing Competence self-Assess-
ment Scale (CNCSS) was developed to evaluate clinical nurs-
ing competence. This study examined correlations between
scores on the NPCI and CNCSS among 280 nurses working
in two acute care hospitals; data were collected from March
to July 2015. Participants self-administered the question-
naires. The NPCI has the following sub-scales: creative care
suited to the patient and their cognitive function, care that
emphasizes the patients viewpoint, care with a psychoso-
that recognizes the will and worth of the patient. Six of the
CNCSS 13 sub-scales were used in this study. Correlation
coefficients were calculated between scores on each ques-
tionnaire; NPCI and CNCSS sub-scale scores were signifi-
cantly correlated. Multiple regression analysis indicated that
the NPCIs supportive human relationships and ethical
practices sub-scales were significantly correlated with all
CNCSS sub-scales. These results indicate that clinical nurs-
ing competence training and accreditation should encourage
nurses to use person-centered care practices to treat elderly
people with dementia.
SESSION 1045 (POSTER)
NUTRITION AND DIET QUALITY II
NUTRITIONAL AND FUNCTIONAL STATUS
OF OLDER PEOPLE LIVING IN YOGYAKARTA,
INDONESIA
T.Arjuna1,2, S.Soenen1, R.Hasnawati2, I.Chapman1,
K.Lange1, N.Luscombe-Marsh1,3, 1. Discipline of Medicine
and National Health and Medical Research Council
(NHMRC) Centre of Research Excellence in Translating
Nutritional Science to Good Health, The University
of Adelaide, Adelaide, South Australia, Australia, 2.
Department of Nutrition and Health, Faculty of Medicine,
Universitas Gadjah Mada, Yogyakarta, Indonesia, 3.
CSIRO Health and Biosecurity, Adelaide, South Australia,
Australia
Malnutrition is associated with poor health outcomes and
places substantial burden on Indonesias healthcare system.
However, the prevalence, and impact, in community-resid-
ing Indonesians aged 65years remains unknown. We con-
ducted a cross-sectional study to determine the nutritional
and serum albumin concentration) and functional (using
grip strength and gait speed), status, of residents from the
Yogyakarta region. Participants from two urban (City of
Yogyakarta; n=324) and two rural (Kulonprogo Regency;
n=203), districts, were assessed. According to the MNA,
5% were malnourished, 54% were at risk of malnutrition
and 41% were well-nourished. Rural and urban partici-
pants were more likely either malnourished (3vs.6 %) or
at risk of malnutrition (73vs.43 %) than well-nourished
(24vs51%). Rural compared with urban participants had
lower body weight (meanSD; 449vs.5212kg), body
mass index (203vs.234kg/m2) and albumin concentra-
tions (3.90.2vs.4.00.2g/dL) (all, P<0.001). Although
there was no difference in grip strength between rural and
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Innovation in Aging, 2017, Vol. 1, No. S1
urban participants (15.96.2vs.16.86.7kg, P>0.05), there WEIGHTED VEST USE FOR PRESERVING MUSCLE
was a tendency for gait speed to differ (P=0.057); post-
hoc analysis, indicated lower gait speed for participants
from the rural district of Panjatan (n=125, 0.510.2 m/s)
and the urban districts of Jetis (n=96, 0.490.2 m/s) and
Gondokusuman (n=221, 0.530.2 m/s) compared with the
rural district of Girimulyo (n=75, 0.600.2 m/s) (P<0.05). In
conclusion, 59% of Yogyakarta citizens were malnourished
or at risk of malnutrition and, although the prevalence of
poor nutrition was greatest for people from rural districts,
functional status assessed by grip strength and gait speed was
largely comparable.
FUNCTIONAL TOOTH UNIT COMPOSITION AND
NUTRIENT INTAKES: THE CONCORD HEALTH AND
AGEING IN MEN PROJECT
K.L.Milledge1,2,3, R.Cumming1,3,4, F.Wright1, F.Blyth1,
V.Naganathan1, D.G.Le Couteur5, V.Hirani1,2,3, 1. Centre
for Education and Research on Ageing, Concord RG
Hospital/University of Sydney, Sydney, New South Wales,
Australia, 2. School of Life and Environmental Sciences,
University of Sydney, Sydney, New South Wales, Australia,
3. ARC Centre of Excellence in Population Ageing Research
(CEPAR), University of New South Wales, Sydney, New
South Wales, Australia, 4. School of Public Health,
University of Sydney, Sydney, New South Wales, Australia,
5. ANZAC Research Institute & Charles Perkins Centre,
University of Sydney, Sydney, New South Wales, Australia
Associations between inadequate nutrient intakes and
poor dentition in older adults have been shown. The aims
of this study are to investigate associations between nutrient
intakes and composition of posterior functional tooth units
(FTUs) in older men.
Preliminary analysis of a standardized validated diet his-
tory assessment and comprehensive oral health examina-
tion in 410 community dwelling men (mean age: 84years)
participating in Concord Health and Ageing in Men Project.
FTUs were categorized as replaced and/or natural teeth and
categorized by number of FTUs. Attainment of Nutrient
Reference Values (NRVs) for total energy and key nutrients
(protein, Fe, Zn, riboflavin, Ca and vitamin D) were incorpo-
rated into a key nutrients variable dichotomised good (5)
or poor (4).
43.2%(n=177) had replaced only FTUs, 31.7% (n=130)
had natural only FTUs and 36.8% (n=151) had <7 FTUs.
Most men met their NRVs, however only 27% met their
NRVs for fibre, 26% for potassium, 13% for calcium and
< 1%, for vitamin D. In adjusted logistic regression analy-
sis, replaced only FTUs, compared to natural only FTUs,
were associated with intakes below the recommendations for
folate OR:1.95(95%CI:1.163.29), riboflavin, 2.23(1.03
4.83), magnesium 2.22(1.323.74) and fibre 1.81(1.06
3.10). Adjusted analysis also showed that men with <7 FTUs,
compared to complete FTUs OR:2.28(95%CI: 1.19, 4.41)
and those with replaced only FTUs, compared to natural
only FTUs 2.00(1.09, 3.66) were more likely to have poor
nutritional intake of key nutrients. Our study shows that
composition of FTUs in older men is associated with inad-
equate intake of some nutrients.
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549
MASS DURING WEIGHT LOSS IN OLDER ADULTS
B.J.Nicklas1, D.Yow1, C.Crotts1, J.Kiel2, K.Beavers3,
R.Henderson1, 1. Wake Forest School of Medicine,
Winston-Salem, North Carolina, 2. Medifast Inc., Owings
Mills, Maryland, 3. Wake Forest University, Winston Salem,
North Carolina
Muscle mass loss during weight loss is partially attrib-
uted to decreased gravitational load; thus, externally replac-
ing lost body mass may be effective for reducing muscle loss
during caloric restriction. To assess the feasibility of this
approach, we randomized 37 older (6580 yrs) adults with
obesity (BMI=3040kg/m2) to a 5-month intervention, with
(Diet+Vest) or without (Diet only) use of a weighted vest dur-
ing normal daily activities. The WL goal of 10% was achieved
using the Medifast 4&2&1 Plan (4 meal replacements,
2 self-prepared meals and 1 snack/day) and weekly group
behavioral counseling meetings. Diet+Vest was asked to wear
a weighted vest, progressing to 10 hours/day, with weight
added weekly according to individual loss of body mass. At
intervention end, vest wear time (meanSD) was 6.72.2
hours/day and vest weight was 13.85.6 lbs. Both groups
lost a similar amount of body mass (Diet= -11.24.4kg
(11.84.5%); Diet+Vest= -11.06.3kg (10.75.9%)). Fat
mass, lean mass, and % body fat decreased significantly
(p<0.0001), with no differences between groups; lean mass
comprised ~1/4th of the total mass lost in both groups
(Diet=2216%; Diet+Vest=2617%). Changes in lower-
extremity physical function (gait speed, chair rise, stair
climb) did not differ between groups; however, leg extensor
strength, power and muscle quality tended to decrease in Diet
(by 39%; p=0.030.15), but were unchanged in Diet+Vest.
These initial results indicate there may be a beneficial effect
of weighted vest use for preserving muscle strength/quality
independent of muscle mass retention.
DIET QUALITY AND COGNITIVE FUNCTION IN
OLDER AUSTRALIAN MEN AND WOMEN
C.Milte, K.Ball, D.Crawford, S.McNaughton, Deakin
University, Geelong, Victoria, Australia
Previous research into nutrition and cognitive function
has focussed on individual nutrients or foods, with inconsist-
ent results. The dietary pattern approach enables assessment
of whole diet quality. The aim of this study is to examine
associations between diet quality and cognitive function in
men and women. Adults aged 5565years in the Wellbeing,
Eating and Exercise for a Long Life (WELL) study (n=617)
completed an 111-item food frequency questionnaire in 2010
and 2014. The dietary guideline index (DGI), a measure of
adherence to the Australian Dietary Guidelines assessed
diet quality. The Telephone Interview of Cognitive Status
modified (TICS-m) assessed cognitive function in 2014.
Associations between previous (2010) and recent (2014)
diet quality and cognitive function were assessed using lin-
ear regression. Key food groups (fruits, vegetables, protein,
dairy, cereals) and dietary behaviours (diet variety, adding
salt, low-fat, high-fibre) were also investigated. There was
no association between 2010 DGI score and TICS-m. After
adjustment for age, education, urban/rural area, depression,
physical activity, BMI and cardiovascular conditions, a higher
2014 DGI score was associated with a higher TICS-m score
550
in men (coefficient=0.04, 95% CI 0.01, 0.07). Associations
between high-fibre bread (coef=1.05, 95% CI 0.11, 1.99),
added salt (coef=-1.79, 95% CI -2.90, -0.68) and TICS-m
were also observed in men. Cross-sectionally, men who con-
sumed a diet closer to the Australian dietary guidelines, with
high-fibre breads and less added salt reported better cogni-
tive function. Future studies should investigate trajectories of
dietary change over time as determinants of cognitive func-
tion in older age.
CONCORDANCE OF ANTHROPOMETRIC,
SELF-REPORTED AND BLOOD MEASURES OF
NUTRITIONAL EVALUATION IN ELDERLY
L.P.Corona1, A.Saron1, D.Nunes2, T.Alexandre3, T.Brito4,
Y.Duarte4, M.Lebrao4, 1. Faculty of Applied Scientes,
University of Campinas, Limeira, Sao Paulo, Brazil, 2.
Federal University of Tocantins, Palmas, Tocantins, Brazil,
3. Federal University of So Carlos, Sao Carlos, Sao Paulo,
Brazil, 4. University of Sao Paulo, Sao Paulo, Sao Paulo,
Brazil
This study aimed to assess the concordance between some
measures often used as nutritional status markers. We used
data from elderly (n=1,256) evaluated in the third wave of
SABE Study (Health, Well-being, and Aging) conducted in
2010 in Sao Paulo, Brazil. We evaluated nutritional status
using the most common measures: Body Mass Index (BMI),
hemoglobin and albumin concentrations, calf circumfer-
ence, score in mini nutritional assessment (MNA) and self-
perception of nutritional status (question: do you consider
yourself well-nourished?). Differences between groups were
estimated using x2 test with Rao-Scott correction, consider-
ing populational weights for estimates. The prevalence of
Hypoalbuminemia (<3.5g/dL) was 7.9% of low body weight
elderly (BMI<22kg/m2), proportion similar to normal weight
elderly (6.8%; p=0.652). Anemia was more prevalent in low
weight elderly, but the difference was not significant (12.2
and 7.2, respectively; p=0.078). Both anemia (15.9% and
7.5%, p=0.019) and hypoalbuminemia (15.9% and 7.5%,
p=0.019; 20.1% and 7.5%, p<0.001) were more prevalent in
elderly with calf circumference <31cm in relation to those with
values31cm. They were also more prevalent in those consid-
ered malnourished by MNA comparing with well-nourished
(anemia: 14.4 and 5.9%, p=0.011; hypoalbuminemia: 21.6
and 6.0, p=0.002). Hypoalbuminemia was significantly higher
in those who self-perceived malnourished (14.9% and 7.5%,
p=0.019), but anemia and low calf circumference were not sig-
nificantly. Thus, nutritional status is a complex part of geriatric
evaluation and should count on several measures, including
anthropometric, self-perception and blood indicators, to allow
a complete understanding of nutritional status, once body
weight alone may not reflect it correctly.
SALT CONSUMPTION AND OVERWEIGHT AMONG
OLDER ADULTS: DATA FROM NUTRITION UP 65
P.Moreira1,2,3, P.Padrao1,3, A.Santos1, N.Borges1,
C.Afonso1, A.Sousa1, R.Guerra1, T.Amaral1, 1. Faculty of
Nutrition and Food Sciences, University of Porto, Portugal,
Porto, Portugal, 2. Research Center on Physical Activity and
Leisure, University of Porto, Porto, Portugal, 3. EPIUnit
- Institute of Public Health, University of Porto, Porto,
Portugal
Innovation in Aging, 2017, Vol. 1, No. S1
A few studies suggested that salt consumption might be
related with weight gain. We aimed to quantify salt con-
sumption in a representative sample of Portuguese older
adults and to evaluate the association between salt intake
and overweight (including obesity).
A cluster sampling approach was used, representing
Portuguese older adults (65 years) according to age, sex,
education level and regional area within the Nutrition UP
65 study. This cross-sectional evaluation was conducted in
2015 and 2016. From a sample size of 1500 participants,
1312 were eligible for the present analysis, 57.3% were
women, 23.5% were aged 80years. Salt consumption was
evaluated through one 24h urinary sodium excretion and
excessive salt consumption was defined as 5g/day, accord-
ing to the World Health Organization cut-offs. Overweight/
obesity was defined as BMI>27kg/m2, according to the
Nutrition Screening Initiative criteria for older adults. Amul-
tivariable binary logistic regression model was conducted to
evaluate the association between salt consumption and over-
weight/obesity, and Odds Ratios (OR) and respective 95%
Confidence Intervals (95%CI) were calculated.
Salt consumption 5g/day was observed in 85.1% par-
ticipants [median (interquartile range)=7.9(4.6) g/day], and
the prevalence of overweight or obesity was 69.6%. After
adjusting for potential confounders, excessive salt consump-
tion (OR=1.48, 95%CI: 1.062.17) was associated with
being overweight/obese.
These results emphasize the need for implementing nutri-
tional strategies concerning the reduction of salt consump-
tion among this age group, and particularly in the overweight
or obese.
This project was granted by the Public Health Initiatives
Programme (PT06), financed by EEA Grants Financial
Mechanism 20092014.
ASSOCIATION OF BODY COMPOSITION AND
PHYSICAL FUNCTION WITH VENTILATORY
LIMITED OBESE OLDER ADULTS
M.D.Opina, T.Brinkley, M.Gordon, B.J.Nicklas, Wake
Forest School of Medicine, J Paul Sticht Center on Aging,
Winston Salem, North Carolina
We evaluated whether ventilatory limitation during peak
cardiopulmonary exercise testing is associated with worse
body composition and physical function in healthy older
adults with obesity but without chronic pulmonary disease.
177 healthy adults, 6580years old, with obesity (BMI=30-
45kg/m2) underwent cardiopulmonary exercise testing on a
treadmill, body composition measurement using DXA, and
physical function assessment. Participants were categorized
into 4 groups based on the lower 95% confidence limit for
mean VO2peak (17.49ml/kg/min) and the median breath-
ing reserve at peak exercise (BRpeak, 37.2). Those with
low VO2peak/low BRpeak were considered to have venti-
latory limitation (VL,n=33), normal BRpeak/low VO2peak
had non-ventilatory limitation (NVL,n=48), low BRpeak/
high VO2peak were healthy obese (HOb,n=55), and normal
BRpeak/high VO2peak were fit obese (FOb,n=41). VO2peak
was lowest in VL (14.71.7ml/kg/min vs 15.51.7ml/kg/
min vs 20.7
2.6ml/kg/min vs 19.9ml/kg/min) and was
associated with lower oxygen pulse (10.31.5ml/HR vs
10.82.2ml/HR vs 13.32.5ml/HR vs 13.63.1ml/HR)
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Innovation in Aging, 2017, Vol. 1, No. S1
and higher VE/CO2 (34.25.2 vs 30.13.1 vs 31.72.5 vs We investigated energy intake in malnourished patients at
28.53.1) compared to NVL, HOb, and FOb respectively hospital discharge and its association with functional limita-
(p<0.0001 for all). While total body mass was similar across
all groups, fat mass and percent body fat was highest in VL
and lowest in FOb (p<0.0001). Lean body mass was lowest
in VL and highest in normal FOb (p=0.03). Low VO2peak
groups had lower short physical performance battery scores
(p=0.02), slower gait speed (p<0.0001) and 400-meter walk
(p<0.0001) compared to high VO2peak groups, independ-
ent of BRpeak. In conclusion, ventilatory limitation at peak
exercise capacity is associated with worse body composition
in older obese adults without primary lung disease.
PROBLEMATIC DRINKING IS ASSOCIATED TO
MUSCLE MASS AND MUSCLE FUNCTION IN
ELDERLY MEN WITH DIABETES
N.Buchmann1,2, D.Spira1,2, I.Demuth1,2, K.Norman1,2, included. 53.5% were malnourished (MNA7) and 46.5%
E.Steinhagen-Thiessen1,2, 1. Charite - Research Group on
Geriatrics, Berlin (germany), Berlin, Germany, 2. Charite -
Universittsmedizin Berlin, Berlin, Berlin, Germany
Backgroung: Alcohol consumption is particular serious in
diabetic subjects (T2D), as hypoglycemic states can occure
due to an inhibition of hepatic glycolysis. Muscle is supplied
with energy by the breakdown of glucose, frequent episodes
of hypoglycemic conditions could result in muscle break-
down. Aim of the current analysis within the Berlin Aging
Study II (BASE-II) was to analyze the association of problem-
atic drinking behaviour to muscle mass and muscle function
in diabetes.
Methods: Cross-sectional data of 1456 elderly BASE-II
participants (50.8% women; 644years old) were analysed.
Alcohol consumption and problematic drinking was assessed
using the Alcohol Use Identification Test (AUDIT). Muscle
mass was measured using dual energy X-ray absorptiometry
(DXA), grip strength using a Smedley dynamometer. Adjusted
regression models were calculated to assess the association of
problematic drinking to muscle mass and grip strength.
Results: Problematic drinking was evident in 11.1% of
BASE-II participants, 12.1% had diabetes. In adjusted mod-
els (adjustment for age, BMI, smoking status, morbidities,
HOMA-IR, CRP, TSH, physical activity and antidiabetic
medication) we found a statistically significant association
between problematic drinking to muscle mass (Beta: -22.5;
SE: 9.8; p = 0.026) and grip strength (Beta: -7.8; SE: 2.9;
p = 0.010) in elderly diabetic men. These results were not
evident in women and subjects without T2D.
Discussion: Alcohol consumption, particularly problem-
atic drinking is associated with poorer muscle mass and grip
strength in elderly men with diabetes. This topic should be
adressed in these subjects as they could be at increased risk
for early dependency.
ENERGY INTAKE AND FUNCTIONAL LIMITATIONS
IN MALNOURISHED, GERIATRIC PATIENTS AT
HOSPITAL DISCHARGE
K.Franz, L.Otten, L.Bahr, U.Mller-Werdan, K.Norman,
Charit - University Medicine Berlin, Research Group on
Geriatrics, Berlin, Germany
Inadequate dietary energy intake results in weight loss
which is associated with functional limitations and frailty in
geriatric individuals (1).
IAGG 2017 World Congress
551
tions, grip strength and risk of depression.
Malnutrition was assessed with the Mini-Nutritional
Assessment (MNA) and dietary intake at discharge with a
24h-recall. Energy intake below 24 kcal/kg body weight/
day was considered low (2). Frailty was identified with the
Fried criteria (3). Restrictions in self-reported functional
limitations (Longitudinal Aging Study Amsterdam question-
naire), activities of daily life (ADL), depression (Center for
Epidemiologic Studies) and appetite (Council on Nutrition
appetite questionnaire) were evaluated by validated ques-
tionnaires. Patients were questioned regarding fall frequency
within the previous 12months. Grip strength was measured
with dynamometry.
115 patients (77.5
6.9 years; 55.7% women) were
were at risk (MNA 811). 55.7% had low energy intake
(174 kcal/kg body weight/day; 0.70.3g protein/kg body
weight/day). 72.2% were pre-frail/frail. 98.2% had func-
tional limitations. According to ADL, 67.9% were depend-
ent. 52.1% were at risk of depression, 67.0% exhibited loss
of appetite and 61.7% had fallen in the previous 12months.
Patients with low energy intake were more often function-
ally impaired (72.7% vs. 50.0%, p=0.018). Energy intake at
discharge correlated with grip strength (r=0.308, p=0.001).
In the majority of malnourished geriatric patients at hos-
pital discharge, energy intake is still below reference values
and is associated with functional limitations and reduced
strength.
1.Roberts et. al. J Nutr Health Aging,2000.
2.Gaillard etal. Clin Nutr,2007.
3.Fried et.al. J Gerontol AMed Sci,2001.
6-MONTH OUTCOMES OF AHOME-DELIVERED
MEAL PROGRAM FOR ACUTE NUTRITIONAL RISK
R.Di Maria-Ghalili1, K.Thoman1, E.Albajri1, N.Laverty2,
J.Nasser1, 1. Drexel University, Philadelphia, Pennsylvania,
2. MANNA, Philadelphia, Pennsylvania
Purpose: To describe the changes in self-rated health
status in individuals at acute nutritional risk who received
medically-appropriate frozen meals delivered weekly by a
community-based organization.
Methods: Individuals with an acute illness and at acute
nutritional risk who were referred by a healthcare professional
to receive medically-appropriate home-delivered meals for
up to 6months from the Metropolitan Area Neighborhood
Nutrition Alliance (MANNA) in Philadelphia, PA were
invited to participate in the program evaluation. Telephone
interviews were conducted at baseline (within 2 weeks of
receiving meals), 1month, 3month and 6months. The fol-
lowing tools from the Performance Outcome Measurement
Project (POMP) were administered at each time period: sat-
isfaction with home-delivered meals, functional status, and
social/emotional well-being.
Results: A total of 52 (Mean age 60.79 years 13.69)
individuals agreed to participate in the program evaluation
over a 3 month period. Participants were primarily female
(61.5%), were Black (71.2%) and lived alone (55.8%). The
primary diagnosis of participants included cancer (44.2%),
renal disease (23.1%), diabetes (15.4%) and HIV/AIDS
552
(15.4%). At baseline 32.7% of participants had weight loss,
19.2% were at risk for malnutrition, and 13.5% had an
impaired ability to prepare meals. Compared to baseline, at
6-months there was an overall increase in self-rated health
status (p=.006), and increased satisfaction with social activ-
ity (p=.01).
Conclusions: Individuals with an acute illness and at acute
nutritional risk reported an increase in self-rated health and
social activity while receiving weekly medically-appropriate
home-delivered meals for 6months.
THE RELATIONSHIP BETWEEN SCHISANDRAE
CHINENSIS SUPPLEMENTATION AND MUSCLE
STRENGTH IN OLDER WOMEN
S.Lim5, H.Park2,3, J.Park1, J.Jang4, K.Kim1, J.Ryu1, 1. co-morbidities at the last BIA measurement and the mortal-
Institute of Taekwondo for Health and Culture, Dong-A
University, Busan, Korea (the Republic of), 2. Department of
Health Care and Science, Dong-A University, Busan, Korea
(the Republic of), 3. Department of Preventive Gerontology,
National Center for Geriatrics and Gerontology, Nagoya,
Japan, 4. Institute of Convergence Bio-Health, Dong-A
University, Busan, Korea (the Republic of), 5. Research
Foundation for Industry-Academy Cooperation, Dong-A
University, Busan, Korea (the Republic of)
Background: Several studies reported that the direct
relaxation effect of schizandra chinesis on animal smooth
muscle was more dominant than the endothelium depend-
ent NO pathway in corporal tissue and that activation of
K+ channels and inhibition of TRPC6 channels could be
one mechanism of schizandra chinesis induced relaxation
of smooth muscles. The fruit of Schizandra chinensis (SC)
is a well-known traditional herb used for pharmacological
purposes in Asian countries (e.g., Korea, China and Japan),
however, the association of SC sippl. and physical function in
older population remains unclear.
Purpose: A controlled, randomized, double-bind trial to
evaluate the effect of schizandra chinesis supplementation on
skeletal muscle mass and muscle force in older women.
Subjects and Methods: Forty-eight female participants
(intervention group, n=26; control group, n=22) were
included in this study. The intervention group performed
ingested two capsules containing either schizandra chine-
sis or cellulose with every day for 12 weeks breakfast and
dinner. The schizandra chinesis capsule contained 250mg of
schizandra chinensis, whereas the placebo capsule contained
250mg cellulose. Comparison of changes in body compo-
sition measured by DXA, muscles quadriceps strength by
Biodex, and laboratory tests between the control and inter-
vention groups during 12 weeks.
Results: After intervention, significant group time inter-
actions for the strength of quadriceps muscle force were
found. Also, significant group time interactions for appen-
dicular skeletal muscle mass were found.
Conclusion: Schizandra chinesis supplementation may
help to improve the age-related loss of skeletal muscle mass
and muscle force in older women.
BIOIMPEDANCE-DERIVED PHASE ANGLE AND
MORTALITY AMONG OLDER PEOPLE
L.Genton4, K.Norman2, A.Spoerri3, C.Pichard4, estimates of US hospitalizations. Characteristics of older and
V.Karsegard4, F.R.Herrmann5, C.Graf1, 1. Rehabilitation
and palliative Care, University Hospitals of Geneva, Bernex,
Innovation in Aging, 2017, Vol. 1, No. S1
Geneva, Switzerland, 2. Charite University Medicine
Berline, Berlin, Germany, 3. Social and Preventive Medicine,
University of Bern, Bern, Switzerland, 4. Clinical Nutrition,
University Hospitals of Geneva, Geneva, Switzerland,
5. Geriatrics, University Hospitals of Geneva, Geneva,
Switzerland
Phase angle measured by bioelectrical impedance analy-
sis (BIA) may be a marker of health state. This study aims
to investigate the link between phase angle and mortality in
older persons, and to evaluate whether we can define a phase
angle cut-off.
We included all adults over 65 years who underwent
a BIA measurement at the Geneva University Hospitals
between 1990 and 2011. We retrieved the phase angle and
ity until December 2012. The analyses were performed with
the Nutriguard device because they allow the calculation
of sex-, age- and body mass index (BMI)- standardized phase
angle using German reference values. Sex-specific and stand-
ardized phase angle were categorized into quartiles, where
quartile 1 corresponds to the lowest phase angle values and
is used as reference category. We evaluated the association
of mortality with sex-specific or standardized phase angle
through univariate and multivariate (age, sex, comorbidities,
BMI categories and settings) Cox regression models, Kaplan-
Meier curves and ROC curves.
1307 (38% women) underwent a measurement with the
Nutriguard device. Death occurred in 628 persons (44%
women). In a multivariate Cox regression model, the risk of
mortality decreased progressively as the standardized phase
angle quartile increased (HR 0.71 (95%CI 0.58, 0.86), 0.53
(95%CI 0.42, 0.67), 0.32 (95%CI 0.23, 0.43). The discrimi-
native value of continuous phase angle, assessed as the area
under the ROC curve, was 0.724 (95%CI 0.70, 0.75) not
leading to define an acceptable phase angle cut-off to per-
form individual prediction of mortality.
This study shows the association of phase angle and
mortality in elderly patients, independently of age, sex,
comorbidities, BMI categories and settings (ambulatory vs
hospitalized).
COMPARISON OF OLDER VS. YOUNGER
HOSPITALIZED ADULTS WITH AMALNUTRITION
DIAGNOSIS IN THE U.S., 2010
R.Di Maria-Ghalili1, J.Slaughter1, E.W.Gonzalez1,
P.Abeysekara1, H.Resnick2, P.Guenter3, 1. Drexel
University, Philadelphia, Pennsylvania, 2. Resnick
Chodorow LLC, Silver Springs, Maryland, 3. American
Society for Parenteral and Enteral Nutrition, Silver Springs,
Maryland
Purpose: To examine differences in demographic char-
acteristics and comorbidities in a nationally representative
sample of older (65years) and younger (1864years) hos-
pitalized patients with diagnosis of malnutrition (dxmal).
Methods: Data are from the 2010 Healthcare Cost and
Utilization Project (HCUP), which contain patient-level data
with ICD-9CM diagnosis codes on hospital inpatient stays.
Data were weighted to generate nationally representative
younger adults with a dxmal during their hospital stay were
identified and compared.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Results: Among patients with a dxmal, those 65years
were 1.5 times more common than those <65 (727,858 vs
467, 378). Older dxmal patients were more likely to have
chronic comorbidities than younger adults. However, among
older dxmal patients, length of stay (11.6 vs 13.7 days,
p<.001) and cost of care ($80,191 vs 106, 535, p<.001) were
lower and more older dxmal patients died during their hospi-
tal stay (10.7% vs 6.6%, p<.001). Older dxmal patients were
three-times more likely to be admitted to the hospital from
a skilled nursing facility (6.4% vs 2.0%, p<.001), and twice
as likely to be discharged to an intermediate or skilled care
facility (49.2% vs 25.0%, p<.001).
Conclusions: Older hospitalized dxmal patients appear
to be more frail and have greater comorbidity than their
younger counterparts. While their length of stay and cost of
care is lower, their mortality is higher. It may be beneficial
to carefully monitor nutritional status in hospitalized older
adults with dxmal, especially those admitted from skilled
nursing facilities.
IDENTIFICATION OF AMULTIDIMENSIONAL FOOD
AMINO ACIDDEFINED CIRCADIAN LONGEVITY
ZONE
R.J.Martin1, S.A.Raphaelson2, H.Raphaelson3,
W.Ashford4, A.D.Pruchnicki5, R.Schnoll6, 1. Blueberry
Health Study / MMT Corp, Sherman, Connecticut, 2.
Midwife Services, Espanola, New Mexico, 3. Mansfield
Senior Center, Mansfield, Connecticut, 4. Stanford/ Veterans
Affairs Aging Research Ctr, Palo Alto, California, 5. Mount
Sinai St. Lukes Hospital, New York, New York, 6. Brooklyn
College City University of New York, New York, New York
The amino acids cysteine, glycine, serine and tyrosine
all increased steadily during evolution of primate to human
milk, hinting that this combination may support the extraor-
dinary human longevity which co-evolved. Methionine con-
tinued its long downward trend during primate evolution, so
this amino acid declined steadily in heart tissue and then milk
proteins from mice to man, spanning cat, dog, cow, horse
and elephant evolution as well as rodent and primate. These
amino acid changes are sufficiently precise to enable unbi-
ased SIMCA multivariate analysis to predict primate/human
lifespan with 99 percent accuracy, and to score and map all
foods within the US Department of Agriculture Nutrition
Database (Release 26)into zones comprised of proportions
resembling short-lived species, or milk from the longest-lived
primates. This presentation provides a tour of foods with
longevity-correlated proportions, generally higher in serine
and tyrosine and lower in methionine, which map together in
20-dimensional amino-acid-space near human milk, caviar
and germ-line tissues that defy aging indefinitely. These care-
fully-evolved proportions are then linked to daily circadian
peak periods of high methionine and genetic damage that
by hypothesis represent a burst of daily aging that occurs
unless we protect ourselves by carefully selecting nutrient
proportions at each meal (either baboon-like proportions or
non-aging-germ-line proportions). Longevity-linked ratios
in burritos are then shown to predict surprisingly low rates
of Alzheimers, cancer, heart disease, stroke and other age-
associated illnesses within Hispanic-Americans aged 80 and
above, and the partial reversal of advanced kidney disease
when cats are fed a specially-formulated kidney-support diet.
IAGG 2017 World Congress
553
SARCOPENIC OBESITY INDUCED BY SHORT-TERM
HIGH-FAT FEEDING IN AGED RAT
L.Wang1,2, Q.Ruan1,2, Y.Zhang3, Z.Bao1,2,3, Z.Yu1,2,
1. Shanghai Institute of Geriatrics and Gerontology,
Shanghai Key Laboratory of Clinical Geriatrics,
Shanghai, China, 2. Department of Geriatrics, Huadong
Hospital, and Research Center of Aging and Medicine,
Shanghai Medical College, Fudan University,Shanghai
200040, China, Shanghai, China, 3. Department of
Gastroenterology, Huadong Hospital, Shanghai Medical
College, Fudan University, Shanghai, China
Background: Sarcopenic obesity was defined as the combi-
nation of excess weight and reduced muscle mass or strength.
Studies described the loss of muscle mass and strength in
aged rat. And short-term high-fat feeding in rat increased the
fat accumulation in multiple organs.The object of the study
was to establish a rat model of sarcopenic obesity by short-
term high-fat feeding.
Methods: Male SD young (2-month) and old (18-month)
rats (n=30 respectively) were fed a control diet (CD) (n=15
respectively) or a high-fat diet (HFD) (n = 15 respectively)
for 8 weeks. Body composition was measured by magnetic
resonance techniques at the age of 4 and 20months respec-
tively (n=59). Grip strength normalized to lean body mass
was measured in rats of each group (n=59). Muscle function
were further examined by different stimulated protocols to
determine the changes in contractile characteristics including
the the maximum twitch force (Pt) and the maximum tetanic
force (Po). The hindlimb muscles of 8 rats were collected
for pathological experiments. Muscle lipid contents were
reflected by Sudan black B staining and LAI (lipid accumula-
tion index).
Results: In young rats, HFD consumption resulted in
significant increases in body weight, fat mass, and muscle
mass compared with control diet. In aged rats, however,
muscle mass was slightly reduced in HFD-fed group com-
pared with control group. Meanwhile, body weight and
fat mass in HFD-fed old rats increased compared with old
control rats.Muscle lipid content was increased in glyco-
lytic tibialis anterior muscle but no changes in oxidative
soleus muscle for the HFD-fed rats. Grip strength was
significantly reduced in HFD-fed old rats compared with
old control rats. However, no significant difference in grip
strength between HFD-fed young rats and young control
rats. The maximum twitch force (Pt) and the maximum
tetanic force (Po) of hind-limb skeletal muscle were sig-
nificantly decreased in HFD-fed old rats compared with
rats of other groups.
Conclusions: These results showed that a rat model of
sarcopenic obesity could be established in aged rats by short-
term high-fat feeding.
DIETARY HABITS OF JAPANESE ELDERLY IN AREAS
WITH HEAVY SNOWFALL
Y.Iiyoshi, C.Inoue, Community Health Nursing, Niigata
College of Nursing, Joetsu, Niigata, Japan
[Purpose] This study examines the dietary habits of in the
Japanese elderly individuals in areas with heavy snowfall.
[Methodology] Questionnaires were distributed to 1004
elderly in City B, Prefecture A; 494 responses were targeted
for analysis. Survey items included attributes, food intake
554
conditions, dietary habits, impression of a balanced diet,
height, weight, deglutition state, medical status, self-rated
level of health, and measurement of psychological inde-
pendence. Scores for dietary variety were calculated from
food intake conditions. The scores were classified into three
groups. Taking dietary variety as the criterion variable and
attributes, dietary habits, BMI, deglutition state, medical
examination status, and measurement of psychological inde-
pendence, TMIG-IC as explanatory variables, an 2 test or
correlation coefficient was calculated.
[Results] Average age was 75.7 (SD7.1) years, males were
45.5% and females were 54.5%, family composition was
couples at 40.7% and those living alone at 10.5%. Average
BMI was 22.8 (SD3.2). Individuals making food on their
own were 47.6%. Means of shopping included shopping by
car at 59.1%; 81.6% preferred supermarkets for shopping
for perishables. The average dietary variety score was 3.4
(SD2.2). For dietary variety, gender, level of health, impres-
sion of a balanced diet, shopping means, meal preparation,
and sharing side dishes were significantly related. Dietary
variety and mental independence had a weak correlation.
For females, Dietary variety and JST-IC subscale (informa-
tion gathering) had a weak correlation.
[Discussion] This study suggests that self-rated level of
health and level of mental independence are important indi-
cators for dietary variety.
MODEL OF RELATIONS BETWEEN THE SOCIAL
DETERMINANTS OF HEALTH ASSOCIATED WITH
OBESITY IN THE ELDERLY
M.M.Stival, L.R.Lima, S.S.Funghetto, C.G.Volpe, second and final phase contributed to the discontinuance of
W.S.Santos, M.V.Costa, M.G.Karnikowski, Nursing,
University of Brasilia, Taguatinga, Brazil
Objective: To test the plausilidade the hypothetical model
of relations between the social determinants of health (SDH)
in a population of obese elderly. Design: Cross-sectional
descriptive study conducted with the elderly population
of a health family program of Distrito Federal, Brazil.
Participants: 206 elderly classified as obese in the nutri-
tional assessment performed by Mass Index and bioelectrical
impedance. To research the SDH was used Household Survey.
The Path Analysis was used AMOS, SPSS 20.0 to determine
the relationships between variables. Results: the education
explained 6.9% of the income variation (=0.262), income
and gender explained 9.3% of the variation in alcohol con-
sumption ( = 0.255), 6.4% of the smoking variable was
explained by age (=-0.159), gender (=-0.182) and educa- ity fractures or osteoporosis than Whites. Broadband ultra-
tion (=-0.135), 7.3% of physical activity was explained by
alcohol consumption (=0.124) and for leisure (=0.188), in studies to explore the association between vitamin D levels
2.9 % of the variation in the consumption of vegetables
( = 0.170) and 3.3% of fruit ( = 0.182) was explained investigated vitamin D status with corresponding BUA meas-
by the presence of the diet, 2.7% of the diet variable vari-
ation was explained by income (=0.164), 3.5% of family
funcionalide was explained directly by age (=0.168) and
education ( = 0.148), 8.3% of community involvement is
explained by gender (=0.190) and education (=0.216). subjects completed a large baseline questionnaire including
Conclusion: SDH influence in obesity in the elderly in respect
of how the elderly live and the conditions that have to live.
Innovation in Aging, 2017, Vol. 1, No. S1
THE ADHERENCE OF ELDERLY WOMEN WITH
METABOLIC SYNDROME TO AFOOD RESTRICTION
PROGRAM
K.Medeiros1, G.F.de Melo1, F.Agostinho2,3, 1.
Universidade Catlica de Braslia, Braslia, Brazil, 2.
Universidade de Rio Verde, Rio Verde, Brazil, 3. Faculdade
Mineirense - FAMA, Mineiros, Brazil
In this study, 40 elderly women with metabolic syn-
drome joined a food restriction and exercise program (EF) of
271days divided into three phases: Phase I(21days), Phase
II (90days) and phase III (160days). In Phase Iparticipants
received a food plan (PA) prescribed with calorie restric-
tion of 30%, attended lectures, workshops and an aerobic
and anaerobic EF program. In the other phases they were
instructed to proceed with the proposed protocol without
direct monitoring of the nutritionist. Anthropometric, bio-
chemical, food consumption and adherence to the PA data
were collected before (pre) and after (post) each phase. At the
end of phase I, II and III the study found a quantitative adhe-
sion to the program of 100%, 60% and 20% respectively.
Significant statistical difference was found when comparing
the averages of before and after phase I of the anthropo-
metric data: Abdominal Circumference (pre: 100,36cm and
post: 94,87cm (p = 0.001)); Body Mass (before: 72,07kg
and post: 69,92kg (p=0,001)); Percentage of body fat (pre:
40.07% and after: 38.62% (p=0.003)); Body Mass Index
(pre: 30,07Kg / m2 and after: 29.17kg / m2 (p = 0.001)).
Weight loss and the individual monitoring with the profes-
sional nutritionist presented themselves as factors that con-
tributed positively to the adhesion of the elderly women to
the program. The absence of a professional nutritionist in the
the elderly.
SESSION 1050 (POSTER)
OSTEOPOROSIS
ETHNIC VARIATIONS IN VITAMIN D LEVELS AND
BONE QUALITY IN BLACKS AND WHITES
R.O.Sakamoto1, D.Thorpe2, R.Knutsen2, L.Beeson2,
S.Knutsen2, 1. California State University, Fullerton,
Fullerton, California, 2. Loma Linda University, Loma
Linda, California
Studies have shown that vitamin D deficiency is common
in Blacks, yet Blacks have lower prevalence of bone fragil-
sound attenuation (BUA) bone measurements have been used
and bone quality in White and non-white populations. We
urements assessed cross-sectionally in a bi-ethnic cohort: 232
Blacks and 260 Whites, aged 3095years. Subjects were part
of the calibration sub-study of the large Adventist Health
Study-2 (AHS-2) of about 96,000 participants. At enrollment,
information on demographics, dietary practices, and medical
history. At the calibration clinics, blood was drawn for later
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
serum 25(OH)D assessment and calcaneal BUA measured.
In multivariable analyses, age was negatively associated with
BUA, most strongly among females, but also among males
(-coefficient -0.69 and -0.28, respectively). Gender and race
modified the relationship of serum vitamin D on BUA. In
males, after adjusting for age, race, BMI.history of fractures,
physical activity, smoking history and calcium intake, serum
vitamin D was positively associated with BUA (-coefficient
5.35 p .05) and after also adjusting for serum vitamin D,
BUA among Black men was significantly higher than among
White men (-coefficient 6.95 p .05). However, for women,
after also controlling for menopausal status and hormone
therapy, there was no difference in BUA between Black and
White females. Further studies are needed to understand how
racial/ethnic differences in hypovitaminosis D influences
bone health.
OSTEOPOROSIS TREATMENT AMONG OLDER
WOMEN IN THE NATIONAL AMBULATORY
MEDICAL CARE SURVEY (NAMCS)
L.Bozzi, P.Gaitonde, S.Tom, University of Maryland
School of Pharmacy, Baltimore, Maryland
The safety of bisphosphonates has been called into ques-
tion recently. While substitutes for osteoporosis management
have become more common, profiles of those using substi-
tute medications are not known. We hypothesized that older
women (age 65 years) with chronic comorbidities would
substitute other medications for bisphosphonates compared
to younger women (age <65 years). We analyzed visit data
of 2015 osteoporotic women from the 20052012 National
Ambulatory Medical Care Survey (NAMCS). Osteoporosis-
related treatments included bisphosphates, selective estro-
gen receptor modulators, denosumab, teriparatide, calcium,
Vitamin D, and estrogen supplements. We used multivariable
logistic regression to examine the relationship between age
and comorbidities with prescription of bisphosphonates ver-
sus other osteoporosis medications, adjusting for potential
confounders including race, physician specialty, and payer
type. We weighted the estimates by drug mentions to account
for the complex sampling frame. The majority of patients
were White (79%), age 65 years (73%) with 3 comor-
bidities (59%). Of osteoporosis-related treatments, bispho-
sphonates comprised the majority of osteoporosis-treatment
medications (68%). Women age 65 years had a similar
distribution of substitute medications as younger women
(30% versus 22%), and those with 3 comorbidities were
similar to those with fewer comorbidities (31% versus 30%).
Those with 3 comorbidities (Odds Ratio (OR): 1.12; 95%
Confidence Interval (CI): 0.841.49) had a similar likelihood
of receiving substitute medications compared to women with
fewer comorbidities. In recent NAMCS data, the majority
of osteoporosis-related treatments included bisphosphonate
prescriptions. Age and comorbidities did not influence the
type of osteoporosis medication prescribed.
ASSOCIATIONS BETWEEN TRABECULAR BONE
SCORE AND VERTEBRAL FRACTURES ACCORDING
TO SPINE T-SCORES
K.Kim1,2, J.Lee1,2, S.Lim1,2, H.Jang 1,2, 1. Internal
Medicine, Seoul National University Bundang Hospital,
Seongnam-si, Kyunggi-do, Korea (the Republic of), 2. Seoul
IAGG 2017 World Congress
555
National University College of Medicine, Seongnam-si,
Kyunggi-do, Seongnam-si, Kyunggi-do, Korea (the Republic
of)
Trabecular bone score (TBS) has been shown to be sig-
nificantly related to vertebral fractures. The study aimed to
evaluate the associations between TBS and vertebral frac-
tures according to BMD T-scores.
Areal BMD at the lumbar spine (L1-L4) was assessed in
957 women aged 45 years and older from Seoul National
University Bundang Hospital from February 2015 to 2016
using dual x-ray absorptiometry (DXA) scan and TBS was
further analyzed using iNsight software (Med-Imaps, Pessac,
France). Vertebral fractures were identified on lateral X-ray
films of the spine.
Mean age was 66.410.5 years and vertebral fractures
were observed in 93 (9.7%) subjects. Twenty-four percent of
fractures were occurred in normal BMD, 44.1% in osteope-
nia and 32.3% in osteoporotic ranges. According to the TBS
levels, 7.5% fractures were happened in higher TBS levels
(>1.350), 55.9% in middle TBS (1.2011.350), and 37.8%
in lower TBS levels (1.200). Adjusted odds of lumbar spine
T score for fractures was 0.40 (95% CI 0.320.51, p<0.001).
Odds of each increase of 1 SD in TBS was 0.75 (95% CI
0.570.98, P <0.05). Adjusted ORs for lumbar spine T-score
were only significant in osteoporotic or osteopenic subjects,
whereas adjusted ORs for 1SD increases in TBS was only
significant in women with normal T-scores.
In conclusion, both lumbar spine T-score and TBS were
significantly associated with vertebral fractures. However,
lumbar spine T-score predicts fractures well in women with
osteopenia or osteoporosis, but TBS levels are better predict-
able in subjects with normal BMD.
PREVENTIVE EFFECTS OF TREATMENT FOR
OSTEOPOROSIS ON AGE-RELATED WEIGHT LOSS IN
POSTMENOPAUSAL WOMEN
T.Urano1, M.Shiraki2, T.Kuroda3, S.Tanaka4, F.Urano5,
K.Uenishi6, S.Inoue7, 1. Department of Geriatric Medicine,
Faculty of Medicine, International University of Health and
Welfare, Chiba, Japan, 2. Research Institute and Practice
for Involutional Diseases, Nagano, Japan, 3. Public Health
Research Foundation, Tokyo, Japan, 4. Kyoto University,
Kyoto, Japan, 5. Washington University School of Medicine,
St. Louis, Mississippi, 6. Kagawa Nutrition University,
Saitama, Japan, 7. Tokyo Metropolitan Institute of
Gerontology, Tokyo, Japan
Decline of body weight with aging is a major risk fac-
tor for frailty, osteoporosis and fracture, suggesting that
treatment for osteoporosis may affect body composition.
However, the effects of treatment for osteoporosis on body
composition are not well known. The present study aimed
to identify the relationship between treatment for osteopo-
rosis and body composition markers. We measured bone
mineral density (BMD), body composition, and bone remod-
eling markers in 551 Japanese postmenopausal women
with Selective estrogen receptor modulators (SERMs)
(SERM treatment group; N=143) treatment, with bispho-
sphonates treatment (BP treatment group; N = 193) and
without treatment by any osteoporosis drug (No treatment
group; N=358) for 4 to 7years (mean observation peri-
ods; 5.5years) and analyzed the relationship of these with
556
BMD, body mass index (BMI), body weight, and biochemi-
cal markers. The mean (SD) age of the participants was in
68.9 (9.3) year SERM treatment group, 68.6 (9.8) year in
BP treatment group and 63.7 (10.6) year in No treatment
group. Percent-changes in body weight and BMI were sig-
nificantly different between women taking SERMs or BPs
and those not taking any osteoporosis drugs (P<0.01 and
< 0.01, respectively). In multiple linear regression analysis,
SERMs and BPs treatment was a significant independent
determinant of body weight and BMI. Long-term use of
SERMs and BPs may prevent reductions in BMI and body
weight, usually observed in elderly women.
ESTABLISHING AN ANTI-OSTEOPOROSIS MEDICA
TION MONITORING AND MANAGEMENT SERVICE
IN NORTHERN TAIWAN
D.Chan1,3, C.Hong1, I.Lee1, L.Hung1, C.Chang1, J.Peng2,
K.Tsai1, R.Yang1, 1. National Taiwan University Hospital,
Taipei, Taiwan, 2. National Taiwan University Hospital,
Bei-Hu Branch, Taipei, Taiwan, 3. National Taiwan
University Hospital Chu-Tung Branch, Hsinchu County,
Taiwan
Background/Purpose: Recently data showed that adher-
ence of oral anti-osteoporosis medications (AOMs) were
only about 40% in 4months and 20% in one year in Taiwan.
We aimed to determine the effects of AOM management pro-
gram on medication adherences in northern Taiwan.
Methods: Five hundred patients with osteopenia/osteopo-
rosis and with/without fractures with one of the following
criteria were referred to this program: newly prescribed with
AOMs, recent change of AOMs, poor adherence to AOMs
or participating physicians requests. Research coordinators
conducted baseline assessments, which included osteoporo-
sis/fracture diagnosis and risks, medical conditions, and life
styles. Educational booklet on osteoporosis managements
was provided and taught after assessments. The primary
outcome was the osteoporosis medication adherence meas-
ured by medication possession ratio (MPR, at 4, 8, 12, and
18 months after enrollment. Bone mineral density (BMD)
was measured by dual X-ray absorptiometry (DXA) at femo-
ral neck, total hip, and lumbar spine (L1-L4) at baseline and
when indicated by treating physicians. This report presented
4month follow-up data.
Results: Mean age was 74.510.4years for the entire Methods: A total of 348 senile men were involved and
cohort (87.0% were women). The lowest mean T-score
was -2.930.81. About 7/8 (87.4%) patients had at least weight, parent brittle fracture history, oral steroid history,
one chronic medical condition. For the entire cohort,
49.8% were newly prescribed with AOMs, 11.0% were
recent change of AOMs, 7.8% were poor adherence to
AOMs, and 31.4% were requested from participating
physicians. At baseline, 47.2% used Denosumab, 17.2%
used Zoledronic acid, 15.4% used Alendronate, 10.8%
used Raloxifene, 7.4% used Ibandronate, 1.8% used
Teriparatide and 0.2% used Strontium ranelate. About 3/4
(73.4%) were reimbursed by National Health Insurance.
Overall medication adherence at 4 months was 95.9%.
Specifically, 100% for Denosumab and Zoledronic acid,
99.4% for Teriparatide, 98.8% for Ibandronate, 88.3%
for Alendronate, 80.8% for Raloxifene, and 58.8% for
Strontium ranelate.
Innovation in Aging, 2017, Vol. 1, No. S1
Conclusion: Our preliminary data suggested that media-
tion management program significantly improved adherence
in 4months with pending one year follow up data.
A DEMONSTRATION STUDY OF THE FRACTURE
LIAISON SERVICE (FLS) MODEL OF CARE
A.Singer2, D.Lee1, D.Zeldow1, 1. National Bone Health
Alliance (NBHA), Arlington, Virginia, 2. MedStar
Georgetown Hospital, Washington, District of Columbia
Although half of women and one-quarter of men over 50
sustain an acute osteoporotic fracture, less than a quarter
receive appropriate secondary fracture prevention. The goal
of this demonstration project was to examine the effective-
ness of a a cloud-based registry application to support the
FLS model of care (FLS App) for secondary fracture pre-
vention at 3 academic medical centers.
Methods: The Bone Health Collaborative (National Bone
Health Alliance, National Osteoporosis Foundation and
CECity/Premier), developed a web-based registry application
to deploy the FLS model of care to coordinate post-fracture
care. The pre-post study design examined the number of
men and women over age 50years who received appropriate
assessment (bone mineral density [BMD], vitamin D levels)
and pharmacologic treatment within 6 months of an acute
fragility fracture. A retrospective chart review was used to
collect baseline data at each health care facility (N=344
patients). For the post evaluation (N= 148 patients), the FLS
coordinator or champion examined these parameters during
the 6 months following enrollment and collected pertinent
data on the FLS App. Provider and data collection surveys
were used to elicit provider satisfaction and barriers to col-
lecting patient information prior to implementation of the
project and at the conclusion of the study. Comparisons
between pre-post FLS periods were done using chi-square
tests.
FRACTURE PREDICTIVE VALUES OF FRAX FOR
SENILE MEN IN BEIJING
Z.Zhao, Beijing Friendship Hospital Affiliated to Capital
Medical University, Beijing, China
Objective: To evaluate the fracture predictive applicability
of FRAXFracture Risk Assessment toolfor senile men
in Beijing, and to discuss the effect of 25(OH)D on FRAX.
the personal data were collected including the age, height,
history of rheumatoid arthritis, drking history and smoking
history. The serum concentrations of 25(OH)D were meas-
ured, amd bone mineral denisity at lumbar spine1-4 (L1-4), left
femoral neck, and total hip were measured by dual-energy
X-ray absorptiometry. Each individual 10-year hip and major
osteoporotic fracture probability was calculated by FRAX
Chinese model. Participants were divided into 4 groups by
age and 4 groups according to serum 25(OH)D levels. The
results of FRAX in different groups were comparaed, and
the effect of vitamin D status on FRAX was investigated.
Results: Only 4 participants achieved the diagnostic crite-
ria of high risk of osteoporotic fracture. The 10-year prob-
ability of hip fracture was 0.960.31 (0~4.2) and increased
with age. The difference was statistically significant between
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
groups of all age (P<0.05). The 10-year probability of major
osteoporotic fracture was 3.570.98 (1.37.6), and the Survey in Taiwan 1999. We chose this dataset as it has data
difference was not statistically significant between groups
of all age (P<0.05). The 10-year probability of hip fracture
increased with decreasing vitamin D levels, and the difference
was statistically significant among all groups (P<0.05). The
10-year probability of major osteoporotic fracture of vita-
min D deficient group was higher than the probability of suf-
ficient group (P<0.05). Conclusion: FRAX Chinese modle
may underestimate 10-year osteoporotic fracture probability
of semile men in Beijing. Many factors such as vitamin D
nutritional status maybe to improve the predictive value.
SIGNIFICANT GENE-GENE INTERACTION OF TNF-
AND VDR ON OSTEOPOROSIS COMMUNITY-
DWELLING ELDERS
L.Liao2, C.Lin1, T.Li2, F.Wu2, C.Yang1, W.Lin1, 1. China univariate (=-0.87, 95% CI: -4.73, 2.99) and by multivari-
Medical University Hospital, Taichung, Taiwan, 2. China
Medical University, Taichung, Taiwan
Osteoporosis (OST) is a complex multifactorial disease.
Prior studies evaluated gene effects seperately on OST. We
evaluated gene-gene interactions of polymorphisms in tumor
necrosis factor- (TNF-) and vitamin D receptor (VDR)
genes on OST in elders.
A total of 472 elders were included from Taichung
Community Health Study for Elders; polymorphisms (TNF-
: rs1799964, rs1800629, rs3093662; VDR: rs7975232,
rs1544410, rs2239185, rs3782905) were genotyped. Bone
mineral densities (BMD) of lumbar spine (LS), femoral neck
(FN), and total hip (TH) were measured by DEXA. Overall
and site-specific OSTs were defined as BMD T-score 2.5
standard deviations. Predictive models ability to discrimi-
nate OST status was evaluated by areas under the receiver
operating characteristics (AUROC) curve.
After considering age, BMI, physical activity, smoking,
and drinking, significant interactions of TNF- rs1799964
and VDR rs2239185, and TNF- rs1800629 and VDR
rs3782905 on overall and LS OST; interaction of TNF-
rs1799964 and VDR rs3782905 on LS OST in women
were observed (P < 0.05). AUROC (95% CI) for Model1
(traditional factors), Model2 (Model1 + rs1800629 and
rs3782905), and Model3 (Model2 + gene-gene interaction)
for overall OST were 0.77 (0.70, 0.84), 0.79 (0.72, 0.86), and
0.81 (0.75, 0.88) in women, respectively. There were signifi-
cant differences in AUROC between Models3 and Model1
(P=0.028), and Models3 and Model2 (P=0.047), indicating
gene-gene interaction improved OST discrimination.
Adding gene-gene interaction into traditional factors
model did improve OST risk prediction in Han Chinese
elders, and help to identify high-risk individuals for OST
appropriate management and intervention.
SERUM MAGNESIUM AND BONE HEALTH: ASTUDY
OF THE ELDERLY NUTRITION AND HEALTH
SURVEY IN TAIWAN 1999
J.Gau1,4, M.Bann1, M.Nakazawa3, B.C.Clark1,4, W.Pan2, had significantly higher scores on the powerful others sub-
1. Ohio University, Athens, Ohio, 2. Institute of Biomedical
Sciences, Academia Sinica, Taipei, Taiwan, 3. University of
California at San Diego, San Diego, California, 4. Ohio
Musculoskeletal & Neurological Institute, Athens, Ohio
IAGG 2017 World Congress
557
We analyzed data from the Elderly Nutrition and Health
on both serum Mg levels and bone health. Among partici-
pants who had blood samples obtained (N=1,509), 210
older adults had reported fracture(s). Variables included in
our linear regression models for BUA were age, sex, blood
levels of hemoglobin, albumin, and creatinine. For logistic
regression models for self-reported fracture, BUA measure-
ment was included in addition to the above covariates. Our
study revealed that self-reported fracture cases (N=210,
female 56%, mean age 72.66.2) and controls (N=1,352,
female 47%, mean age 71.85.2) had similar mean serum
Mg levels (2.200.19 vs. 2.180.19mg/dL). Fracture cases
had significantly lower mean BUA compared to controls
(5421 vs. 6119, p<0.001) as well as in T- and Z-scores.
Serum Mg level and BUA was not significantly associated by
ate linear regression (=0.29, 95% CI: -2.94, 3.52). Adjusted
odds ratio (OR) of serum Mg level for self-reported fracture
was 1.74 (95% CI: 0.81, 3.77). We observed that increasing
age, female gender, lower hemoglobin and lower creatinine
levels were independent risk factors for lower BUA values.
Participants with higher BUA had lower risk of self-report
fracture (adjusted OR=0.985, 95% CI: 0.975, 0.995). Age
and sex became insignificant with adjusting the above vari-
ables. In conclusion, our study of a population-based survey
of Taiwanese elderly revealed that serum Mg level was not
associated with bone density measurement by BUA nor with
self-reported fractures.
ARE KNOWLEDGE AND LOCUS OF CONTROL
IMPORTANT FACTORS IN REDUCING RACIAL
INEQUITIES IN OSTEOPOROSIS?
N.C.Wright, M.E.Melton, N.V.Ivankova, S.L.Davies,
E.Levitan, K.G.Saag, University of Alabama at
Birmingham, Birmingham, Alabama
There are unexplained racial inequities in osteoporosis
prevention activities. We recruited Black and White women
with osteoporosis (T-score -2.5 at any skeletal site) to inves-
tigate the role that knowledge and locus of control play in
the racial differences on osteoporosis prevention activities.
We measured osteoporosis knowledge using the 10-item
Osteoporosis and You scale. We measured locus of con-
trol using the Multidimensional Health Locus of Control
(MHLOC) scale, which assesses three belief dimensions:
internal, chance, and powerful others (e.g. doctors, fam-
ily members, spiritual being). We used MHLOC Form Ato
assess overall health and Form C to assess bone health.
Forty-five women (White: 36; Black: 9)completed scales. The
mean (SD) age was 73.3 (9.5) years with no difference in age
between the two groups. We observed higher osteoporosis
knowledge among White women [8.5 (1.2) out of10] com-
pared to Black women [6.7 (3.1); p-value=0.015]. We did
not find racial differences in the MHLOC internal or chance
belief subscales for overall health; however, Black women
scale [Black: 23.8 (6.4); White: 18.5 (4.6), p-value=0.009].
We did not find any racial differences in any MHLOC sub-
scales for bone health. To date, our study revealed that Black
women have lower overall osteoporosis knowledge and
higher dependence on others for their overall health. This
558
knowledge can be used to generate targeted educational
interventions for Black women and provide guidance for
healthcare providers to improve and emphasize osteoporosis
prevention activities with Black women.
FRACTURE RISK AMONG TAIWANESE ELDERLY:
ASTUDY OF THE ELDERLY NUTRITION AND
HEALTH SURVEY
M.Bann1, J.Gau1, M.Nakazawa2, W.Pan3, 1. Ohio quently missed items. Two questions were found to be statis-
University, Concord, Ohio, 2. University of California at
San Diego, San Diego, California, 3. Institute of Biomedical
Sciences, Academia Sinica, Taipei, Taiwan
The Elderly Nutrition and Health Survey in Taiwan 1999
dataset was used for analyzing risk factors of self-reported
fracture. Patient survey data was available for 2038 patients,
including: 290 self-reported fractures, demographic, smoking
& alcohol use status, past medical history, current medica-
tion use, and dietary recall data. Variables, including dietary
intakes, medication or supplement, were examined for a sig-
nificant association with PUD. Association between PUD and
fracture was used to build a multi-variable logistic regression
model. Variables included in the logistic regression models
were age, sex, use of supplements, PUD, GI medication use,
total calorie intake, folic acid intake, magnesium intake, and
phosphate intake. The results show PUD is associated with
self-reported fracture with crude odds ratio(OR) of 1.71
(95% CI, 1.222.40, p=0.0017). Similarly, GI medication use
is associated with self-reported fracture with crude OR=1.96
(95% CI, 1.412.72, p<0.001). Multivariate logistic regres-
sions were created step-wise to demonstrate the relationship
between PUD, GI medication use and fracture. Age, gender
and supplement use remain significant at p<0.05; all die-
tary intake variable became insignificant. Adjusted OR for
PUD becomes insignificant at 1.37, (95% CI: 0.9342.004,
p=0.11) while GI Medication use remains significant with
adjusted OR=1.68 (95% CI: 1.1632.424, p=0.0057).
Overall, the model has a p-value=0.9206 for goodness of fit
criteria. The step-wise approach for building the multivari-
ate logistic regression model demonstrated that GI medica-
tion use is more heavily weighted as a covariate with PUD
to explain the self-reported fracture in the Taiwanese Elderly
Nutrition and Health Survey Data.
KNOWLEDGE OF OSTEOPOROSIS AMONG THE
LAYPERSON
R.Burgess, A.Parker, J.Roberts, William Carey University, 85 to 99years and 744 (0.1%) were centenarian. Of these
Hattiesburg, Mississippi
The purpose of this study was to determine the knowledge
of laypeople about osteoporosis. Specifically, is there a gen-
erational or gender difference in knowledge of osteoporosis?
Osteoporosis and associated fractures are serious public
health concerns. Millions of dollars are spent yearly to edu-
cate the public about prevention of and control of osteopo-
rosis. Aliterature review revealed a sparse documentation of
the general publics knowledge concerning osteoporosis.
A 23 item True/False survey to assess basic knowledge
was developed by the researchers based on a review of the
literature. Participants were recruited using an on-line sur-
vey platform along with pen and paper formats at onsite
locations- college campus and senior citizen luncheons.
Innovation in Aging, 2017, Vol. 1, No. S1
One hundred thirty- five completed surveys were returned
(Age: 1830: n=41; 50-older: n=94) (Gender: males: n=41;
females: n=94).
Independent t-tests revealed a statistically significant dif-
ference in age and gender: older females (age 50 and older)
demonstrated a greater knowledge base of osteoporosis than
their male and younger (age 1830) counterparts.
Chi square analyses were performed on the 6 most fre-
tically significant. Agreater number of males than expected
thought osteoporosis could be prevented. Agreater number
of younger participants than expected thought a family his-
tory of fractures was not a risk factor for osteoporosis. There
were other frequently missed items that revealed a knowl-
edge deficit regardless of age and gender. A greater under-
standing of these deficits are essential as educators equip
physical therapy students to become effective health care
practitioners.
CHARACTERISTICS OF ANTI-OSTEOPOROTIC
MEDICATION UTILIZATION FOR OLDER ADULTS IN
TAIWAN
S.Hwang1,2, H.Chang1,2, F.Chen1,2, 1. Department of
Family Medicine, Taipei Veterans General Hospital, Taipei,
Taiwan, 2. National Yang Ming University School of
Medicine, Taipei, Taiwan
Background: Osteoporosis is one of the major public
health issue worldwide. In Taiwan, the prevalence of osteo-
porosis was about 11% for those who over 65 years old.
Current status of utilization of anti-osteoporotic medica-
tions among older adults and characteristics of prescrip-
tion pattern among health professionals in Taiwan was not
well-explored.
Aim: The aim of this study was to examine the charac-
teristics of anti-osteoporotic medication utilization and pre-
scription pattern for older adults in Taiwan.
Methods: This study was a secondary data analysis by
using the Taiwan National Health Insurance Research
Database from 2001 to 2011. Older adults aged over
65years old were included.
Results: During 2001 and 2011, 1,169,457 older adults
aged over 65 years were identified. Of them, 1,169,457
(52.0%) were female. For age distribution, there were
642,548 (54.9%) aged between 65 to 74 years, 415,512
(35.5%) between 75 to 84 years, 110,743 (9.5%) between
older adults, 38,523 (3.20%) had ever been prescribed of
anti-osteoporotic medications. Among available anti-osteo-
porotic medications in Taiwan, the most frequently pre-
scribed medication was Fosamax 29,634 (76.9%), followed
by Evista 6,439 (16.7%), Forteo 2,628 (6.8%), Calcitonin
1,525 (4.0%), Bonviva 1,161 (3.0%), and Aclasta 532
(1.4%). Top 5 health professionals prescribed anti-osteo-
porotic medications were orthopedic doctors (61.5%),
neurosurgeon (14.2%), rheumatology doctor (4.8%), reha-
bilitation doctor (4.2%), family physician (3.3%).
Conclusion: The prescription of anti-osteoporotic medi-
cation is lower than the prevalence of osteoporosis. More
attention should be paid for under treatment of osteoporosis
in Taiwan.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
APPLICATION OF HEALTHCARE INTEGRATION IN
PERIOPERATIVE PERIOD MANAGEMENT OF AGED
HIP ARTHROPLASTY
L.Yang1,2, H.Zhou1, Z.Sheng1, C.Liu1, D.Chen1, J.Hu1, from older women and is associated with a higher risk of
Y.Chen1, 1. Department of Orthopaedic Surgery, the
Affiliated Hospital of School of Medicine of Ningbo
University, Ningbo, Zhejiang Province, China, 2. College of
nursing, Zhejiang Chinese Medical University, Hangzhou,
Zhejiang Province, China
Objective: To assess the application effect of Healthcare
integration in perioperative period management of aged Hip
arthroplasty. Methods: 30 patients were randomly selected
from 60 patients to implement Heathcare integration man-
agement model(the experimental group), tranditional care
service mode was given to the other 30 patients(the control
group). On the 14th day after operation, patientssatisfaction
degree, health education awareness and clinical nursing com-
pliance were compared. Results: Compared with the control
group, the patients satisfaction degree, health education
awareness rate, clinical nursing compliance of the experimen-
tal group were improved. Conclusions: Compared with ordi-
nary care model, heathcare integration model can improve
the patients satisfaction and awareness rate, smooth the
clinical nursing process, alleviate the pain of patients, and
improve the quality of patients life. So it is adviced that
heathcare integration model be widely applied in periopera-
tive period management of aged Hip arthroplasty.
BONE MINERAL DENSITY TESTS AND THE RISK OF
FRACTURES AND ADMISSION
B.Oh, Family Medicine, SMG - SNU Boramae Medical
Center, Seoul, Korea (the Republic of)
Introduction: Korean National Health Screening Program
for the Transitional Ages (NSPTA) underwent a bone mineral
density test to target 66-year-old woman. By comparing the
ratio diagnosed with osteoporosis between the examinees
and non-examinees, outpatient care according to the diagno-
sis, and hospital admission by the fracture, the largest com-
plication of osteoporosis, the effectiveness of screening will
be determined.
Methods: Data from NSPTA was used, which offers
basal health screening and bone mineral density results of
women aged 66 years. Community-dwelling elderly were
followed from 2007 to 2011 to determine the outcome
measures of overall fractures, femoral fractures and admis-
sions for femoral fractures. Also we compared drug-related
osteoporosis cure rate, admission rate due to osteoporosis-
related fractures.
Results: Participants comprised 909,869 women aged
66years; non-Screening Group334,267 (36.7%), Screening
group was 575,602 (63.3%). Diagnosis rate of osteoporosis
underwent a bone mineral density test subjects was 45.4%;
by DEXA scan rate was 57.1%. Determining the odds ratio
for prescription drugs based on examination status by logis-
tic analysis, adjusted OR is 1.68 (95% C.I. 1.621.74), which
means prescription rate increases in BMD Screening Group.
As a result of comparing the admission rate for hip fracture,
the major complications of osteoporosis, hospitalization
IAGG 2017 World Congress
559
is reduced by approximately 17% in the Screening Group
(adjusted hazard ratio 0.83).
Conclusions: Osteoporosis is a high prevalent disease
hospitalization due to fractures. Therefore, it is advisable
to screen the bone mineral density for drug therapy in pre-
vention and early detection. This can significantly reduce
hospitalizations due to hip fracture and therefore leads to
cost-effectiveness.
SESSION 1055 (POSTER)
PREVENTION, HEALTH CARE AND HEALTH
PROMOTION
A CLINICS-BASED SURVEY ON THE DETERMINANTS
OF SUCCESSFUL SMOKING CESSATION IN OLDER
ADULT SMOKERS
K.Wu1, Y.Hou1, K.Cheng1, Y.Gu1, L.Huang2, 1.
Department of Family Medicine, Tainan Municipal
Hospital, Tainan, Taiwan, 2. Health education Unit, Tainan
Municipal Hospital, Tainan, Taiwan
This study aims to identify determinants of success-
ful smoking cessation after three months of treatment and
six months of follow-up, and to investigate the differences
smoking cessation behaviours in older adult smokers.
192 patients that aged 65 y/o and more all attended a
smoking cessation clinic at a General Hospital in Taiwan
from 2011 to 2014. These patients filled up a questionnaire
which included demographic, morbid and smoking hab-
its data. They were subjected to an interview at the clinics
to determine their treatment for 3 months. 6 months and
3years later, patients were contacted by telephone and were
asked if they remained without smoking.
After 6 months and 3 years, 126 and 67 patients were
contacted and 31.3% and 19.3% of patients responded that
they were still without smoking. After 6months of follow-up,
on univariate analysis, successful 16-week clinics follow-up
completement, sucessfully smoking cessation at 3-month fol-
low-up and medication use, appeared as a protective factor
associated to abstinence. On multivariate analysis, only suc-
essfully smoking cessation at 3-month follow-up appeared as
a protective factor. However,
After 3years, on univariate analysis, less cigarette smok-
ing number and sucessfully smoking cessation at 3-month
follow-up appeared as a protective factor associated to absti-
nence. On multivariate analysis, still only sucessfully smoking
cessation at 3-month follow-up appeared as a protective factor.
In this clinics-based sample of older smokers, the use of
medication including Nicotinine patches and Varenicline
was associated with better abstinence rates in initial half
one year. Young-old adult smokers, more cigarette smoking
number and not able to complete 16-week clinics follow-up
appeared as a risk factor to continue smoking. Successfully
smoking cessation at 3 month was a leading factor associ-
ated to abstinence.
560
PHYSICAL SIGN FOR DETECTING COGNITIVE
DECLINE IN COMMUNITY-DWELLING OLDER
ADULTS
T.Abe1, Y.Soma3, N.Kitano4, T.Jindo4, A.Sato1, jects (17 males and 10 females; mean age 65.41years) who
K.Tsunoda5, T.Tsuji6, T.Okura1, 1. University of Tsukuba,
Ibaraki, Japan, 3. Hirosaki University, Aomori, Japan,
4. Physical Fitness Research Institute, Meiji Yasuda Life
Foundation of Health and Welfare, Tokyo, Japan, 5.
Yamaguchi Prefectural University, Yamaguchi, Japan, 6.
Chiba University, Chiba, Japan
Previous cohort studies that investigated the association
between physical and cognitive function conducted only
either physical or cognitive assessment in their follow up sur-
vey. Therefore, the relationship between changes in physical
and cognitive functions is unclear. The study aimed to inves-
tigate whether change in physical functions is associated
with change in cognitive function. In this study, the data was
obtained from the Kasama study, a cohort study in Japan;
and the follow up period was 3 years. Only older adults
without cognitive impairment at baseline were included and
131 participants (72.24.7 yrs.) were eligible. We used 6
physical performance tests: grip strength, one-leg standing
balance, 5 times sit-to-stand, timed up and go, 5-m habitual
walk, and peg moving task to measure physical function.
To measure cognitive function, five tests were administered
including tests of attention, memory, visuospatial function,
verbal fluency, and reasoning. The total score was defined
as cognitive function. Multiple regression analyses were con-
ducted. We entered change in cognitive function as depend-
ent variable and each of the change in physical function as
independent variables, and age, sex, education, body mass
index, medical history of hypertension and heart disease,
depressive mood, intake medicine, knee pain, and upper-
extremity pain as covariates. Changes in 5-m habitual walk
( = -0.207, P = 0.026) and peg moving task ( = 0.178, and were randomly allocated in the intervention and control
P = 0.042) showed significant association with change in
cognitive function. These results suggest that deterioration
of gait speed and hand dexterity is a useful sign for detecting
cognitive decline.
AYUSH RASAYANA IMPROVES FITNESS AND
QUALITY OF LIFE IN OLDER ADULTS
V.Gunasekaran1, P.Mundada1, P.Chatterjee1,
A.Chakrawarty1, S.Sharma2, B.Bharti2, K.Dhiman2,
A.B.Dey1, 1. Geriatric Medicine, All India Institute of
Medical Sciences, New Delhi, India, 2. Central Council for
Research in Ayurvedic Sciences, New Delhi, New Delhi,
India
Introduction: Ayurvedic formulations have been used in
India for thousands of years to promote health, physical fit-
ness and endurance. This on-going clinical trial assesses the
efficacy and safety of one such formulation Ayush Rasayana.
Methodology: Healthy volunteers between 6075 years
without any health issue with the exception of controlled
hypertension were included. After systemic cleansing with
Ayush Rasayana-A for initial 6days, they were administered
Ayush Rasayana-B twice daily for next 6months. Detailed
clinical and biochemical assessment done before entry and
at 30, 90 and 180 days. Six-minute walk distance, quality
of life using WHOQOL-BREF questionnaire were used as
Innovation in Aging, 2017, Vol. 1, No. S1
parameters of efficacy. Any previous drugs and access to
usual healthcare were allowed.
Results: Amid-term analysis was carried out in 27 sub-
completed the trial. Mean (SD) six-minute walk distance
at baseline, 3 months and 6 months was 419.41(76.93),
448.74(90.51) and 456.33(88.30). Improvement in walk-
ing distance was 29.33 metres at 3months and 36.93 metres
at 6 months (p<0.01).WHOQOL-BREF (0100) score at
baseline, 3rd and 6th month in Physical health domain was
55.26(8.20), 61.07(6.32) and 59.93(7.56), [p=0.13]; in
pscychological domain was 52.89(10.99), 59.33(10.42)
and 61.22(7.56), [p<0.01]; in social domain was
62.30(13.66), 68.85(6.97) and 71.07(7.97), [p<0.01]; in
environment domain was 70.41(11.37), 76.48(8.30) and
76.85(6.35), [p<0.01]. No adverse effects were reported.
Conclusion: There is significant improvement in six-
minute walk distance and quality of life. This drug seems to
positively affect ageing process and further studies needed to
relish its full potential.
EFFECTIVENESS OF COGNITIVE STIMULATION
IN MAINTAINING COGNITIVE CAPACITY OF AN
ELDERLY COHORT
A.M.Vicentin, A.Bonilha, L.Ramos, Federal University of
So Paulo, So Paulo, So Paulo, Brazil
The study objective is to analyze the effectiveness of health
promotion actions in the prevention of functional losses due
to cognitive impairment of the elderly. It is a controlled inter-
vention study, nestled within a cohort population resident
in the neighborhood Vila Clementino, in So Paulo city,
Brazil. From the application of the CDR (Clinical Dementia
Rating), the elderly were classified as cognitively normal
(CDR=0) and with mild cognitive impairment (CDR=0.5)
groups.. The elderly had undergone a screening for depres-
sion, neuropsychological tests (MoCA, MEEM, list of words
and naming animals) and an evaluation of independence in
daily life. The intervention groups attended the Memories
Workshops (MW) twice a week in a total of 34 meetings,
80-minute-long each (physical activity, computer activ-
ity and chat about the workshop experience). Preliminary
results have shown that a non-pharmacological intervention
such as the MW can have a positive impact in the functional
capacity of a population sample of elderly with CDR <1, as
it promotes the maintenance/improvement of cognitive func-
tionality measured by the MoCA score when compared with
controls, especially if the degree of improvement or worsen-
ing in the score is controlled in the analysis (among those
who had greater improvement the majority was in the inter-
vention group). The study is still including subjects to enlarge
the sample and thus enable a more robust statistic of effec-
tiveness of this kind of intervention in the primary health
care level, as a protective factor against cognitive losses of
this age-group.
REACH LIFESTYLE INTERVENTION: FEASIBILITY OF
DELIVERING AN INSTRUCTOR TRAINING COURSE
L.Burnett2, N.Cherneski2, L.Fleig4, K.Milne5,
L.Giangregorio6, L.Clemson7, M.C.Ashe1,2,3, 1. Family
Practice, The University of British Columbia, Vancouver,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
British Columbia, Canada, 2. Centre for Hip Health and
Mobility, Vancouver, British Columbia, Canada, 3. The
University of Adelaide, Adelaide, South Australia, Australia,
4. Freie Universitt Berlin, Berlin, Germany, 5. Cardea
Health Consulting, Vancouver, British Columbia, Canada,
6. University of Waterloo, Waterloo, Ontario, Canada, 7.
University of Sydney, Sydney, New South Wales, Australia
Return to Everyday Activities in the Community and
Home (REACH) is a lifestyle intervention model for mid-
dle-aged and older adults. The goal of REACH is to reduce
sedentary behaviour, increase physical activity, and increase
adoption of strength and balance exercises. In this feasibil-
ity study we completed a formative evaluation to assess the
effectiveness, impact and reception of the REACH instructor
training course. Our aim was to summarise perceptions of the
model and identify gaps in curriculum delivery. The REACH
Instructor training course occurred over four sessions, each
of two hour duration. The training methods included didac-
tic and participatory elements, plus a comprehensive instruc-
tors manual and handouts. The participants were provided
with foundational knowledge, including principles of behav-
iour change theory. Participants also practiced teaching
components of the program to their peers. We conducted
semi-structured interviews at the end of the training session,
and administered a Patient Education Materials Assessment
Tool for Printable Materials (PEMAT-P) and session feed-
back forms. There were three participants who completed the
study; all were community-based exercise physiologists with
an average of 17 (8) years of experience. Emerging themes
from participants feedback included: credentials required,
how to best prepare instructors for teaching REACH, the
ideal learning setting and linking the instructor manual to
presentation slides. The PEMAT-P scores for the instructor
manual were 98 (0.03) % for understandability, and 100%
for actionability. Each session was rated very good or excel-
lent for presentation style and overall rating. We applied par-
ticipant feedback to the existing instructor curriculum.
ASSOCIATION OF SELF-RATED HEALTH IN
COMMUNITY-DWELLING ELDERLY PEOPLE OF
JAPAN
A.Marui, Y.Ishikawa, S.Kaneko, Y.Kamiyama, cognitive decline. Future intervention studies are needed to
N.Aizawa, Dokkyo Medical University School of Nuresing,
Mibu, Tochigi, Japan
Japan is known for its population longevity, however,
people should be aware that longevity with health is better
than a longer life in bad health. This study made analysis of
socio-economic backgrounds, sleep, depression, chronic dis-
ease, long-term care and lifestyle factors related to self-rated
health (SRH) in community-dwelling elderly people in Japan.
Cross-sectional research of community-dwelling elderly
people was carried out in Mibu-town in Eastern Japan in
2015. 665 residents aged over 60years old, participated in
the study and completed a questionnaire. The results from
SRH using a four-step scale were later categorized into two
groups Good and Poor Health. Binary logistic regression
was used to identify the factors associated with Good SRH.
The average age of the participants was 71.3 years old
(SD 6.5, range 6098). 50.2% of those were female and
84.5% of them answered that they were healthy. The charac-
teristics of Good in SRH were non long-term care, a feeling
IAGG 2017 World Congress
561
of satisfaction with life, nondepression, without cardiovas-
cular or orthopedic disorders, without medication, having a
regular exercise regime and keeping an active lifestyle.
People subjectively felt that Good for their SRH was
closely related to doing regular exercise themselves and by
being active. Further, we found no associations between
socio-economic backgrounds, living alone and quality of
sleep. It was indicated, by the end of this study, that it is
important to keep the elderly active as this enables them to
gain a feeling of satisfaction in regards to their own personal
health.
LIFELONG MAINTENANCE AND INCREASES IN
READING ENGAGEMENT IS ASSOCIATED WITH
BETTER COGNITIVE HEALTH
T.Hammond, S.Bardach, X.Zhang, E.Abner, G.Jicha,
The University of Kentucky, Lexington, Kentucky
Cognitive reserve theory proposes that early life cognitive
experiences can reduce risk of late-life cognitive decline. Yet
little information exists in the literature to describe whether
increasing mid- and late- life cognitive engagement can have
the same effect, bolstering cognitive reserve and potentially
delaying the onset of late-life cognitive decline and demen-
tia. In order to address this question, we analyzed self-report
of reading engagement at ages 6, 12, 18, 40, and at present
time in subjects spanning the cognitive continuum from nor-
mal to MCI to dementia in the Alzheimers Disease Center
cohort at the University of Kentucky using adjusted regres-
sion modeling (n=489). Reading engagement at ages 6, 12,
and 18 was not significantly associated with lower CDR Sum
scores. However, reading engagement at age 40 and current
reading engagement was significantly associated with lower
CDR Sum scores (p<0.05 and p<0.001, respectively). We also
found that an increase in reading engagement over the life-
time was associated with lower CDR Sum scores (p<0.001),
and that reading engagement increase after age 18 was more
strongly associated with lower CDR Sum scores than read-
ing engagement increase before age 18 (p<0.01 vs. p>0.05
respectively). These data suggest that lifelong maintenance
and continued increases in reading engagement across the
lifespan in mid- and late-life may be beneficial in delaying
elucidate the role that reading engagement might play in
avoiding or delaying cognitive decline.
THE EFFECT OF ADHERENCE TO DIABETES
GUIDELINES ON NURSING HOME ENTRY AND
HEALTH AT TIME OF ADMISSION
A.P.Yashkin, I.Akushevich, A.I.Yashin, Boidemography
of Aging Research Unit, Center for Population Health and
Aging, Duke University, Morrisville, North Carolina
Diabetes Mellitus (DM) is a chronic disease that is highly
prevalent in the U.S.and is associated with multiple co-mor-
bidities as well as reduced physical and cognitive function.
When admitted to nursing homes, beneficiaries with DM are
characterized by comparatively high levels of functional disa-
bility, the presence of many co-morbid conditions, and could
represent a sub-population of residents requiring especially
intensive care and representing a dis-proportional social
and financial burden. Adherence to diabetes management
guidelines such as those provided by the American Diabetes
562
Association (ADA) have been shown to be protective against
many diabetes-related adverse health outcomes, but the role
of adherence in reducing the risk of requiring nursing home
care and/or improving the overall health status at time of
admission has not been fully addressed. The purpose of this
paper is to identify how adherence to ADA guidelines in
U.S. Medicare beneficiaries age 65+ affects the risk of nurs-
ing home entry and functional, cognitive and co-morbidity
status at the time of admission. Data from the Health and
Retirement Study, linked to Medicare administrative claims
was used to identify the presence of a new diagnosis of DM,
the presence of co-morbidities and adherence to guidelines.
Data on new nursing home admissions as well as detailed,
professional in-person new resident assessments were drawn
from the HRS-linked Minimum Dataset. The results of this
study will aid in public health awareness efforts aimed at
combating the diabetes pandemic and reducing the burden
of DM to both the patient and society.
RATIONALE FOR MAINTAINING HIGH
25-HYDROXYVITAMIN D CONCENTRATIONS YEAR
LONG
W.B.Grant, Sunlight, Nutrition and Health Research
Center, San Francisco, California
Higher solar UVB exposure and vitamin D status have
been found associated with reduced risk of many adverse
health outcomes including autoimmune diseases, cancer, car-
diovascular disease, cognitive dysfunction, dementia, diabetes
mellitus, infectious diseases, etc., as well as lower mortality
rates and increased life expectancy. The types of studies on
which these findings are made include geographical and tem-
poral ecological, observational, interventional, and labora-
tory studies. For a number of the outcomes, the roles of UVB
and vitamin D are considered causally linked to better health
outcomes based on the criteria for causality in a biological
system outlined by A. Bradford Hill. Recently, it was also
determined that the higher mortality rates in winter are due
to lower UVB doses and 25-hydroxyvitamin D [25(OH)D]
concentrations resulting in effect on gene expression associ-
ated with immunity and physiology. Globally, mean 25(OH)
D concentrations are near 54 nmol/L, varying in midlati-
tudes from about 3545nmol/L in winter to 6575nmol/L
in summer. The optimal 25(OH)D concentration is in the
90110 nmol/L (3644ng/mL) range.. To achieve the opti-
mal range using supplements takes 15004000 IU/d vita-
min D3 depending on season and individual environment,
genetics, and lifestyle. Based on 25(OH)D concentration-
health outcome relations from observational studies, it is
estimated that population mortality rates could be reduced
by 1520%, leading to increases in mean life expectancy by
about two years. Increasing vitamin D supplementation and
food fortification at the population level appears to be the
most efficient way to increase healthy life expectancy.
SEX DIFFERENCES IN POSTURE AND PHYSICAL
FUNCTION IN JAPANESE ELDERLY WITH EXERCISE
HABITS
T.Ueda1,2, Y.Shiba3, S.Watanabe2,4, 1. Sanno Rehabilitation
Clinic, Ota-ku Tokyo, Japan, 2. Institute for Gerontology
J.F. Oberlin University, Machida City, Tokyo, Japan, 3.
Kitasato University, Sagamihara City, Kanagawa Prefecture,
Innovation in Aging, 2017, Vol. 1, No. S1
Japan, 4. J.F. Oberlin University Graduate School of
Gerontology, Machida City, Tokyo, Japan
A cross-sectional study described kyphosis to be related
to decrease physical function and quality of life. However,
few longitudinal studies have investigated changes due
to kyphosis. We aimed to determine sex-related differ-
ences in postural changes and decreased physical function
in Japanese community-dwelling elderly with exercise. The
subjects participated in an interview and physical function
measurement at baseline and follow-up 5 years later (19
men, 17 women; mean age, 72.54.9 years). We used the
Wilcoxon signed-rank test to analyze sex-related variables.
After 5 years, we observed significant decreases in the 5
measurement items in the men as follows: kyphosis angle
(KA; from 162.44.7 to 160.24.4, p=.022), one-leg
standing time (from 42.7123.4 to 38.123.4 s, p=.012),
grip strength (GS; from 37.76.9 to 33.96.8kg, p<.01),
the range of anteflexion in standing (ROA-ST; from 4.76.9
to 1.07.3cm, p<.01), Fall Efficacy Scale International score
(from 26.710.1 to 30.712.8, p=.031). In the women,
4 measurement items significantly decreased as follows:
KA (from 166.15.8 to 160.55.4, p<.01), GS (from
25.22.6 to 23.72.5kg, p<.01), ROA-ST (from 13.66.8
to 11.57.7cm, p<.01), weight-bearing index (from
61.2%15.2% to 53.0%12.7%, p<.01). The age-related
changes in physical function differed according to sex. The
decreases in the measurement values were related to balance
ability in men and to muscle strength in women. Our sub-
jects had higher levels of physical function than those in a
previous study. In conclusion, exercise-related balance and
muscle strength training from middle age are important for
the physical functions of men and women, respectively.
SELF-REPORTED SLEEP, DEMOGRAPHICS, AND
HEALTH IN SENIORS IN MIBU, JAPAN
Y.Ishikawa, A.Marui, S.Kaneko, Y.Kamiyama,
N.Aizawa, Dokkyo Medical University, Mibu, Tochigi,
Japan
Sleep disturbance is often reported by the elderly with
15% to 30% complaining of insomnia around the world.
Poor sleep in later life represents a significant public health
concern because of its association with cognitive decline,
impaired social interaction, interfered daytime activities.
To understand sleep quality and its associated factors,
a cross-sectional study was carried out in Mibu town in
Eastern Japan in 2015. A questionnaire that included the
Pittsburgh Sleep Quality Index, sociodemographic, comor-
bid health conditions and life styles was delivered to non-
institutionalized elderly aged over 60, 805 subjects (75.8%)
completed the questionnaire, which included an analysis.
The average age of the participants was 71.5 years (SD
6.6, range 6098). 51.2% female, 30.9% were over 75, and
9.7% were living alone. 34.2% of the participants reported
poor sleep quality. Logistic regression analysis revealed that
overall sleep quality was strongly associated with stress,
depressive symptoms and having more than one chronic
medical condition. Having an eye or ear problem or orthope-
dic conditions were also associated with poor sleep. However,
this study suggested that a low BMI, lack of daytime activity
and taking naps were not associated with poor sleep quality.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Several factors may explain poor sleep in seniors and the
study suggests stress and poor mental health management
are considerable interventions for quality of sleep. As pri-
mary care providers we should be more concerned with our
clients sleep, and this can be achieved at the same time of
managing their disease or conditions.
DEVELOPMENT OF THE HEALTHY AGING MODEL:
AGROUNDED THEORY STUDY
L.Thiamwong1, M.McManus2, J.Suwanno3, 1. College of
Nursing, University of Central Florida, Orlando, Florida, 2.
University of the Ozarks, Clarksville, Arkansas, 3. Walailak
University, Tasala, Nakhon Si Thammarat, Thailand
To develop a model of healthy aging from the perspective
of Thais, a grounded theory approach, including in-depth
interviews and focus groups, was used. A purposive sam-
ple of 39 community-dwelling adults aged 4085years old
was interviewed. The Thai healthy aging model composed
of three themes: normality, nature, and dharma. In Thai,
they are called tham-ma-da, tham-ma-chat, and tham-ma, or
Thai 3Ts. The theme of normality encompasses subthemes
of staying physically active by being involved in plenty of
physical activities, and being mentally active with creative
and thoughtful hobbies and work. The theme of nature
encompasses subthemes of living simply and being careful
with money. The theme of dharma encompasses subthemes
of enjoyment through helping family and participating in
community activities, staying away from stress and worries
by talking openly and honestly with someone, making merit,
and helping other people without expecting anything in
return. Agreater understanding of healthy aging is a benefit
for older adults and health care providers in an intervention-
design process. Research can contribute valuable informa-
tion to shape policy for healthy aging as well.
NEW SIMPLIFIED DIAGNOSTIC METHOD TO
SCREENING FOR POSTPRANDIAL HYPOTENSION IN
OLDER PEOPLE
M.Gaubert-Dahan1, D.Bonnet-Zamponi2,3, R.Abbas3,
1. GHI Le Raincy-Montfermeil, Montfermeil, France, 2.
OMEDIT (Observatoire des MEdicaments Dispositifs
mdicaux et Innovations Thrapeutiques) Ile de France,
Paris, France, 3. Dpartement dpidmiologie et recherche
clinique, CIC-EC 1425, Groupe Hospitalier Paris Nord Val
de Seine, AP-HP, Hpital Bichat, Paris, France
Background: Postprandial hypotension (PPH) is a preva-
lent but not well diagnosed disorder in the older people. The
reference PPH diagnostic method is too demanding, because
blood pressure (BP) needs to be measured 8 times in 2 hours.
Our primary objective was to define a new simplified PPH
diagnostic method and to evaluate its performances.
Methods: Cross-sectional study of 104 patients (70
women, 34 men) with high risk of postprandial hypotension
admitted to two geriatric rehabilitation units in France. BP
was measured twice before the midday meal in seated posi-
tion at the table, and every 15 minutes for 90 minutes after
the end of the meal. Receiver Operating Characteristic curves
were plotted for each postprandial BP measure to determine
the best postprandial measure in terms of sensitivity and
IAGG 2017 World Congress
563
specificity. The optimal diagnostic threshold was calculated
with Youdens index according to BP difference before and
after the meal.
Results: Anew simplified diagnostic method is proposed:
a decrease of at least 10mmHg systolic BP between BP meas-
ures before the meal and 75 minutes after the end of the
meal. This new method had a sensitivity of 82% (IC 95%
66 92)and a specificity of 91% (IC 95% 81 97).
Conclusion: This new diagnostic method is fast, efficient
and suitable for everyday use. It could improve PPH diagno-
sis in older people. Larger studies are needed to validate it.
SESSION 1060 (POSTER)
RESIDENTIAL LIVING OPTIONS
BACCALAUREATE-EDUCATED REGISTERED NURSES
IN NURSING HOMES: POSITIONING AND ROLE
IMPLEMENTATION
R.Backhaus1, H.Verbeek1, E.van Rossum1,2,
E.A.Capezuti3, J.Hamers1, 1. Department of Health
Services Research, CAPHRI School for Public Health
and Primary Care, Maastricht University, Maastricht,
Netherlands, 2. Research Centre on Autonomy and
Participation, Zuyd University of Applied Sciences, Heerlen,
Netherlands, 3. Hunter College, City University of New
York, New York, New York
In Dutch nursing homes, few registered nurses (RNs)
work in direct resident care and baccalaureate-educated RNs
(BRNs) are an especially scarce resource. It is unknown yet
to which extent organizations make use of the BRNs exper-
tise and how their roles are differentiated from those of other
staff members.
The aim of this qualitative study was to obtain insight
into different roles that BRNs currently hold in institutional
long-term care as well as explore the factors that impede
their employment. In total, 26 semi-structured individual
interviews (directors, ward managers, BRNs) and three
group interviews (RNs, certified nurse assistants) were held
in organizations that did or did not employ BRNs in nursing
homes.
Directors not employing BRNs reported that low resident
health acuity, disinterest of BRNs in the setting and the added
costs of hiring BRNs hindered their employment. Directors
that employ BRNs have a clear vision of how to utilize their
role in the facility. Within and between organizations, there is
variation regarding the positioning of BRNs. All BRNs fulfil
ward- or location-transcending tasks that exceed direct resi-
dent care. For example, they coach direct care teams, super-
vise interns or have specific expertise areas (e.g., physical
restraints or emotion-oriented care).
This study found different possibilities how BRNs are
working in nursing homes. Their added value is difficult to
quantify, but positive effects for residents (e.g., less pain) and
direct care teams (e.g., more confidence) were mentioned.
The actual effectiveness of different ways to utilize BRNs
should be tested in future studies.
564
DETERMINANTS OF LIVING ARRANGEMENTS FOR
ELDERS TRANSITIONING FROM ANURSING HOME
INTO THE COMMUNITY
C.Fabius, J.T.Robison, University of Connecticut,
Farmington, Connecticut
The Money Follows the Person (MFP) Demonstration
allows nursing facility residents to transition into community
living arrangements. Research has shown racial differences
in living arrangements Blacks are more likely than Whites
to live in multigenerational households. Transitioning into
the community may also be accompanied by challenges (i.e.
lack of housing). This study examines the influence of race,
choice, and transition challenges on living arrangements in
N=659 (n=495, 75% White, n=164, 25% Black) older (aged
65+) MFP participants in Connecticut. Multinomial and
binomial regression models predicted living arrangements
in unmarried and married participants. Findings show that
among unmarried participants, Blacks are more likely to live
alone or with family, and Whites are more likely to live with
a live-in caregiver/supervised housing. White participants
were also more likely to report having helped choose their
home. Women and participants with more functional needs
are more likely to live with family as well as with a live-in
caregiver/supervised housing compared to those living alone.
Having service challenges was a negative predictor of living
with family, and having financial challenges was a negative
predictor of living with a live-in caregiver/supervised hous-
ing compared to living alone. Among married participants,
having more functional needs predicts living with a spouse,
while those with housing challenges are less likely to live
with a spouse. Research should further explore the impact
of transition challenges on rebalancing programs. Findings
can influence community housing plans and inform the field
of gerontology with respect to cultural patterns in housing
and service use.
MEDICAID BENEFICIARIES ACCESS TO
RESIDENTIAL CARE SETTINGS
M.Lepore, M.Knowles, K.Porter, J.M.Wiener, RTI 23.2%, though rates varied significantly with cognitive func-
International, Washington, District of Columbia
Residential care settings (RCSs) are community-based
housing and supportive services providers. Many RCSs
predominantly serve older adults and younger people with
physical disabilities. Medicaid beneficiaries access to these
RCSs is of concern to policymakers and other stakeholders
because providing community-basedrather than institu-
tionalservices is potentially less expensive and preferred
by most people. To better understand Medicaid beneficiaries
access to RCSs that focus on older adults and young peo-
ple with physical disabilities, we examined Medicaid poli-
cies in 50 states and the District of Columbia, interviewed
subject matter experts (n=7), and conducted four state case
studies informed by reviews of policies and interviews with
stakeholders (n=27). Interviewees identified numerous fac-
tors influencing Medicaid beneficiaries access to these RCSs,
including the supply of Medicaid-certified RCSs relative to
the older adult population, Medicaid reimbursement rates,
initiatives that affect room and board costs for Medicaid
beneficiaries, and policies that may incentivize RCSs to serve
Medicaid beneficiaries. These factors can affect Medicaid
beneficiaries access to RCSs by limiting the number of RCSs
Innovation in Aging, 2017, Vol. 1, No. S1
that participate in Medicaid, restricting the number of beds
that RCSs allot to Medicaid beneficiaries, and by determin-
ing whether room and board rates will be affordable for
Medicaid beneficiaries. The implications of these findings
vis--vis implementation of federal Medicaid home and com-
munity-based services rules and continued implementation
of managed long-term services and supports programs are
discussed.
ANTIPSYCHOTIC AND RESTRAINT USE AMONG
LONG-STAY NH RESIDENTS: IMPACT OF CMS
REGULATORY CHANGES
J.A.Lucas1, J.R.Bowblis2, 1. Seton Hall University, South
Orange, New Jersey, 2. Miami University, Oxford, Ohio
APMs have potential for adverse effects and mortal-
ity risk for NH residents with dementia. CMS initiated its
National Partnership (March 2012) to reduce APM use,
implemented public reporting an APM quality measure (July
2012), and revised NH surveyor guidelines and training to
identify unnecessary APMs and compliance with new demen-
tia care standards (May 2013). We determine NH response
to these initiatives, by examining change in APM and physi-
cal restraint utilization among long-stay NH residents and
whether these vary with resident cognitive functioning.
Using data from 20112013 Minimum Data Set, we exam-
ined long-stay residents in free-standing facilities that did
not have CMS-approved indications for APM (N8million).
Linear probability models controlled for resident and facil-
ity characteristics and determined how restraint and APM
rates change in response to each CMS initiative. Results were
stratified into groups: no dementia/mental illness, dementia
without symptoms (i.e., behavioral symptoms, delusions/hal-
lucinations), dementia with symptoms, and severe mental ill-
ness consistent with APM utilization (e.g., bipolar, psychosis,
and severe depression). Pre-initiative physical restraint use
averaged 2.5%, with rates higher among those with demen-
tia and severe mental illness. Among all groups, restraint use
declined with each initiative. Pre-initiative APM use averaged
tioning (7.0%-66.2%). All groups saw declines in APM use
with each CMS initiative; largest decline was among demen-
tia residents without symptoms (27.8%), smallest among
residents with mental illness (9.7%). Regulatory efforts to
reduce APM prescribing had a significant impact, without
an increase in physical restraint use; effectiveness varies with
resident cognitive functioning.
DETERMINING HOME AND COMMUNITY-BASED
SERVICE USE AMONG OLDER MONEY FOLLOWS
THE PERSON PARTICIPANTS
C.Fabius, J.T.Robison, University of Connecticut,
Farmington, Connecticut
The use of home and community-based services (HCBS)
has been examined in research on community-dwelling
elders. Research has not yet investigated the determinants of
HCBS use among elders participating in a nursing facility
transition program such as the Money Follows the Person
(MFP) Rebalancing Demonstration. Further, race may be
a factor in HCBS use previous findings in community-
dwelling populations have been mixed. The current study
utilized The Andersen Behavioral Model of Health Service
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Use to examine racial differences in determinants of HCBS
use among N=240 frail older MFP participants (aged 65+;
76%, n = 182 White, 24%, n = 58 Black). Binary logis-
tic regression models predicted the use of three services:
24-hour care, per diem home health care, and functional
care. Results showed that determinants vary for each out-
come. Women and those with more ADL/IADL needs were
more likely to have 24-hour care, while married participants
and those reporting instrumental support were less likely
to use this service. In contrast, being married and receiving
instrumental support were determinants of per diem home
health care, while those with more ADL/IADL needs were
less likely to use home health care. Black race, ADL/IADL
need, and financial inadequacy were all negative predictors
of functional care. Anegative interaction effect between race
and gender (Black women) was also present in determining
the use of functional care. Results from this study provide
policymakers and providers with a better understand of the
types of services MFP participants are using.
CAREGIVER STRESS AMONG FAMILY CAREGIVERS
OF OLDER PERSONS IN JAPAN
K.Kageyama1, Y.Sawada2, M.Ono3, 1. Health Science,
Tokyo University of Technology, Tokyo, Japan, 2. Nihon
Fukushi University, Nagoya, Japan, 3. Kansai University of
Social Welfare, Ako, Japan
Family caregivers who provide care on a regular basis for
their elderly loved ones at home often feel physically and
emotionally overwhelmed. This study was conducted to
investigate the physical and emotional stress of family car-
egivers in Japan.
A total of 123 caregivers were asked to freely describe
their experiences, sentiments, emotions and opinions about
providing elderly care at home. Of those, 64 caregiv-
ers (78.1% female, Mage=65.529.93, r=52%) provided
responses in as much detail as desired. Their responses were
grouped and analyzed according to content.
Results indicated that the caregivers reported emotional
distress (37.5%) as well as positive attitude toward caring
for their loved one (23.4%), feeling worried about their own
or the loved ones health and life in the future (21.9%), their
gratitude for those who share the responsibility of provid-
ing care for their loved one (17.2%) and/or for care services
providers (12.5%), lack of time for self-care and/or social life
(15.6%), thinking of placing the loved one in a long-term-
care facility (9.4%), suicidal and/or murdersuicide thinking
(4.7%).
Despite the wide range of home-care services available
through the long-term care insurance system, family mem-
bers still have to provide some forms of care. This study sug-
gests that it is important to offer a variety of services and
supports that help them to ward off or cope with their stress
before they burnout.
AN INVESTIGATION ON NURSING SUPERVISORS
DILEMMA IN LONG-TERM CARE FACILITIES
S.Chang-Lee, M.Chung, Asia University, Taichung, Taiwan
This research aims for investigating the dilemma of
nursing supervisors in long-term care facilities. Amongst
researches on supervisor pressure, few focus on trials and
tribulations of nursing supervisors in long-term care facilities.
IAGG 2017 World Congress
565
Most of the related researches are quantitative studies aim-
ing at nursing in acute health-care institutions, which makes
further understanding of difficulties in working from nursing
supervisors in long-term care facilities infeasible. This study
adopts phenomenology and in-depth interviews with fifteen
nursing supervisors in long-term care facilities to approach
the perception and experience of nursing supervisors from
long-term care facilities.The main results are as follow:
I.Attention to both administrative management and clini-
cal practice
II.Insufficient human resources for heavy demands
III.Complex interpersonal interactions
IV.The grope for the even point with superiors
V.Mushy moral issues
VI.Exceptionals in disguise with no time to spare
This study finds nursing supervisors in long-term care
facilities are multi-tasking. Their dilemma stems from the
conflicts in correspondence, overloaded responsibilities in
work and risks, and the lack of autonomy.
FAMILY MEMBERS ROLE IN FACILITATING HEALTH
CARE FOR RESIDENTS WITH DEMENTIA IN
ASSISTED LIVING
T.J.Sharpp, Nursing, California State University -
Sacramento, Elk Grove, California
The purpose of this presentation is to describe the results
of an ethnographic study in two assisted living (AL) com-
munities regarding the family members role of facilitating
health care for residents with dementia. AL communities
were originally designed as a housing model; but it is now
estimated that over 50% of the residents in AL have some
form of dementia and may require more services. Registered
nurses are not required to be employed in AL communities
in California, thus health care is coordinated by unlicensed
personnel and family members. The setting for this ethno-
graphic study was two dementia-only AL communities in
California. Participant observation was conducted over
six months focusing on the interactions between residents,
families, and employees. Open-ended interviews were con-
ducted with twelve employees and nine family members.
The data were analyzed for themes regarding how fam-
ily members and employees communicated regarding the
health care of the residents with dementia. Two qualitative
themes: Acknowledging Barriers and Assertive Advocacy
emerged from the qualitative data regarding how family
members perceived the exchange of health care information
regarding their loved ones with dementia. Family members
and employees described the barriers regarding communica-
tion but acknowledged that family members who assertively
advocated for their loved ones can overcome the barriers.
The frustrations expressed by family members may lead to
disruption in the continuity of care. Healthcare providers
and gerontologists can provide education to families of older
adults about how to advocate for smooth coordination of
health care.
PEACEFUL DEATH VALUED AS AGAIN: INSIGHTS
FROM FAMILY MEMBERS OF NURSING HOME
RESIDENTS WITH CANCER
M.E.Bern-Klug, Social Work, The University of Iowa, Iowa
City, Iowa
566
Knowing the type of medical care nursing home (NH) res-
idents want at the end of life is important so that appropriate
care can be pursued. Results of a qualitative study of 24 fam-
ily caregivers of NH residents with a cancer diagnosis in the
Midwest USA will be presented. Respondents ages ranged
from 2575, 7 were men, 16 were adult children, all were
white, and half had work experience in the medical field.
Interviews with family members were taped, transcribed,
and analyzed using content analyses and key sensitizing con-
cepts from Tversky and Kahnemans, Prospect Theory of
Decision-Making Under Risk (1979, 2011).
Findings indicate that family members were more con-
cerned about avoiding a painful protracted dying process for
their loved one, than they were with trying to extend the
time the resident remained alive. That perspective appeared
to be related to the perception of the reference point (where
the resident was in the continuum of death on one hand and
perfect health on the other). He said to me, Dont keep me addressed by the paper is whether it is necessary to develop a
alive just to keep me alive and We were beyond the point
of trying to fix things and make things better. And A few
years ago she said she had a goal to make it to 90shes
done that and she has said she is ready to go anytime.
Findings suggest new avenues for research related to per-
ceptions about the residents reference point, consistency
between residents and family about reference points, and how
those perceptions can influence medical decision-making.
LONG-TERM CARE IN TURKEY: ARE WE READY TO
MEET OLDER PEOPLES CARE NEEDS?
S.Oglak1, A.Canatan2, I.Tufan3, S.Acar4, N.Avci5, 1. A.Backman3, K.Sjgren3, H.Lvheim3, D.Edvardsson2,
Labour Economics and Industrial Relationship, Adnan
Menderes University, Aydin, Turkey, 2. Gazi University
Department of Sociology, Ankara, Turkey, 3. Akdeniz
University, Department of Gerontology, Antalya, Turkey, 4.
Municipality of Dinar, Mayor of Dinar, Afyon, Turkey, 5.
Adana Residential Care and Rehabilitation Center, Adana,
Turkey
Aging of population affects all aspects of the society ranging
from the healthcare to welfare systems, public finances, fam-
ily life and LTC issues, as well. Turkeys population is younger
than that of European countries. However, the ageing popula-
tion is growing rapidly in Turkey As a result of the increase in
the aging population, health expenditure and long-term care
services needs have swiftly increased, and this increase, as well
as becoming a noteworthy situation, has posed a serious threat
to Turkey, including the ones having an extremely powerful
social security system, for the future. In Turkey, currently there
is no long-term care insurance system. The elderly are usually
taken care of within their own family. Long-term care infra-
structure are extremely scarce. At the same time, home care and
social care are least developed in Turkey, with the scarce public
supplies being rationed by quantity and treated as last resort
options by families and private providers. Public and private
support for long-term care for older persons still is not visible
and at national level it is often a non-issue. However, in recent
years, quite important steps are being taken for long-term care
to innovative implemantations has been witnessed. We will
point out some good practices about long-term care for older
people in Turkey.
Innovation in Aging, 2017, Vol. 1, No. S1
MEASURING CARE OUTCOMES: THE AUSTRALIAN
COMMUNITY CARE OUTCOMES MEASURE
(ACCOM)
M.D.Fine, Macquarie University, Sydney, New South Wales,
Australia
Measuring outcomes is essential for the success of aged
care services delivered to people in their own home, yet to
date, there has been no simple to use, practical methodol-
ogy available for use in the community care field. This paper
reports on the development and extensive field trial of the
ACCOM, an Australian outcomes measurement tool that is
based in part on a UK tool - the Adult Social Care Outcomes
Toolkit (ASCOT), and is administered together with data
on the demographics and capabilities of consumers. The
research has been undertaken in partnership with a number
of leading home care providers in NSW on measuring out-
comes in case managed home care services. Akey question
country specific approach. Can there be a universal measure
of care outcomes?
SESSION 1065 (POSTER)
WORKFORCE AND CAREGIVING ISSUES IN LONG
TERM CARE
EXPLORING THE IMPACT OF LEADERSHIP IN AGED
CARE ON JOB STRAIN AND SOCIAL SUPPORT
2. School of Nursing and Midwifery, La Trobe University,
Melbourne, Victoria, Australia, 3. Ume University, Ume,
Sweden, 3. Department of Community Medicine and
Rehabilitation, Ume University, Ume, Sweden
It is well known that aged care staff experience high levels
of job strain, and it is evident that aged care staff that expe-
rience job strain are exposed to increased risk for adverse
health effects. Leadership is a factor that has been associ-
ated to job strain in the literature, however, the impact of
managerial leadership on job strain and social support has
not been clarified within this context. The aim of this study
was to explore associations between leadership, job strain
and social support among care staff in aged care. This study
has a nation-wide, cross-sectional design, including staff
in 188 residential aged care facilities throughout Sweden.
Participating staff (n=3661) completed surveys which
included questions about staff characteristics, valid and reli-
able measures of leadership behavior, job strain and social
support. Statistical analyses of correlations and multiple
regression analysis with interaction terms were conducted.
The result revealed that leadership behaviors among manag-
ers had a significant association with job strain and social
support. Higher levels of leadership behaviour were related
to lower lever of job strain and higher level of social support.
Further, levels of leadership moderated the impact of social
support on job strain. The leadership behaviors from aged
care managers seem to contribute to supportive environment
in terms of increased social support and thus, alleviate job
strain among staff.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE INFLUENCE OF TEAMWORK ON HEALTHCARE
WORKERS JOB SATISFACTION AND DESIRE TO
PROVIDE QUALITY CARE
S.Dahlke, S.Stahlke, Faculty of Nursing, University of
Alberta, Edmonton, Alberta, Canada
Background: Effective teamwork is widely regarded as a
means of delivering safe, effective, and patient-centered care
and improving patient outcomes, especially when it involves
caring for populations with complex health challenges, such
as the frail older adults, who often live in long term care
institutions.
Objective: This aim of this study was to examine how
healthcare workers working with older adults perceived
teamwork and how teamwork affected care delivery and job
satisfaction.
Method: Focused ethnographic methods were used to
collect data in two residential care settings. Interviews were
conducted with 22 healthcare providers who worked in a
variety of roles.
Results: Characteristics of effective teamwork were:
respect, listening, trust, and common goals. Barriers/facilita-
tors of teamwork were: communication, commitment to the
work, and familiarity. Perceptions about who was considered
a team member varied with narrower views about team mem-
bership among healthcare workers providing direct care to
older adults. There were expectations that leadership should
create an environment that supports teamwork. Moreover,
little things like scheduling, role clarification, and working
with someone you knew impacted on teamwork experiences.
Conclusions: Healthcare workers identified that effective
teamwork increased their job satisfaction and commitment
to provide better care to older adults; yet, perceptions about
who was on the team varied. More research is required to
understand how to expand healthcare workers perceptions
about who they can include as part of the team and how
leadership can foster teamwork.
EXPLORING THE ADAPTIVE AND TECHNICAL
CHALLENGES NURSING STAFF EXPERIENCE IN
USING NEW TECHNOLOGY
S.Kennerly1, T.Yap2, 1. College of Nursing, East Carolina
University, Chapel Hill, North Carolina, 2. Duke University,
Durham, North Carolina
The Pressure ulcer prevention (PrU) care standard for
U.S. nursing home (NH) residents is repositioning every 2
hours to minimize pressure exposure; however, on-time repo-
sitioning nursing staff compliance is low. This study exam-
ined the adaptive and technical challenges nursing staff faced
when using new technology to facilitate repositioning of NH
residents. A21-day trial with a convergent mixed methods
pre/post-test design compared resident and staff outcomes
at a southeastern US NH. The Leaf Patient Monitoring
System, a wireless system with sensor worn mid-sternum
tracks (position, repositioning frequency; enabling percent-
age of on-time compliance calculation) resident movement
24-hours a day, cueing staff when repositioning is required.
Web-based surveys completed by staff (RNs, LPNs, CNAs)
pre/post intervention were the Nursing Culture Assessment
Tool (NCAT), Perceived Organizational Support (POS),
and Affective Organizational Commitment (AOC). During
post-intervention focus groups (2, n=13), staff perspectives
IAGG 2017 World Congress
567
were gathered. NH staff data and Leaf monitoring data
were quantitatively analyzed. Qualitative analyses using
transcribed focus group sessions identified core concepts,
applied satisfaction-based apriori codes, and allowed emer-
gence of new themes. Staff on-time repositioning compliance
improved from 59.8 to 77.3%. Staff responded positively
to repositioning cues and described an enhanced sense of
teamwork in order to achieve on-time repositioning, believ-
ing that usual care was provided faster. Adaptive and techni-
cal challenges will be discussed. Nursing cultures normative
ranking percentage increased and communication, satisfac-
tion, and professional commitment item scores positively
corresponded with focus groups. Also, POS and AOC scale
scores improved. Triangulated findings revealed nursing
staffs enhanced experience by using new technology.
MEASUREMENT AND OUTCOMES OF PERSON-
CENTERED CARE IN LONG-TERM CARE SETTINGS:
ALITERATURE REVIEW
J.Lee, 1. University of Alberta, Edmonton, Alberta, Canada,
2. CapitalCare, Edmonton, Alberta, Canada
Person-centred care (PCC) is widely acknowledged
among health care professionals as a best practice approach,
but there is little available evidence on the impact of PCC in
long-term care (LTC) settings.This literature review provides
research-based evidence to describe the tools available and
the examined outcomes of PCC in LTC settings for the resi-
dent, care staff, and family members.The inclusion criteria
to select studies included peer-reviewed literature discussing
measurement related to PCC in a LTC setting and/or tools
that were adapted to measure PCC in a LTC setting.Thirty-
one studies published from 2001 up to 2016 met the inclu-
sion criteria and five categories of studies investigating PCC
outcomes were established. Staff outcomes were most often
investigated, followed by resident outcomes, and family out-
comes were the least investigated. The various outcomes of
PCC are mixed. Overall, PCC is correlated with positive out-
comes, although some studies reported unchanged or nega-
tive outcomes after implementing PCC. Alimited number of
instruments exist designed to measure PCC and there is no
consensus in the examined studies on the best instrument to
use to measure outcomes of PCC. This investigation was to
be completed during a year-long research internship, there-
fore the search did not require a large number of databases
or a longer period of time to be examined. A more thor-
ough investigation, including a larger number of databases
searched as well as a longer time period for searching, is rec-
ommended to better determine the effectiveness of PCC.
EXAMINING THE IMPACT OF NURSING CULTURE
ON TECHNOLOGY USE TO FACILITATE CARE
PRACTICES
T.Yap1, S.Kennerly2, 1. School of Nursing, Duke
University, Durham, North Carolina, 2. East Carolina
University, Greenville, North Carolina
A positive cultural environment in nursing is vital
to achieving quality outcomes. The Nursing Culture
Assessment Tool (NCAT) captures general aspects of nurs-
ings occupational subculture with results that can be used
to advance care practices and outcomes. The subcultures
influence was explored in this mixed methods study when
568
using new technology, the Leaf resident activity monitor-
ing system, in long-term care (LTC) as part of a pressure
ulcer (PrU) prevention protocol and quality improvement
processes. The LTC contracted with Leaf Healthcare to
train staff in system use. All nursing staff (RNs, LPNs,
CNAs) were asked to complete a pre (n=34) and post-
test (n=38) web-based electronic 19-item NCAT survey
and demographics before and after a 21-day repositioning
intervention. Repositioning activities of LTC residents at
low, moderate, and high risk for developing a PrU were
monitored 24-hours a day with Leafs sensor worn mid-
sternum. All residents (n=44) were monitored for time
periods ranging from 2 to 21days with the staffs on-time
repositioning increasing. NCAT Cronbachs alpha was
0.93 (pre) and 0.94 (post). Communication subscale scores
significantly (F=4.605, p=.035) improved pre (m=8.79) to
post (m=9.55) intervention. Selected items for NCAT com-
munication (F=6.63, p=.012) and satisfaction (F=5.34,
p=.024) significantly increased posttest. The subcultures
overall normative ranking percentage increased from 30.9
to 58.2%. The technology provided staff with new infor-
mation which stimulated communication about reposition-
ing and contributed to their satisfaction with the quality of
care provided. The dynamic interaction between nursing
culture and the use of new technology in the care environ-
ment merits further research.
A STAFF PERCEPTION OF RELATIONSHIP BETWEEN
FAMILY AND STAFF IN LONG-TERM CARE
FACILITIES IN KOREA
H.Jang1, Y.Suh2, 1. Hanyang University, Seoul, Korea
(the Republic of), 2. Yonsei University, Seoul, Korea (the
Republic of)
Family and staff cooperative interaction in caring for
older adults in long-term care facilities is recommended;
however its importance and outcomes are poorly under-
stood in Korea. The purpose of the study was to explore
the staffs perception of his/her relationship with fam-
ily caregivers of institutionalized elders with dementia
in Korea. This qualitative study design was used. Data
were collected through focused group interviews using
an interview guide from May to June, 2016. Four focus
group interviews were conducted with a total of 21 staffs
in four long-term care facilities in Korea. The collected
data were analyzed by qualitative content analysis using
the MAXQDA12 program. Mean age of the participants
was 50.1 (SD=8.1) years old, and the majorities were
female (95.2%). Mean working period of the partici-
pants was 5.6years with a range of 1.8 to 16years. Four
themes were emerged; 1) Disconnected relationships;
2) Monitored relationships; 3) Supportive relationships;
and 4) Collaborative relationships. Staff who had devel-
oped a collaborative relationship with family caregivers
was more likely to provide information about residents
care, to acknowledge the family caregivers help to their
relative, to use open communication, to share responsibil-
ity, and to let family caregivers involve in problem-solv-
ing. Findings of this study may help healthcare providers
to establish collaborative care, to prevent any conflict
between family caregivers and staff in long-term care
facilities.
Innovation in Aging, 2017, Vol. 1, No. S1
DEVELOPMENT OF THE STRAIN IN DEMENTIA
CARE SCALE
A.Orrung Wallin1, M.Bird2, K.Anderson3, A.Edberg1,
1. Health and Society, Kristianstad University, Lund,
Sweden, 2. Dementia Development Services Centre, Bangor
University, Bangor, Gwynedd, United Kingdom, 3. Aged
Care Evaluation Unit, Southern NSW Local Health District,
Queanbeyan, New South Wales, Australia
Many staff working in residential aged care facilities
gain satisfaction from working with people with dementia,
however, they also experience significant stress. High lev-
els of stress among the staff can in turn affect the quality
of the care provided to residents. There is thus a need for
instruments to measure staff strain in the dementia-specific
residential care environment. The aim of the study was to
develop an instrument investigating strain among staff work-
ing in dementia care i.e. the Strain in Dementia Care Scale.
The instrument was initially developed through experiences
of strenuous aspects of work identified in six focus group dis-
cussions with 35 nurses in Australia, Sweden and the United
Kingdom. Apreliminary 64-item scale was in the next phase
reduced to a 29-item scale after being distributed to 927 staff
working in dementia care in Australia and Sweden. In the
final phase, a confirmatory factor analysis was made after
distributing the 29-item scale to a new sample of 346 staff
in Sweden. The final 27-item scale resulted in a five-factor
solution: Frustrated empathy; difficulties understanding and
interpreting; balancing competing needs; balancing emo-
tional involvement; and lack of recognition. The Strain in
Dementia Scale can be used (a) as an outcome measure of
intervention studies in residential care; (b) to help identify
interventions needed, based on high scores on different fac-
tors, to improve staff well-being in residential facilities and,
in turn, those they care for; and (c) to generally highlight the
importance of improving issues related to staff strain.
OLDER ADULT HOME HEALTH AIDES: AVIABLE
OPTION
G.McGhan, D.McCaughey, R.Herald, University of
Alabama at Birmingham, Birmingham, Alabama
The need for Home Health Aides (HHAs) contin-
ues to grow due to the aging of the population and older
adults increasing preference to be cared for in their homes.
Contributing to the shortage of qualified HHAs are the
repetitive injuries, high job demands, poor benefits and lower
pay they often experience. Suggestions have been made that
older workers are more prone to workplace injuries and
hence, are more costly to employee than younger workers.
To address these perceptions, data from the 2007 National
Home Health Aide Survey was used to examine the relation-
ship between injuries and outcomes, as well as the frequency
of injuries and sick days for HHAs. Post hoc analyses were
conducted to identify differences by age groups (n= 3,377).
Using OLS and multinomial logistic regression, injured
employees were found to have lower job satisfaction (=
-.119, p-value <.001), higher turnover intentions (= .069,
p-value <.001), and be less likely to recommend their agency
for care (= -.099, p-value <.001) than non-injured employ-
ees. Older workers (over 55 years and 23.7% of sample)
had significantly higher job satisfaction (F=5.35, p<.001),
lower turnover intention (F=8.15, p<.001) but no significant
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
differences in injury rate or sick days taken. Older HHAs
in this study had better outcomes and were neither injured
nor sick more often than their younger counterparts. With an
aging workforce and the need to fill existing vacancies, older
workers offer a viable and accessible employee pool to help
meet the growing demand for HHAs.
PROFESSIONAL DEVELOPMENT OPPORTUNITIES
FOR PERSONAL CARE WORKERS: SEE THEM SHINE
S.Davis, A.Campbell, R.Capp, Applied Gerontology,
Flinders University, Bamawm, Victoria, Australia
Under the Encouraging Better Practice Initiative, the
Australian Commonwealth Department of Health and Aged
Care funded a team from Flinders University to develop and
disseminate the Dementia Dynamics Toolkit to all residen-
tial aged care homes in the country with the aim of building
capacity in person-centred dementia care. In Australia, the
largest percentage of the workforce in residential aged care
comprises personal care workers, who are lowest paid and
largely part-time. As such, opportunities to engage in profes-
sional development activities and build capacity in their role
as the primary personal care-givers in an organisational set-
ting are limited. To determine the feasibilityof defined profes-
sional development opportunities for this important group of
staff, a national, competitive fellowship program for personal
care workers was offered as part of the Dementia Dynamics
Toolkit project. The Dementia Dynamics Fellowship com-
prised fully funded attendance to an international demen-
tia conference being held in Australia, a full day educational
workshop and mentor support for 12months to complete a
small project in the aged care home in which they worked.
Ten fellowships were awarded to personal carers from across
the country. This paper presents a selection of the journeys
these personal care workers embarked on during their fel-
lowships, the impact it had on their personal and profes-
sional development and the outcomes for the care homes in
which they worked. The personal care workers own views
are presented through excerpts of short videos talking about
their experiences going to a conference for the first time,
developing and completing their project and their perspec-
tive of the impact of their projects.
THE PREVALENCE AND RISK FACTORS ASSOCIATED
WITH ELDER ABUSE IN NURSING HOMES IN CHINA
F.Dai, L.Wang, R.Chen, L.Wang, Henan Province
Peoples Hospital, Zhengzhou, China
Elder abuse is a serious problem in some areas but always
to be hidden. However, abuse tendency is an important vari-
able to predict abuse behavior. The purpose of this study is to
investigate the prevalence and risk factors of caregiver abuse
in nursing homes. Acluster sampling survey was conducted
in Zhengzhou of China. 360 nursing staff in nursing homes
were recruited. Data were collected with general informa-
tion, the caregiver Abuse Screen(CASE), Workplace Social
Capital(WSC), and Maslach Burnout Inventory General
Survey(MBI-GS). The results showed that the rate of abuse
tendency to professional caregivers is high in nursing homes.
Working over 3 months in nursing homes, WSC, exhaus-
tion, reasons of job-selecting, and ADL scores of the elderly
IAGG 2017 World Congress
569
residents are correlated with abuse tendency. Therefore,
abuse tendency of professional caregivers should be evalu-
ated further continuously. It suggested that long-term care
facilities should provide more humanistic environment to
improve working conditions of the nursing staff, shorten
their daily work time, increase the salary, aiming to make
them more positive and delivery higher quality of care to the
elderly residents with chronic illness.
THE DIFFERENT VIEWS OF RESIDENTS AND CARE
STAFFS OF PERSON-CENTERED CLIMATE IN
NURSING HOMES, CHINA
H.Feng1, P.Mao1, L.Xiao2, X.Y.Yang1, H.M.Xia1, 1.
Xiangya Nursing School, Changsha, Hunan Province,
China, 2. School of Nursing and Midwifery, Adelaide, South
Australia, Australia
Introduction: In China, the perspective of residents and
care staff towards the climate of the nursing homes are
unknown due to lack of studies in this area.
Methods: A cross-sectional study was conducted to
explore residents and staffs perspective of erson-Centered
Climate in nursing homes, in Hunan Province. A stratified
cluster sampling method was used to recruit 260 old people
and 350care staffs from 20 nursing homes using the Person-
centered Climate Questionnaire-Patient version(PCQ-P)
and Person-centered Climate Questionnaire-Staff version
(PCQ-S).
Results:In toal, 251 residents and 302 care staffs com-
pleted the questionnaires.The range of age was 7089years
old. The range of age was 4655years old. The Cronbachs
alpha values of PCQ-P and PCQ-S in Chinese version
were the same 0.93.The mean score(SD) of the PCQ-P
was 59.69(11.49),and the mean score(SD) of PCQ-S was
66.3(9.7). Correlation analysis showed that residents age,
the marital status, health condition were factors affect-
ing their perspective of person-centered climate of nursing
homes. Staffs age, education level and the attributes of nurs-
ing homes were the factors affecting staffs perspective of
person-centered climate in nursing homes.
Conclusion: The residents perceived person-centered cli-
mates scores were lower than those of care staff. The findings
have implications for staff education and training to improve
resident-centred care in nursing homes in China.
SESSION LB1070 (POSTER)
LATE BREAKER POSTER SESSION 3
ACCESS TO HEALTH CARE IN RURAL CHINA:
THE INFLUENCE OF TRAVEL DISTANCE ON
HEALTHCARE DECISION-MAKING
H.Ruan, Institute of Population Research, Peking
Universiy, Beijing, Beijing, China
In 2009, China established several new schemes to pro-
vide social health care coverage for the vast majority of its
1.3 billion citizens. However, continued separated health-
care system creates inequalities in access that disadvantage
people in rural areas. Because public hospitals and clinics
570
are insufficient to meet their needs, older adults with seri-
ous health problems often must travel great distances to
obtain care. This study draws on the Andersen Behavioral
Model to examine this trade-off between accessing quality
of care and travel distance in health care decision-making.
Based on nationally representative data from the Study
on Global Aging and Adult Health (SAGE) (N =4,445),
multinomial-logistic regression was used to examine the
influence of distance traveled on health services utilization.
Controlling for the effects of relevant predisposing, enabling
and need factors, distance decreased older adults use of pri-
vate (OR=0.48, P<0.01) and public (OR=0.22, P<0.01) clin-
ics, but it had the opposite effect on use of public hospitals
(OR=1.52, P<0.001). Health status and availability of high
quality medical care in their home province moderated this
relationship; in cases of poor health, distance played a less
significant role in choice of clinics, but a greater role in choos-
ing a high-quality hospital regardless of distance (OR=2.09,
p<0.01), while the availability of local medical resources
lessened the impact of distance (OR=2.221, P<0.01). In sum,
distance reduced the probability of older adults clinic use,
but not their decision to seek sophisticated hospital services,
especially in cases of poor health and the absence of high-
quality care locally. Feasible schemes must contend with this
growing issue of distance to high-quality facilities in health
care decision-making of older adults in rural China.
LEISURE CONSTRAINTS OF URBAN CHINESE
OLDER ADULTS: ACASE STUDY OF SUZHOU
Y.Niu1, D.Wang2, H.J.Gibson1, 1. Tourism, Recreation
and Sport Management, University of Florida, Gainesville,
Florida, 2. Soochow University, Suzhou, Jiangsu, China
As the Chinese population ages, concerns are raised over
the wellbeing of its elderly. Leisure has been shown to play
a significant role in the physical and psychological wellbeing
of older adults (Broughton etal, 2016; Heo etal, 2010), yet
not all older adults have access to leisure (Liechty & Genoe,
2013). This study explored the constraints that limit the lei-
sure activities of Chinese older adults and analyzed the dif-
ferences in perception of these constraints by demographic
characteristics. Residents from three communities of Suzhou,
China aged 55+ were surveyed (N=285) during July 1720,
2016. A questionnaire containing 18 constraints to leisure
participation were assessed by the respondents using a 5
point Likert-type scale. Afactor analysis of responses yielded
four constraint factors (Cronbachs alpha=0.80, accumu-
lated variance=81.24%): (1) subjective and social factor (6
items, leisure awareness, consumption habit, care giving and
interpersonal relations with children and friends), (2) health
(4 items, physical health, injury and health accident percep-
tion and health care), (3) support service (4 items, manage-
ment, leisure education, guidance and information access)
and (4) facilities (4 items, leisure space, environment, leisure
facilities and community-level organizations). A one-way
ANOVA revealed significant differences between living state,
health, marriage, leisure expenditure, income with the four
factors. Suggestions were proposed to address the problems:
including the introduction of leisure education, the provi-
sion of facilities, the accessibility of affordable products, the
Innovation in Aging, 2017, Vol. 1, No. S1
availably of health care, and the encouragement of leisure
industry provision for older adults.
CHANGES IN DEPRESSIVE AND ANXIETY
SYMPTOMS IN ADULTHOOD: FINDINGS FROM THE
VA NORMATIVE AGING STUDY
H.Lee1, C.M.Aldwin1, S.Choun1, R.Nath1, A.Spiro2,
1. School of Social and Behavioral Health Sciences,
Oregon State University, Corvallis, Oregon, 2. VA Boston
Healthcare System & Schools of Public Health and
Medicine, Boston University, Boston, Massachusetts
Combat exposure influences posttraumatic stress dis-
order (PTSD) throughout the lifespan, including late life
(Kang et al., 2016; Settersten, 2006). While PTSD is often
comorbid with depression and anxiety (e.g., Stander etal.,
2014), surprisingly few studies examine whether combat
exposure influences the age-related trajectories of depressive
and anxiety symptoms (Ginzburg etal., 2010). We examined
whether these trajectories differed depending on combat
exposure (combatant vs. non-combatant) and specifically
whether killing someone had stronger effects than general
combat exposure. We utilized survey data collected in 1985,
1988, and 1991 from men in the VA Normative Aging
Study; response rates were >80%. The sample included
978 men (Mage=59.7 in 1985, SD = 7.2, range = 4186),
mainly WWII and Korea-era veterans, of whom 392 (40%)
saw combat and 80 (8.2%) indicated that they had killed
someone. Unconditional growth curve models showed that
veterans had U-shaped trajectories of both depressive and
anxiety symptoms, decreasing until ~60 and increasing
again in the late 60s. In the conditional growth curve mod-
els, the interaction of combat and age2 indicated that, for
combat veterans compared to non-combat veterans, their
levels of both depressive and anxiety symptoms increased
sharply in late life. However, the indicator of killing experi-
ence did not add significant variance to the model, perhaps
because relatively few veterans had this experience. Thus,
combat intensified the age-related changes in anxiety and
depressive symptoms, suggesting that combat veterans may
need more mental health assistance in late life.
FAMILY, FAITH, AND FATALISM: AGENCY IN
OLDER APPALACHIAN FAMILIES DEALING WITH
GYNECOLOGICAL CANCER
E.Potter, K.R.Allen, K.A.Roberto, Virginia Polytechnic
Institute and State University, Blacksburg, Virginia
Patient-centered cancer care promotes individualized
care and engages patients in the decision-making process.
This decision-making responsibility often involves family
input, welcomed or not. Older women in rural Appalachia
are reported to have low levels of agency and high levels
of fatalism (i.e., viewing health as pre-determined) regard-
ing cancer. In Fall 2016, we explored the consequences of
patient-centered care among older Appalachian women with
gynecological cancer and their family members. This qualita-
tive study combined Elders Life Course concepts of trajec-
tories and agency with Johnsons Model of Cancer-Related
Information Seeking to examine agentic processes among
families and older Appalachian women with gynecologi-
cal cancer before, during, and post-cancer treatment. Using
thematic content analysis, we focused specifically on how
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
older women enacted agency through information seeking
and avoidance. We conducted a total of 53 semi-structured
interviews with 20 White women (aged 5182; M=67.1) liv-
ing in central Appalachia and 1 to 2 members of their family
(n=33). Findings demonstrated three transitions throughout
the cancer experience and resulted in the creation of four tra-
jectories of information-seeking ranging from surrendering
control, accepting death, caring for oneself, or advocating
for others. Findings also highlighted the role and limits of
family members in information-seeking, womens personal
transformation in self-efficacy and passion for community
empowerment, faith-informed fatalism, and the value of per-
sonal ownership during cancer experience. We recommend
redefining fatalism and conceptualizing information-seeking
as a mechanism of agency. Findings call for continued doc-
tor-patient dialogue regarding desire and use of information,
and further examination of rural expressions of agency.
DRIVING CESSATION AND DEPRESSIVE SYMPTOMS:
GENDER AND CROSS-NATIONAL DIFFERENCES
E.Choi, S.Cho, S.Um, Y.Kim, Kyung Hee University, of medical information. Most respondents (67.4%) agreed
Yongin-si, Gyeonggi-do, Korea (the Republic of)
Background: Previous research showed that driving cessa-
tion is significantly related to depressive symptoms (Ragland
etal., 2005). However, limited studies have considered gen-
der and cross-national differences. This study aims to investi-
gate (1) gender differences in the association between driving
cessation and depressive symptoms, and (2) whether there
is a cross-national variation between Korean and U.S older
adults.
Methods: Using data from the 2014 National Elderly
Survey (KIHASA) in the Korea and the Health and Retirement
Study (HRS) in the US, a total of 4,274 older adults (2,062
Korean citizens and 2,212U.S residents) aged 65 years
were selected. Geriatric Depression Scale-15 and Center for
Epidemiologic Studies Depression Scale-10 were used to
measure depressive symptoms in Korean and U.S sample,
respectively. Demographic characteristics, disease burden,
and cognitive functioning were included as covariates.
Results: Significant differences were found in the preva-
lence of driving cessation between nations. Korean elderly
was more likely to stop driving than elderly in the U.S (34%
vs. 9.5%). Women were more likely to cease to drive in both
countries. In the U.S, driving cessation was significantly
related to higher levels of depressive symptoms in both gen-
der. However, in Korean older adults, driving cessation was
associated with higher levels of depressive symptoms only
in men.
Conclusions: The results indicate that the relationship
between driving cessation and depressive symptoms differs
across gender and nations, suggesting that driving cessation
may increase depressive symptoms, especially for the U.S res-
idents. Future research is more needed to examine underlying
mechanisms.
DO MY PATIENTS NEED ALL THEIR MEDICINES?
REGISTERED NURSES VIEWS ON DEPRESCRIBING
N.Ailabouni1, D.Mangin2, J.M.Tordoff1, P.S.Nishtala1, 1. these indicators of SEP both directly and indirectly are asso-
University of Otago, Dunedin, New Zealand, 2. McMaster
University, Hamilton, Ontario, Canada
Registered nurses are key players in caring for older peo-
ple and are major influencers of prescribing and deprescribing
IAGG 2017 World Congress
571
in residential aged care facilities (RACFs). However, studies
investigating their opinions about these processes are lim-
ited. This study therefore aims to investigate nurses views
and perceptions on medicines use and deprescribing in this
setting. A cross-sectional survey was mailed to 307 nurse
managers of a nationally representative sample of RACFs.
A purpose-developed, pre-tested, 48-item structured ques-
tionnaire was used that included both open-ended and close-
ended questions. Questions were grouped according to each
stage of the medicine use process (prescribing, medicine
charts, receiving dispensed medications, administration and
monitoring). Adedicated section to explore nurses views on
deprescribing was included. We received 91 questionnaires in
total; yielding a response rate of 29.6%. Adescriptive analy-
sis was conducted to analyse close-ended question responses,
and a thematic analysis was carried out to analyse open-
ended question responses. Nurses highlighted several chal-
lenges including achieving medicine reconciliation for new
residents, access to physicians to admit patients in a timely
fashion, and issues pertaining to lack of clear transcribing
that deprescribing implemented with the help of a clinical
pharmacist, would be beneficial and could improve medica-
tion adherence (44%), benefit the residents quality of life
(50.5%) and reduce the length of time spent by nurses on
medicines administration (35.2%). This study sheds light on
important challenges faced by nurses, regarding medication
management. The majority of nurses supported the idea of
deprescribing; however a small proportion of them disagreed
that it would be beneficial or had no opinion. Increased
awareness regarding polypharmacy and potential depre-
scribing benefits, is necessary to help achieve optimisation of
medicine use in older people.
SOCIOECONOMIC POSITION ACROSS THE LIFE-
COURSE AND COGNITIVE ABILITY IN MIDLIFE
E.Foverskov1,2, E.Mortensen1,2, J.Pedersen1,2, M.Osler1,2,3,
R.Lund1,2, 1. Department of Public Health, University of
Copehagen, Copenhagen, Denmark, 2. Center for Healthy
Aging, University of Copenhagen, Copenhagen, Denmark,
3. Research Centre for Prevention and Health, Glostrup
Hospital, Glostrup, Denmark
Cognitive ability is associated with morbidity and mor-
tality in old age and has been proposed to be a marker of
successful ageing. There is growing interest in understanding
how socioeconomic position (SEP) across the life-course may
influence the development of cognitive ability. However, few
studies have been able to include measures of early life ability
and separate the effect of life-course factors that adds vari-
ance to later ability from variance that has persisted through-
out life. This study is based on 2481 men born in 1953 from
the Danish Metropolit Cohort who have completed ability
tests at age 12, 18 and 57. The data is unique because it in
addition to these three tests contains longitudinal prospective
register information on childhood SEP, educational attain-
ment and occupational skill levels throughout adulthood.
Structural equation models were used to investigate how
ciated with cognitive ability in midlife, when accounting for
childhood ability. Estimating standardized coefficients, we
found significant direct paths from childhood ability (0.86)
and adult occupational skill levels (0.13) to midlife ability.
572
The association between childhood SEP and midlife ability
was fully explained by the other study variables, and thus
only the indirect effect was significant (0.35). Educational
attainment was found to have a negligible effect on midlife
ability. The results suggest that individual differences in
midlife cognitive ability are mainly due to differences in early
life ability, but that occupational skill levels in adulthood and
SEP in early life may additionally have implications for cog-
nitive development over the life-course.
CAREGIVER-CARE RECIPIENT RELATIONSHIPS
ARE ASSOCIATED WITH NEUROPSYCHIATRIC
SYMPTOMS IN DEMENTIA
E.Vernon1, B.Cooley1, W.Rozum1, G.Rattinger2,
S.Behrens1, J.Tschanz1, 1. Utah State University, Logan,
Utah, 2. Binghamton University, Binghamton, New York
Closer caregiver-care recipient (CG-CR) relationships
have been associated with lower informal care costs and
better cognitive and functional outcomes in persons with
dementia. Considering difficulties in treating neuropsychiat-
ric symptoms (NPS) and their significant detrimental effects
on caregivers and care-recipients in dementia, we examined
whether closer CG-CR relationships were associated with
severity of overall NPS and specific subdomains in demen-
tia. NPS were assessed by the Neuropsychiatric Inventory-12
(NPI-12) in 252 CG-CR dyads in the Dementia Progression
Study a longitudinal-population based study in Cache
County Utah. Caregivers reported on relationship closeness
using the Whitlach Relationship Scale. Linear mixed models
examined the association between NPI-12 total score and
symptom subdomains with CG-CR closeness (time-varying)
in separate models. When controlling for caregiver burden,
kin relationship, and dementia severity, each increasing unit
of closeness was associated with an approximate 3-point
lower NPI-12 score (b=-2.73, p=.002), and an approximate
1-point slower increase in NPI total score per year (b=-0.92,
p=0.046). In NPI subdomains, closer relationships were asso-
ciated with lower affective domain scores (b=-0.15, p<0.001)
and lower agitation/aggression scores (b=-0.13, p<0.001).
These results suggest that closeness in CG-CR relationship, a
modifiable factor, may help reduce severity or slow intensifi-
cation of NPS in dementia patients, which may be clinically
significant for challenging symptom management. Extending
prior findings that higher CG-CR closeness also predicts
better cognitive and functional outcomes and lower infor-
mal costs of care, enhancing the CG-CR relationship may
improve quality of life in the care dyad and possibly avoid or
delay costly outcomes such as institutionalization.
ORAL-HEALTH PROFESSIONALS AS AFIRST
POINT OF CONTACT FOR ELDER ABUSE VICTIMS:
ASCOPING REVIEW
B.MacDonald1,2, A.Hussain1,2, C.Aliman1,2, J.Fujioka1,2,
K.David3,4, R.M.Mirza1,2, C.Klinger1,2, L.McDonald1,2,
1. Factor-Inwentash Faculty of Social Work, University of
Toronto, Toronto, Ontario, Canada, 2. National Initiative
for the Care of the Elderly, Toronto, Ontario, Canada, 3.
Lakehead University, Orillia, Ontario, Canada, 4. Lakehead
University, Faculty of Social Work, Orillia, Ontario, Canada
Oral-health professionals, which include dentists, ortho-
dontists and dental hygienists, are often the first point of
Innovation in Aging, 2017, Vol. 1, No. S1
contact for older adults experiencing various types of elder
mistreatment (such as abuse and neglect). The scheduled and
routine nature of the visit often provides an opportunity
to recognize any indicators of mistreatment over a longer
period of time. A2017 technical report completed on support
services for victims of elder mistreatment highlighted that
oral-health professionals are an underutilized ally in identi-
fying and intervening with abused or neglected older adults.
However, training in the identification of elder mistreatment
by oral-health professionals as well as protocols for report-
ing are not well established. In addition, entities such as the
Public Health Agency of Canada have begun changing the
scope from dental professionals to oral-health profes-
sionals to capture the important role this range of front-line
professionals plays. Ascoping review was completed to gain
an in-depth understanding of the role of oral-health profes-
sionals with respect to elder mistreatment, and as crucial
resources in community settings. Ten peer-reviewed and grey
literature databases were searched for empirical studies pub-
lished after 2000. This synthesis review analyzes approaches
that oral-health professionals may utilize to identify different
types of elder mistreatment and ensure their clients safety
moving forward (i.e., duty to report). Findings suggest that
oral-health professionals equipped with appropriate educa-
tion, training and awareness can be key in early detection
of elder mistreatment. This merits further research, policy
and practice attention to the role of oral-health professionals
intervening in cases of elder mistreatment.
SES TRAJECTORIES, RECESSION HARDSHIPS, AND
DAILY WELL-BEING AMONG ADULTS IN THE
UNITED STATES
A.Surachman, D.Almeida, The Pennsylvania State
University, University Park, Pennsylvania
Objectives. To examine how life-course trajectories of
socioeconomic status (SES) and the experience of hardships
during recession predict daily well-being across adulthood.
Methods. Data from the baseline survey and the daily
diary study of the Midlife in the United States (MIDUS)
Refresher study were combined, resulting in 782 partici-
pants (55.6% female, M age=47.91 y.o.) who reported on
5,849days of information including daily stressors and daily
well-being. Participants childhood SES was combined with
their formal educational attainment and adult SES, result-
ing in five SES trajectories: stable low, downwardly mobile,
upwardly mobile, stable high, and mixed (no clear patterns).
In addition, the recession hardships included job, home, and
financial impacts of the economic downturn on individuals.
The associations among SES trajectories, recession hardships,
and daily well-being was analyzed using multilevel modeling.
Results. Participants in the stable low and downwardly
mobile groups, but not in the upwardly mobile group, sig-
nificantly reported a higher level of recession hardships, daily
negative affect, and daily physical symptoms compared to
participants in the stable high group. Higher levels of reces-
sion hardships were also associated with worse daily well-
being. The impact of SES trajectories and recession hardships
on daily physical symptoms was stronger among women,
while their association with daily negative affect was stronger
among older participants.
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Innovation in Aging, 2017, Vol. 1, No. S1
Discussion. Upward mobility, especially through the
attainment of a better education, is the key to alleviating the
negative impact of childhood socioeconomic disadvantage
on later well-being, particularly during and post-recession.
MENTAL HEALTH PROFILES OF DEMENTIA
SUBTYPES IN OLDER VETERANS
A.X.Lai1,2,3, A.R.Kaup1,3, A.L.Byers1,3, 1. R&D, San
Francisco VA Medical Center, San Francisco, California,
2. University of California, Berkeley, Berkeley, California,
3. University of California, San Francisco, San Francisco,
California
Little is known about whether specific mental health
issues are more prevalent in certain dementia subtypes. This
study examined psychiatric disorders and suicidal behav-
ior among older veterans with different dementia subtypes.
The sample included 4,951,919 older veterans (50 years)
who used Veterans Health Administration healthcare ser-
vices. Data were from the National Patient Care Database
and National Suicide Prevention and Application Network
for fiscal years 20122013. International Classification of
Diseases, 9th Edition codes were used to identify psychiatric
diagnoses and dementia subtypes, and Pearsons chi-square
tests were used to determine prevalence of mental health
conditions among dementia subtypes. Among older veterans,
0.03% were diagnosed with frontotemporal, 0.52% with
vascular, 0.66% with Alzheimers, 0.08% with Lewy body,
0.30% with senile, and 3.45% with not otherwise speci-
fied dementia. Older veterans with any dementia had higher
prevalence of mood and anxiety disorders and suicidal
behavior than those without dementia (p<.001). Specifically,
those with frontotemporal and vascular dementia had the
highest rates of major depression (13.04%, 10.94%), post-
traumatic stress disorder (15.11%, 13.17%), and suicidal
behavior (0.36%, 0.21%), whereas those with Alzheimers
had the lowest rates of these disorders (<8%, p<.001) and
suicidal behavior (0.07%, p<.001). Furthermore, older vet-
erans with frontotemporal and vascular dementia had the
highest prevalence of comorbid (11.05%, 10.10%), and 3
multiple (10.41%, 6.83%) mental health issues, while those
with Alzheimers had the lowest prevalence of these issues
(<5%, p<.001). Specific mental health issues are more prev-
alent in certain dementia subtypes, and likely increase the
complexity of treating patients with these subtypes.
THE ASSOCIATION BETWEEN COGNITIVE
IMPAIRMENT AND CHANGES IN PATTERNS OF
ACTIVITY ENGAGEMENT
T.Amano, S.Park, N.L.Morrow-Howell, Washington
University in St. Louis, St. Louis, Missouri
Previous studies have shown that the overall pattern of
engagement in various activities is associated with cognitive
health in later life. To date, little evidence exists to what extent
change in cognitive function may affect changes in activity
engagement patterns over time. This study investigated the
longitudinal patterns of social activities among older adults
and examined whether, and to what extent, changes in cog-
nitive function influence the transition patterns. Data from
the 2008 and 2012 Health and Retirement Study were used.
Atotal of 2,987 participants aged 65 or older were included
in analyses. Latent transition analysis and multinomial
IAGG 2017 World Congress
573
logistic regression analysis were used. Cross-sectional pro-
file analysis identified High Active, Active Leisure, Passive
Leisure, and Low Active groups in each wave of the study.
Longitudinal profile analysis derived four transition patterns:
three groups in three Stayer, remain high, remain moderate,
and remain low and one Changer group: active to less active
group. Multinomial logistic regression analysis showed that
people who developed cognitive impairment were more
likely to transition as Changer compared to remain high or
remain moderate. This study adds to the extremely limited
empirical evidence about stability and dynamics of later year
social engagement: our findings showed that majority of the
sample belonged to Stayers (87.4%) and subgroup (12.6%)
belonged to Changer. Importantly, those who developed cog-
nitive impairment were at risk of becoming disengaged in
various activities, even in relatively short periods of time.
These empirical findings add to the importance of identify-
ing older adults with declining cognitive function.
EVALUATION OF ARELATIONSHIP-CENTRED
MEALTIME EDUCATION INTERVENTION FOR
CANADIAN LONG-TERM CARE
S.Wu1, H.H.Keller1,2, H.Dunn2, S.Iuglio1, V.Vucea1,
J.M.Morrison1, 1. Kinesiology, University of Waterloo,
Waterloo, Ontario, Canada, 2. Schlegel-UW Research
Institute for Aging, Waterloo, Ontario, Canada
Mealtimes are an important aspect of quality of life for
residents in long-term care (LTC), yet little attention has been
directed to improving the quality of relationships between
care staff and residents or the physical dining environment.
C.H.O.I.C.E.is a multi-component (i.e., education, training,
leadership, communication) intervention to improve rela-
tionship-centred care (RCC) and overall mealtime experi-
ence for residents. This study used the Mealtime Scan (MTS),
a comprehensive and reliable tool, to evaluate the potential
of C.H.O.I.C.E.to improve physical, social and RCC meal-
time practices over time. C.H.O.I.C.E. was implemented
(April-November 2016) within two units of a LTC home
in Southern Ontario, Canada. Data were collected by two
trained, assessors (one per unit) at baseline, 8, 16, and 24
weeks (5 mealtime observations per assessor per time point).
Linear regression analysis determined the association of
time, unit, and time*unit interaction with 4 MTS summary
scales (physical or social environment, RCC, overall atmos-
phere; 8-point scale). Units differed on number of residents
in the dining room at meals (mean=222 vs. 262; p<0.01),
but not number of staff (mean=51). Each global assessment
measure, with the exception of RCC, was found to improve
with time: physical environment [F(3,36)=3.7, p0.05)];
social environment [F(3,36)=3.6, p0.05)]; atmosphere
[F(3,36)=4.8, p0.01)]. An interaction between time and
unit was found for the association with social environment,
and with overall atmosphere. C.H.O.I.C.E.improved several
aspects of mealtime experience in LTC. Results highlight the
potential for change, but also the varying response at unit
level likely due to resident-staff mix and team dynamics.
THE RELATIONSHIP OF EMPLOYMENT AND
HOUSEHOLD AND NON-HOUSEHOLD CAREGIVING
I.Sanidad1, S.Vasireddy2, L.H.Nitz3, 1. University of
Hawaii Manoa Sociology Department, Honolulu, Hawaii,
574
2. University of Hawaii Manoa Economics Department,
Honolulu, Hawaii, 3. University of Hawaii Manoa Political
Science Department, Honolulu, Hawaii
This research examines the relationship between caregiv-
ing for elders, partitioned by place of residence, and being
employed. Recent legislation in Hawaii (SB534 SD1) directed
toward supporting working caregivers inspires this research
project. Caregiving is an intensive activity that can affect not
only physical and mental health but financial health as well.
If caregiving activities lead to early retirement from the work-
force then the financial effects go beyond immediate fiscal
needs and can lead to the caregivers own retirement funds
and Social Security benefits to be reduced. Data (n=97,327)
come from five years, 20112015, of the American Time Use
Survey (ATUS), a U.S.national household survey conducted
on a subset of the monthly Current Population Survey (CPS).
The ATUS is sponsored by the Bureau of Labor Statistics and
conducted by the U.S. Census Bureau. Employment is exam-
ined using logistic regression. Care time is examined by total
time spent caregiving then partitioned into care time given to
household members and care time given to non-household
members. Care is further examined by count of elderly care
receivers also partitioned by whether the care receivers live
in the household of the caregiver. Results indicate that car-
egiving is associated with not being employed but there is a
difference between caregiving for household members and
non-household members. Caring for household members is
more strongly related to unemployment than caring for non-
household members.
THE PATTERN OF GENDER ROLE ATTITUDE
AND MARITAL QUALITY AMONG MIDDLE-AGED
KOREANS
H.Park, H.Jun, S.Joo, Child and Family Studies, Yonsei the process; iv) Sharing responsibility and accountability for
University, Seoul, Korea (the Republic of)
Although gender role attitude is a multidimensional phe-
nomenon, only a limited number of studies has been directed
at understanding its diversity stereoscopically in terms of
family studies. Therefore, the aim of this study was to iden-
tify patterns of gender role attitude among middle-aged
Koreans and to investigate the differences on martial quality
between patterns. For the analysis, the Third National Survey
of Korean Families was utilized and married individuals aged
40 to 59 were analyzed (N=3,704). Using Mplus 7.3, a latent
profile analysis (LPA) was adopted to identify latent profiles
of gender role attitude. Then, using SPSS 23, the analysis of
covariance (ANCOVA) with post-hoc tests was used to ana-
lyze the differences on both marital satisfaction and marital
conflict between patterns. A latent profile analysis of self-
reported gender role attitudes identified three such patterns:
the most egalitarian (33%), the modest egalitarian (48%),
and the least egalitarian (19%). The classes resulting from
the LPA were significantly related to martial satisfaction
but not to marital conflict; those individuals with the most
egalitarian gender role attitude pattern reported higher levels
of marital satisfaction than those individuals with the least
egalitarian gender role attitude pattern. The results of this
study imply that more egalitarian gender role attitude con-
tributes to increasing marital satisfaction but not decreasing
marital conflict and that, its findings may be useful in the
Innovation in Aging, 2017, Vol. 1, No. S1
field of marriage and family therapy to develop educational
programs that seek to improve marital satisfaction in midlife.
INSIGHTS INTO IMPLEMENTING ARELATIONSHIP-
CENTRED MEALTIME INTERVENTION FOR
CANADIAN LONG-TERM CARE
S.Wu1, H.H.Keller1,2, H.Dunn2, S.Iuglio1, V.Vucea1,
J.M.Morrison1, 1. Kinesiology, University of Waterloo,
Waterloo, Ontario, Canada, 2. Schlegel-UW Research
Institute for Aging, Waterloo, Ontario, Canada
Mealtimes are an important aspect of quality of life for
residents in long-term care (LTC). Interventions aimed at
improving mealtimes often give little attention to the qual-
ity of relationships between care staff and residents, and are
designed with a single-strategy approach. C.H.O.I.C.E.is a
multi-component (i.e., education, training, leadership, com-
munication) intervention to improve relationship-centred
care (RCC) and overall mealtime experience for residents
in LTC. The current study evaluates the implementation
of a proof-of-concept relationship-centred mealtime inter-
vention through understanding the perspectives of partici-
pating LTC management and care staff. C.H.O.I.C.E was
implemented (April-November 2016) within two units of
a LTC home in Southern Ontario, Canada. Data were col-
lected post-intervention using staff and management key
informant semi-structured interviews (n=9), which focused
on mealtime changes, intervention components, implemen-
tation strategies, and program sustainability. Data was ana-
lyzed using thematic analysis. Preliminary findings provide
several insights into the program and the implementation
process: i) Knowing the context and culture to meet staff and
resident needs; ii) Getting everyone on board, including man-
agement; iii) Keeping communication lines open throughout
mealtime goals and challenges; v) Empowering and support-
ing staffs creative mealtime initiatives. Participants identi-
fied multiple benefits from the program, most notably an
enhanced appreciation for the importance of meals and an
increase in meaningful socialization with residents. Our
research illustrates the value of C.H.O.I.C.E.and its capac-
ity to improve RCC and residents mealtime experiences.
Findings will inform the next phase of program development.
HOW STEREOTYPE THREAT MIGHT EXPLAIN
STABILITY AND DEFICITS IN OLDER ADULTS
PROSPECTIVE MEMORY
S.Zuber1, A.Ihle2, A.Blum1, O.Desrichard1, M.Kliegel1,
1. Psychology, University of Geneva, Geneva, Geneva,
Switzerland, 2. Center for the Interdisciplinary Study of
Gerontology and Vulnerability, Geneva, Switzerland
Prospective memory (PM; ones capacity to perform a
planned action after a certain delay, e.g. taking ones medica-
tion at specific times) is an important proxy for autonomy
and well-being in old age. The majority of previous studies
observed age-deficits in PM which have so far largely been
associated to the decline of cognitive resources in older
adults. In the current study we suggest a novel, more social-
psychological perspective on this topic. Specifically, sixty
younger and sixty older adults performed two PM tasks.
Half of the participants received instructions emphasizing the
memory component of the tasks (i.e., high stereotype threat
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
for older adults) whereas the other half was instructed that
the tasks evaluated their reading-ability (i.e., low stereotype
threat). Results show (1) that older adults PM performance
was worse than younger adults only in the stereotype condi-
tion (U=302.00, p < .05, d=.54), and (2) that this effect
was limited to the PM task that strongly relied on executively
guided processes (U=225.50, p < .05, d=.60).
In sum, the current findings illustrate for the first time that
the PM deficits commonly observed in older adults might
in fact be the result of age-related stereotypes which can
implicitly and involuntarily be induced by practitioners.
Thus, the present study has significant conceptual as well as
practical implications, indicating potential age-stability of
this crucial everyday function and highlighting the impor-
tance of carefully choosing their wording when practitioners
assess older adults abilities.
DOES COHABITATING FAMILIES INVOLVEMENT
AFFECT DEPRESSION AMONG COMMUNITY-
DWELLING OLDER ADULTS?
S.Yamazaki1, S.Yasumura2, 1. Bunkyo Gakuin University,
Saitama, Japan, 2. Fukushima Medical University,
Fukushima, Japan
We used paired data of older adults and their cohabitat-
ing family members to examine whether daily involvement
of and mental health of family members would affect emer-
gence of depressive symptoms among community-dwelling
older adults 1.5years later. The initial survey was conducted
with 1,229 people aged 70+ without ADL disability and
their cohabitating family members. The questions for the
older adults included their age, sex, education, depression
(CES-D), being alone during the day, social support, ageist
attitudes from family members, mobility, and IADL. The
questions for families included their age, sex, ADL, relation
to the older adult, and mental health. A follow-up survey
was conducted 1.5 years later. The authors analyzed 460
pairs who had answered all the questions.Among the older
respondents, 205 (59.2%) were female, and their mean age
was 77.75.8. Regarding their families, 194 (56.1%) were
female, their mean age was 59.612.4, and 244 (70.4%)
were children. We defined emergence of depressive symp-
toms at the follow-up survey as the dependent variable, con-
ducted logistic regression analysis, and found the following
significant independent variables: depressive symptoms of
the family (OR=2.48, 95%CI 1.016.28), ageist attitudes
from the family (OR=1.16, 95%CI 1.007.23), emotional
support from the family (OR=0.50, 95%CI 0.330.77), and
being alone during the day (OR=2.87, 95%CI 1.147.23).
This study found that cohabitating family members ageist
attitudes in daily living, being alone during the day despite
cohabitation with families, and depressive symptoms of fam-
ilies affect emergence of depressive symptoms among older
adults.
SPORTS GROUP PARTICIPATION REDUCES THE
ONSET OF DEMENTIA AMONG HIGH-RISK OLDER
ADULTS
T.Saito-Kokusho1, T.Takeda2, T.Ojima3, M.Saito4,
C.Murata1, H.Hirai5, K.Suzuki6, K.Kondo7,1, 1.
Department of Social Science, Natl Center for Geriatrics
and Gerontology (NCGG), Obu, Aichi, Japan, 2. Seijoh
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575
University, Tokai, Japan, 3. Hamamatsu University School
of Medicine, Hamamatsu, Japan, 4. Nihon Fukushi
University, Nagoya, Japan, 5. University of Yamanashi,
Kofu, Japan, 6. Aichi Gakuin University, Nisshin, Japan, 7.
Chiba University, Chiba, Japan
Social participation is known to protect cognitive func-
tion in older adults; however, it remains unclear whether it
delays the onset of dementia, especially among those already
at a high-risk. This study examined the association between
the contents of group participation and onset of dementia
among cognitively high-risk and healthy older adults.
Data were obtained from the Aichi Gerontological
Evaluation Study projects 9.4 year cohort dataset.
Respondents were functionally independent adults aged
65years. High-risk and healthy groups were selected based
on the 15-point risk score for dementia onset, which Takeda
and colleagues (2016) developed and validated; 1018 people
with scores 6 and 2395 people with scores of 0 or 1 were
selected as the high-risk and healthy groups respectively.
Eight types of community groups were assessed and exam-
ined in relation to the onset of dementia.
A multivariate Cox regression model revealed that those
participating in a sports group were less prone to the onset of
dementia (hazard ratio, HR: 0.53; 95% confidence intervals,
95% CI: 0.30, 0.94) in the high-risk group compared to the
healthy group (HR: 0.93; 95% CI: 0.60, 1.43). Interaction
terms of sports group participation by the risk score of the
groups showed a marginal effect modification (p < .098),
indicating that the effect of sports group participation was
stronger in the high-risk group.
These findings suggest the importance of sports group
participation on the onset of dementia, particularly in the
high-risk group. Further studies should examine causal rela-
tionships among these variables.
DEVELOPING SUPPORT SERVICES FOR THE
ELDERLY UNDER LONG-TERM CARE INSURANCE
IN JAPAN
Y.Someya1,2, 1. Social Welfare, The Graduate School of
Seirei Chrisitopher University, Urayasu, Chiba, Japan,
2. Institute of Gerontology, University Putra Malaysia,
Serdang, Serdang, Malaysia
This research investigates daily life support and depend-
ency prevention services for elderly people not covered by
the Long-term Care Insurance (LTCI). As these services are
essential for sustaining community living, many agencies try
to develop them in the market.
The Min-kai-kyo agency, which enhances elderly care ser-
vices, conducted this research starting in November 2016.
Questionnaires were faxed to 1,927 service agencies, profit
and non-profit, from November 14 to December 22, 2016.
A total of 225 agencies (11.7%) replied and data analysis
started soon after.
Daily life support services include the following: monitor-
ing the needs of the elderly through home visits, delivering
meals, shopping, providing transportation, senior housing,
exercise classes, cafe salon, etc.
Major outcomes: (1) 9.2% of agencies provided one of
these services before the year 2000 when the LTCI started;
36.9% of them started after 2012. (2) The reasons cited
for providing these services include: meeting future service
576
needs by the LTCI (37.0%); developing services in the mar-
ket (28.6%); supporting elderly in the community (22.8%).
(3) The issues encountered in starting these services include:
labor shortage (72.6%, M.A); difficulties in making a profit
(67.3%); and challenges in securing adequate investment to
expand (36.2%). (4) 29.6 % of agencies are successful busi-
nesses, but 32.3 % of them are in the red. However, 41.1
% of them will maintain services and 33.5 % will expand
services.
In summary, many agencies try to provide these services
to meet the needs of the communities and/or aiming for
future business under LTCI.
FINANCIAL FRAUDS AND THE HEALTH OF MIDDLE-
AGED AND OLDER ADULTS: THE CASE OF SPAIN
M.Zunzunegui1,2, E.Belanger3, J.Ribera-Casado4,
F.Zunzunegui2, F.P.Bland1, 1. Universite de Montreal,
Montreal, Quebec, Canada, 2. Finanzas y Salud, Madrid,
Spain, 3. Brown University, Providence, Rhode Island, 4.
Hospital Clinico de San Carlos, Madrid, Spain
Background: Globally, financial frauds cause loss of
lifetime savings to millions of small savers. Whether finan-
cial frauds have harmful effects on health has not yet been
explored. Our objective was to examine whether fraudulent
behaviors by financial institutions are associated with physi-
cal and mental health problems in affected populations, com-
paring with the health of the general population to which
they belong.
Methods: Pilot study (n=188) conducted in 2015 in the
central region of Spain by recruiting subjects affected by
two major types of frauds (preferred shares and foreign cur-
rency mortgages) using venue-based sampling. Information
about monetary value of fraud, dates for awareness of
fraud, legal claim and financial compensation were collected.
Comparisons of means and prevalence of physical and men-
tal health indicators, sleep and quality of life were carried
out between groups by type of fraud and the 20112012
National Health Survey.
Results: In this conventional sample, victims of financial
fraud had worse health, more sleep problems and worse
quality of life than comparable populations of similar age.
Those who had received financial compensation for lost sav-
ings in preferred shares had significantly better health and
quality of life than those who had not been compensated and
those who contracted foreign currency mortgages.
Conclusion: This pilot research suggests harmful effects
of financial frauds on the health of those affected. Further
research could examine the mechanisms through which
financial frauds impact public health. If these pilot results are
confirmed, psychological and medical assistance should be
provided, in addition to financial compensation.
MUSIC AND MEMORY: UPDATES FROM AN
INNOVATIVE COMMUNITY-LEVEL INTERVENTION
FOR PEOPLE WITH ADRD
D.W.Coon1, M.Cortes1, M.McCarthy1, R.Rio1,
V.Bontrager2, M.Todd1, R.Montague1, M.Burleson1, 1.
College of Nursing & Health Innovation, Arizona State
University, Phoenix, Arizona, 2. Phoenix Symphony,
Phoenix, Arizona
Innovation in Aging, 2017, Vol. 1, No. S1
This presentation expands upon initial findings (changes
in quality of life indicators) from an innovative community-
level, music-based intervention that holds policy implica-
tions for residents with dementia residing in long-term care
communities. Teams of professional symphony musicians
and music therapists delivered this interdisciplinary (music,
music therapy, nursing, and behavioral science) intervention
through 7 music-based events across 6 weeks. Nurse raters
evaluated resident affect before and after each event while
symphony musicians, facility staff, and family caregivers
completed similar self-ratings. Participants also provided
saliva samples to investigate the impact on biomarkers of
stress (salivary alpha-amylase and cortisol). Results support
the intervention in terms of significant changes in participant
mood ratings and in behavioral activation, as measured by
salivary alpha-amylase. Asub-study measuring salivary cor-
tisol supported the ratings, suggesting that morning music
events may have enabled residents to better regulate their
stress responses around an afternoon stressor (bathing).
Nurses also rated the following environmental factors sig-
nificantly more positively on evenings when morning music
events occurred versus those without music events: levels of
verbal/physical disruption at change of shift and dinnertime;
resident cooperation during evening care; overall mood of
the unit; and, number of critical events including falls, acute
illness, deaths, staff shortages. The interventions acceptabil-
ity and perceived benefit were also rated very highly. Results
provided further evidence for the projects conceptual model
that integrated three key parameters (receptive to active;
observation to relationship; and planned to improvisation)
by bridging science and practice and emphasizing the impor-
tance of community-level music-based interventions in long-
term care.
COMPARISON OF PHYSICAL FUNCTION IN DAY
CARE AND HOME CARE SETTINGS AMONG OLDER
ADULTS WITH DEMENTIA
J.Chung1, T.Lee2, E.Yim3, H.Choi2, 1. University of New
Mexico, Albuquerque, New Mexico, 2. Yonsei University
College of Nursing, Seoul, Korea (the Republic of), 3.
Daegu Health College, Daegu, Korea (the Republic of)
Despite increasing enrollment in long-term care (LTC)
insurance in Korea, it is not known whether it has improved
patient outcomes in different settings. The aim of this
study was to compare physical function among older indi-
viduals with dementia in day care (DC) with those in home
care (HC) settings. A retrospective, matched cohort study
design was adopted using the LTC insurance data set from
the National Health Insurance Service in Korea. A total of
7,822 older adults with dementia who received either DC
or HC consistently for 1year were identified. Higher scores
of activities of daily living (ADLs) indicate a lower level of
physical function. Paired samples t tests with a propensity-
scorematched cohort were conducted to examine the rela-
tionship between changes in ADLs and LTC service type.
The final matched sample included 416 individuals in each
group. There was no significant difference in baseline ADLs
between the two groups in the matched cohort (p = .06).
ADL scores after 1year were significantly lower for individu-
als in DC (22.45.1) than for those in HC (23.32.8) (p <
.05). The score had increased by 1.61 for DC and 2.84 for
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
HC, indicating that there was less deterioration in physical
function in the DC group than in the HC group (p < .001).
Physical function of older adults with dementia could vary
according to the LTC service type, and DC is more effective
than HC for delaying the deterioration of ADLs.
SOCIAL CONNECTIONS MEDIATE THE
ASSOCIATION BETWEEN FRAILTY AND MEANING
IN LIFE FOR OLDER PEOPLE
A.Chau, Y.Fang, A.Wong, R.Yu, J.Woo, CUHK Jockey validate findings.
Club Institute of Ageing, The Chinese University of Hong
Kong, Hong Kong, Hong Kong
Meaning in life (MIL) is important for psychological well-
being, especially among older people. While much evidence
showed that frailty has negative impacts on general adjust-
ment and social functioning, little is known about the impact
of frailty on MIL in particular. In this study, we examined the
effect of frailty on MIL, and the mediating role of social con-
nections in this association. Arepresentative sample of 773
Hong Kong Chinese aged 60 and above was interviewed via a
telephone survey. Frailty status and MIL were assessed using
the FRAIL scale and the question Do you feel your life is
meaningful? respectively. Social connections were assessed
using frequency of social contact and loneliness. Compared
to robust older people, frail and pre-frail older people had
lower MIL after controlling for demographics (pre-frail:
= -0.33, p < .001; frail: = -0.58, p < .001). These two nitive outcomes (i.e., speed, spatial, verbal) at ages 70, 75,
groups also reported less frequent social contact and higher
loneliness (ps < .05). Multiple mediation model revealed a
significant indirect effect of frailty on MIL through social
contact (pre-frail: -0.03, 95% CI [-0.07, -0.01]; frail: -0.06,
95% CI [-0.12, -0.01]) and loneliness (pre-frail: -0.11, 95%
CI [-0.18, -0.07]; frail: -0.22, 95% CI [-0.32, -0.14]), indicat-
ing that frailty decreases MIL through reducing frequency of
social contact and increasing loneliness among older people.
These findings suggested that social contact and loneliness
contribute to older peoples MIL and that interventions can
target these two aspects of social connections to improve
MIL in pre-frail and frail older people.
TRANSITIONS ACROSS COGNITIVE STATES AMONG
OLDER ADULTS AND EDUCATION: AMULTI-STATE
SURVIVAL MODEL
A.Robitaille1, A.Van den Hout2, R.J.Machado2, I.Cukic3,
A.Koval1, J.Rijnhart4, J.Skoog5, G.Muniz3, 1. University
of Victoria, Markham, Ontario, Canada, 2. University
College London, London, United Kingdom, 3. University of
Edinburgh, Edinburgh, United Kingdom, 4. VU University
Medical Center, Amsterdam, Netherlands, 5. University of
Gothenburg, Gothenburg, Sweden
This study examines the role of educational attainment on
transitions in later life between cognitive states (i.e., normal
cognitive functioning, mild cognitive impairment, dementia)
and mortality and life-expectancies. Analysis of six inter-
national longitudinal studies was performed using a coor-
dinated approach. Multistate survival models were used to
estimate the transition patterns via different cognitive states
taking conditional life expectancies into account for each
transition pattern. Across most studies, a higher level of edu-
cation was associated with a lower risk of transitioning from
intact cognitive functioning to mild cognitive impairment,
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577
but not with any other transition. Those with higher levels of
education/socioeconomic status had longer non-cognitively
impaired life expectancies. Inconsistent results were found
for the role of education/socioeconomic status on overall life
expectancies. This study highlights the sustained importance
of education in later life and that early life circumstances
can delay later compromised cognitive health. This study
also demonstrates the feasibility and benefit in conducting
coordinated analysis across multiple longitudinal studies to
TRIGLYCERIDES AS AMODERATOR OF
ACCELERATED COGNITIVE LOSS PRIOR TO DEATH
AND DEMENTIA
V.Thorvaldsson, I.Skoog, B.Johansson, Goteborgs
Universitet, Gothenburg, Sweden
Cognitive aging is frequently characterized by accelerated
loss with an onset some years before death (terminal decline)
or dementia diagnosis (pre-clinical dementia). Recent evi-
dence suggest that an elevated level of serum triglycerides
may contribute to accumulation of cerebral amyloids (A)
and potentially also cognitive decline. We evaluated this
issue using data from the H70 study. The sample consisted
of 392 individuals, systematically selected from the general
population of 70 years-olds living in Gothenburg, Sweden,
born in 19011902, and repeatedly measured on three cog-
79, 81, 85, 88, 90, 92, 95, 97, 99, and 100, or until death.
Triglycerides levels were derived from blood samples taken
at age 70 and complete date of death was retrieved from
population register. Dementia diagnosis was made according
to DSM-III-R. We fitted several random change point, and
polynomial, quadratic mixed effects models to the data. Our
findings revealed no evidence that triglycerides levels moder-
ate the onset of the acceleration in either the terminal or the
pre-clinical dementia models. Elevated levels of triglycerides
were however consistently associated with poorer cognitive
performance and, against expectation, also with less steep
decline. When we compared the effect sizes to results using
serum total cholesterol as moderator we found that the
cognitive trajectory was more strongly associated with the
levels of triglycerides than total cholesterol. These findings
support the claim that triglycerides have a role in cognitive
aging but not to the degree that it moderates the onset of the
acceleration.
LONGITUDINAL RELATIONSHIP BETWEEN WORK-
FAMILY EXPERIENCES AND HEALTH AMONG
OLDER WORKERS
E.Cho2, T.Chen1, 1. Duke-NUS Medical School, Singapore,
Singapore, 2. Nanyang Technological University, Singapore,
Singapore
Although the workforce is aging rapidly, work-fam-
ily experiences among older workers are under-studied.
Using five waves of data from the Health and Retirement
Study, we investigated the impact of work-family experi-
ences work-family conflict (WFC; a form of inter-role
conflict that occurs when demands from the two domains
are incompatible) and work-family enhancement (WFE;
experiences in one domain are improved due to experi-
ences in another domain) on older workers health. Based
578
on the conservation of resources theory that posits losing
resources leads to negative outcomes, whereas obtain-
ing resources yields positive outcomes, we hypothesized
that WFC and WFE relate to negative and positive health
among older adults, respectively. WFC that occurs when
an individual has insufficient resources to deal with work
and family demands indicates loss of resources; WFE that
occurs when experience in one domain improves another
domain signals gain of resources. Data from 4509 workers
aged 55 years and older at baseline were analyzed using
growth curve modeling. As predicted, greater work-to-
family conflict related to poor health, while work-to-family
enhancement and family-to-work enhancement were asso-
ciated with better health over time, even after known pre-
dictors of health were controlled for (sex, education, race,
living arrangement, marital status, income). In sum, work-
family experiences are an important predictor of older
workers health, and continued monitoring of work-family
experiences among older workers is warranted. Because
health promotes successful aging at work and work-family
experiences are potentially modifiable, the current findings
are informative for policy makers and organizations that
are trying to retain older employees.
ITS LIKE ACYBER SECURITY BLANKET: THE Jersey, and West Virginia older adults had a significantly
UTILITY OF REMOTE MONITORING IN FAMILY
DEMENTIA CARE
J.E.Gaugler, L.Mitchell, C.Peterson, S.R.Rud, A.Cowl, fall injury (RR=1.57; 95%CI=1.451.69).
S.Trost, Center on Aging, School of Nursing, University of
Minnesota, Minneapoils, Minnesota
The prevalence and considerable challenges of dementia
raise concerns as to the sustainability of the United States
reliance on families to provide care to cognitively impaired
relatives in the community. Experts have proposed that
various technologies could substitute for or supplement
family caregiving. The objective of the current study was
to examine whether one of these technological approaches,
remote activity monitoring (RAM), was perceived as feasi-
ble and useful for family caregivers of persons with ADRD
living at home. As part of a larger, 5-year evaluation of the
efficacy of RAM, the current study utilized a parallel con-
vergent mixed methods design (QUAL + QUAN). Thirty
family caregivers of persons with dementia who have used
RAM for at least 6months were included. Empirical and
open-ended data on perceptions of system acceptability
and utility were examined at 6, 12, and 18months follow-
ing enrollment; correlations, thematic analysis, and a case
oriented merged analysis were utilized. Overall empirical
ratings of RAM utility and acceptability were moderate at
6months. Qualitative themes identified included fit, adjust-
ment period, benefits, and drawbacks/recommendations.
The case oriented merged analysis suggested consider-
able patterns of adaptation to RAM over time. The mixed
methods findings imply that caregivers perceived RAM as
moderately useful, but also that positive adaptation to the
technology took place over time. For systems such as RAM
to operate effectively in home settings, human guidance
and support is necessary for adaptation to take place and
allow such technology to successfully support persons with
dementia and their family caregivers.
Innovation in Aging, 2017, Vol. 1, No. S1
DO DEMOGRAPHICS AND HEALTH STATUS EXPLAIN
OLDER ADULT FALL VARIATION BY STATE?
G.Bergen, E.Burns, M.R.Stevens, E.Parker, Centers for
Disease Control and Prevention, Atlanta, Georgia
The percent of older adult falls in 2014 ranged from 21%
in Hawaii to 34% in Arkansas and fall injuries from 7% in
Hawaii to 13% in Missouri. It is unknown if demograph-
ics, health conditions or the urban rural/status of residence
explain the variation. This study conducted multivariable
analyses to understand variation in fall and fall injury risk
by area of residence.
Data from the 2014 Behavioral Risk Factor Surveillance
Summary for adults aged 65 and older were analyzed. State-
specific crude and adjusted risk ratios were produced for
dependent variables (falls, fall injuries), and by urban/rural
status controlling for demographics (e.g. age, race/ethnicity)
and health conditions (e.g. depression, diabetes). Urban/rural
status was determined by dichotomizing the Rural-Urban
Continuum Code for the subjects county of residence.
Older adults in rural areas had a significantly higher
adjusted risk of falling (RR=1.09; 95%CI=1.051.12) com-
pared with those in urban areas with no significant differ-
ence for fall injury. Older adults in Alaska, Arkansas, D.C.,
Michigan and Maryland had a significantly higher adjusted
falls risk compared to the national average. In Florida, New
lower adjusted risk. Reporting depression was the strongest
adjusted risk for a fall (RR=1.46; 95%CI=1.401.52) and a
Information on how older adult falls vary by residence
can help guide prevention strategies. Rural adults may have
less access to falls screening, assessment, and treatment; this
study demonstrates the need for falls prevention in rural
areas.
COLLABORATIVE CREATION OF CULTURALLY
APPROPRIATE DEMENTIA EDUCATION MATERIALS
FOR NATIVE PEOPLE
C.Carrico1, T.Anastasia1, C.McKibbin1, J.Lewis2, 1.
University of Wyoming, Laramie, Wyoming, 2. Alzheimers
Association, Cheyenne, Wyoming
Little is known about the prevalence of dementia among
American Indians and Alaska Natives (Jervis et al., 2006).
Given that diabetes is a risk factor for dementia and this
condition is highly prevalent among American Indian popu-
lations, it is believed that American Indian elders, like the
general population, would benefit from education to increase
recognition of cognitive loss. The Wind River Reservation,
home to the Northern Arapahoe and Eastern Shoshone peo-
ple, is located in the central-western portion of Wyoming.
The Wyoming Center on Aging in collaboration with tribal
health entities embarked on a multi-step process to create
culturally appropriate education materials to increase the
awareness and recognition of cognitive loss among American
Indians.
Methodology: The methodology for this process included
a review of available dementia education materials for native
people, followed by multiple focus groups and interviews
with key informants to develop a rich understanding of lan-
guage used by native elders about cognitive loss and to iden-
tify appropriate images.
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Innovation in Aging, 2017, Vol. 1, No. S1
Results: Focus groups related the need for messages to be
portrayed using native imagery (stories told with animals;
use of specific shapes and colors), in keeping with oral his-
tory traditions, and the importance of brief text and easily
understood words, rather than lengthy narratives. Specific
images related to cognitive loss were identified.
This presentation will share the results of these focus
groups, examples of the education products created, as well
as detailed information about the methodology utilized,
which has the potential to inform the work of many working
with indigenous people.
HOW ELDERLY JAPANESE MAKE ADECISION ON
WHAT CARE SERVICE TO CHOOSE
T.Taga1,2, S.Matsubayashi3, 1. Waseda Univ., Tokorozawa,
Japan, 2. NPO Center for Dementia Prevention, Tokyo,
Japan, 3. Fuji Care Management Center, Tsurugashima,
Japan
The long-term care insurance system formally requires
clients to sign their care plans in person because they are
contracts between a client and a care manager. But when
elderly Japanese decide what care services to choose, many
of them prefer to make agreements with the involvement of
family members. The author therefore questions whether
elderly Japanese prefer to make decisions with their fam-
ily members, and asks how much family caregivers inter-
vened in elderlies care-service decision-making. Interviews
were conducted from December 2016 to January 2017 in
cities around Tokyo. Sixteen elderly people who were using
long-term care insurance services at home and fifteen family
caregivers were interviewed. Half of the interviewees were
mothers and daughters. The others were married, half of
whom were husbands in care.
Result show that most interviewees in care routinely got
agreement with their family caregivers about service plans.
When family caregivers intervened in their decision-making,
it was because it restricted family members daily lives. The
intervention tended to be stronger if elderlies in care were
more depended on caregivers. Care managers took an infor-
mal role, by mediating between elderlies in care and family
members. Disability since childhood and the care profession
were excepted.
The findings suggest that care plan formats should have
signature blanks for both a client and family members
involved. From the perspective of sociopsychology, such
Japanese decision-making is consistent with the concept of
the interdependent self (Markus & Kitayama, 1991). The
concept may be applicable to east and south-east Asian elder-
lies in care.
DOES PHYSICAL FUNCTIONING DECLINE AFTER
RETIREMENT? ALONGITUDINAL INVESTIGATION
FROM 2006 TO 2016
A.Szabo, J.Allen, C.Stephens, F.Alpass, School of consuming a 10 percent protein diet performed significantly
Psychology, Massey University, Wellington, New Zealand
The impact of retirement on physical health is an impor-
tant focus of ageing research. However, research findings
are inconclusive. To understand for whom and under what
conditions retirement presents health benefits, the pre-
sent study investigated physical functioning pre- and post-
retirement. Using 10-year longitudinal data from the New
IAGG 2017 World Congress
579
Zealand Health, Work, & Retirement Study, multiple linear
trajectories of physical functioning were estimated. Growth
mixture analysis indicated three distinct trajectory profiles.
Profile 1 displayed good physical functioning at baseline,
which steeply declined until retirement, and continued to
decline post-retirement but at a slower rate. Profile 2 was
characterized by poor and declining physical functioning
pre-retirement. Post-retirement, however, this group reported
improvements in physical functioning. Finally, profile 3 dis-
played good and stable physical functioning pre-retirement
and a slow decline post-retirement. Significant differences
were identified across profiles in socio-demographic vari-
ables. Participants in Profile 1 had the lowest qualification
level, medium SES and the highest retirement age. Profile 2
consisted of physical labourers who had a very low SES and
numerous chronic illnesses. Members of Profile 3 were highly
educated individuals with high SES and a professional occu-
pation prior to retiring. Economic living standards increased
post-retirement in all groups. However, the increase in Profile
2 was twice as large compared to the other two groups - an
effect that could be attributed to New Zealands universal
superannuation. In sum, findings indicate that retirement is
beneficial for those with poor health and limited resources.
For the wealthy and healthy, retirement does not necessarily
present health advantages.
A LOW PROTEIN, HIGH CARBOHYDRATE DIET
ATTENUATES BRAIN AGING AND IMPROVES
SPATIAL MEMORY IN MICE
D.Wahl1, V.Cogger1, R.de Cabo2, S.Biet1, S.Simpson1,
D.G.Le Couteur1, 1. Charles Perkins Centre, University of
Sydney, Sydney, New South Wales, Australia, 2. National
Institute on Aging, Baltimore, Maryland
Major discoveries in the understanding aging biology
have been made, particularly by studying calorie restriction
(CR) and intermittent fasting (IF), which remain the most
robust non-genetic interventions to improve healthspan and
lifespan in animal models. Additionally, CR and IF attenuate
symptoms of brain aging in animal models. Recent studies
have shown that low-protein, high-carbohydrate (LPHC)
diets are optimal for lifespan in ad libitum fed animals.
Furthermore, there is evidence that branch-chained amino
acids (BCAA) mediate the effects between diet, longevity,
and healthspan. While a clear link between macronutrient
ratios and healthspan has been ascertained, little is known
about their role in brain health. Therefore, 9 cohorts of male
and female mice were placed on one of 9 diets differing in
protein, BCAA, and carbohydrate ratios. Two cohorts of
mice were also placed on a 20% CR diet or a 20% CR diet
with added BCAA. Barnes maze and novel object recognition
(NOR) tests were performed at 13 and 21 months of age
on the same mice in order to determine spatial and visual
memory performance. Preliminary results revealed that mice
better on spatial memory tests than the other AL groups.
Initial RNA sequencing data on hippocampus revealed clear
genetic expression changes among diet groups. Future work
will focus on protein expression levels, immunofluorescence,
and biochemical enzyme assays in order to determine the
effects of macronutrient ratios on hippocampus plasticity,
vasculature, and inflammation.
580
RESTORING YOUTHFUL CELLULAR IMMUNITY BY
REJUVENATION OF AGED HEMATOPOIETIC STEM
CELLS
H.Leins1,2,3, M.Denkinger2,5, R.Schirmbeck3, H.Geiger1,4, anterior (TA) tissue weights were unchanged. In summary,
1. Institute for Molecular Medicine, Ulm, Germany, 2.
AGAPLESION Bethesda Clinic, Geriatric Research Unit,
Ulm, Germany, 3. Internal Medicine I, Ulm, Germany, 4.
Experimental Hematology and Cancer Biology, Cincinnati
Childrens Hospital Medical Center, Cincinnati, Ohio, 5.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany
Aging-associated remodeling of the immune system
results in its decreased functionality. Most prominent in man
and mice is a significant reduction of nave CD8 T cells in
old individuals, accompanied by a decreased responsiveness
to infection or vaccination. Aging of hematopoietic stem cells
(HSCs) could be a crucial factor in the age-associated immune
remodeling, as old HSC inefficiently produce lymphoid pro-
genitor cells. In vitro inhibition of the Cdc42 Rho-GTPase
activity in aged HSCs with the pharmacological compound
CASIN led to their sustained morphological rejuvenation.
In this study, we ask if and how old HSCs directly affect
the remodeling of the old immune system and whether
CASIN-mediated rejuvenation of aged HSCs contributes to
restoring the functionality of an aged immune system. To
analyze this, young, old and rejuvenated old HSCs (isolated
from immune-competent young or old B6.SJL mice) were
transplanted into T- and B- cell deficient young RAG1-/-
mice. Three months after transplantation, the immune sys-
tem developed from young and CASIN-treated old HSCs
was comparable to a youthful immune system, whereas old
HSCs reconstituted an aged-like immune system as is indi-
cated e.g., by appropriate proportions of nave CD8+ T or
regulatory Foxp3+ CD4+ Treg cells. Most interestingly, the
immune system developed from CASIN-treated old, but not
from old HSCs efficiently respond to vaccination, thus we
could restore de novo priming of HBV-core-specific effector
CD8+ T cell responses. Rejuvenation of old HSCs is there-
fore an attractive strategy to manipulate the age-associated
remodeling of the immune system and to restore its immune
competence.
EXACERBATED AGE-RELATED OBESITY IS
TEMPERED BY RENIN ANGIOTENSIN SYSTEM
E.Bruce, C.S.Carter, Y.Sakarya, H.Z.Toklu, D.Morgan, Interestingly, for the overall lignan predictor, higher lignans
P.J.Scarpace, N.Tumer, University of Florida, Gainesville,
Florida
Diet-induced obesity is exacerbated in senescent com-
pared with young rats in terms of both high-fat (HF) induced
weight gain and increased food consumption resulting in
metabolic abnormalities, contributing to multiple age-related
diseases (diabetes, cardiovascular dysfunction, hypertension).
We previously reported that activation of angiotensin con-
verting enzyme-2 (ACE2), via diminazene aceturate (DIZE)
reduces body weight in HF-fed young rats. We hypothesized
that DIZE would temper or prevent the exacerbated diet-
induced obesity observed in 24-month HF-fed F344xBN
male rats. All senescent rats were HF-fed (60%) for 10days,
during which they consumed two-fold greater kcal and
gained 484g relative to baseline. Rats were then given M.Maruyama1,2, K.Jounai3,1,4, A.Sakamoto1, Y.Morita3,1,
7.5mg/kg/day DIZE s.c. or vehicle (n=6/group) for 26days.
DIZE reduced cumulative food consumption by 21% and
Innovation in Aging, 2017, Vol. 1, No. S1
body weight by 4113g compared to senescent controls over
the treatment period. Adiposity (TDNMR and tissue weight)
was diminished by 22%, whereas brown adipose and tibialis
DIZE treatment resulted in a significant reduction in age-
related diet-induced obesity in HF-fed senescent rats with no
noticeable adverse effects. Our data suggest that DIZE has
potential in the treatment of age-related diet-induced obesity
without negatively impacting skeletal muscle mass, an addi-
tional important outcome for preserving metabolic function.
Future studies may provide insight as to the mechanisms of
these effects, potentially targeting ACE2-mediated increases
in angiotensin (17) acting through the Mas receptor. This
is a known pathway for reducing inflammation, oxidative
damage, mitochondrial function, all essential elements that
contribute to age-related metabolic diseases.
GENDER DIFFERENCES IN PHYTOESTROGEN
INTAKE AND SPEED OF PROCESSING
PERFORMANCE IN OLDER ADULTS
J.Alwerdt, M.Sliwinski, A.D.Patterson, The Pennsylvania
State University, University City, Pennsylvania
Phytoestrogen consumption mimics estrogen in the body,
albeit to a much smaller scale, and therefore represent a
potential dietary intervention to supplement estrogen loss
or hormonal changes. Additionally, studies have reported
that phytoestrogens may benefit cognitive health, although
this may differ among males and females in older adults
due to differences in absorption, hormones, and age-related
changes. In the current study, urinary phytoestrogen con-
centrations (covariate-adjusted standardized for urinary
creatinine) and gender were used as predictors to examine
differences in relation to speed of processing (SOP) measured
by the Digit Symbol Substitution Test (DSS). Participants
were drawn from The National Health and Nutrition
Examination Survey (NHANES 19992002) and consisted
of 354 individuals ranging from 65 to 85years old. Amul-
tiple regression analysis included covariates; age, BMI, race,
education, smoking, socioeconomic status, and urinary cre-
atinine. Among the individual phytoestrogens, genistein
demonstrated significant gender differences relating to SOP.
Females scored higher on the DSS with increased amounts
of genistein while demonstrating the opposite for males.
were associated with better SOP performance in males but
lower SOP performance in females. Overall, females scored
higher on the DSS compared to males regardless of the num-
ber of phytoestrogens. Results suggest that there are signifi-
cant gender differences in both the predictors of genistein
and lignan consumption. Both yielded different associations
demonstrating the potential impact that specific phytoestro-
gens may have on cognitive aging depending on gender. To
become a viable intervention, further research on these gen-
der differences are needed.
A NOVEL FOOD CONSTITUENT POTENTIALLY
MITIGATES INFLAMMATION IN PHYSIOLOGICALLY
AGED MICE
T.Kirisako3,1, T.Matsuda1, D.Fujiwara3, 1. National Center
for Geriatrics and Gerontology, Obu, Japan, 2. Nagoya
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
University Graduate School of Medicine, Nagoya, Japan, 3.
Kirin Co. Ltd., Yokohama, Japan, 4. Koiwai Dairy Products
Co. Ltd., Tokyo, Japan
Defective immune functions are key triggers of incidence
and prevalence of age-related diseases, including infectious
diseases and tumors. Previous works have reported that
some food materials or constituents, for instance, prebiotics
and probiotics, can improve immune defects; however, mech-
anistic linkages remain poorly understood. In this study, we
demonstrate that our novel food constituent X may mitigate
the age-related inflammatory phenotypes in various tissues,
which is probably associated with the serum levels of pro-
inflammatory cytokines. C57BL/6 mice at the ages of 16
(n = 45 mice) or 11 months (n = 20) were used as physi-
ologically aged mice. The serum levels of pro-inflammatory
cytokines, including interleukin-1 and interleukin-6, in
aged mice were higher than those in 1-month-old young
mice (n = 30). Correspondingly, inflammatory phenotypes
were observed in various peripheral tissues of aged mice.
Interestingly, serum levels of these cytokines were reduced by
oral administration of X into aged mice for 6months, which
was seemingly responsible for suppression of the age-related
inflammatory phenotypes in peripheral tissues. These results
suggest that some food materials or constituents may poten-
tially mitigate the age-related physiological defects through
regulation of pro-inflammatory cytokines.
4-HNE-INDUCED INNATE IMMUNE RESPONSES
INFLUENCE ANTI-CARCINOGENESIS IN ROS-
OVERPRODUCED MODEL MICE
T.Ishii1,5, S.Asari1, K.Sugita1,2, K.Yasuda1,3, Y.Yamamoto2,
P.Hartman4, N.Ishii1, 1. Department of Molecular
Life Science, Tokai University School of Medicine,
Isehara, Kanagawa, Japan, 2. School of Bioscience and
Biotechnology, Tokyo University of Technology, Hachioji,
Tokyo, Japan, 3. Education and Research Support Center,
Tokai University, Isehara, Kanagawa, Japan, 4. Department
of Biology, Texas Christian University, Fort Worth, Texas,
5. Institute of Medical Sciences, Tokai University, Isehara,
Kanagawa, Japan
Mitochondrial reactive oxygen species (ROS) which are
mainly generated as an uncoupled consequence of electron
transport cause the cellular and organismal oxidative stress.
It has been previously demonstrated that the excessive mito-
chondrial ROS production caused by mitochondrial complex
II SDHC mutation results in premature death in C.elegans
mev-1 mutant (G71E) and D. melanogaster mev-1-mimic
transgenic flies (I71E), and excessive apoptosis and tumo-
rigenesis in mouse embryonic fibroblast SDHC E69 cells
(V69E) (M. Tsuda, etal. BBRC 2007, T.Ishii, etal. Cancer
Res. 2005, N.Ishii, etal. Nature 1998).
In humans, it has been reported that some mutations in
SDHB, SDHC or SDHD often result in hereditary and/or
sporadic paragangliomas, gastrointestinal stromal tumors
and pheochromocytomas (T. Ishii, etal. BBA 2013). Recently,
Tet-mev-1 conditional transgenic mice have been established
using our uniquely developed Tet-On/Off system, which can
induce the mutated SDHC (V69E) coding gene to be equally
and competitively expressed compared to the endogenous
wild-type SDHC gene. The Tet-mev-1 mice experienced
intracellular oxidative stress by mitochondrial respiratory
IAGG 2017 World Congress
581
chain dysfunction developed low birth weight, growth retar-
dation, age-dependent corneal pathophysiological changes,
low fertility, recurrent miscarriage and age-dependently
disrupted memory consolidation with astrocyte defects (T.
Ishii, et al. Mitochondrion 2011; H. Onouchi, et al. IOVS
2012; Y.Uchino, etal. PLoS ONE 2012; T.Ishii, etal. Redox
Biology 2014; T.Ishii, etal. Aging Cell 2016)
Here, it has been demonstrated that lymphocyte accu-
mulation which is chronically activated with age influences
the anti-carcinogenesis of large-cell lung carcinoma with
oxidative stress in Tet-mev-1 mice. In aged Tet-mev-1 mice,
large-cell neoplastic cells were developed into the lympho-
cyte accumulation in lung. The lymphocytes which were
associated with T cell activation leading to innate immune
responses were initiated by -6 fatty acid peroxidation-
derived 4-hydroxy-2-nonenal (4-HNE). We propose that
the 4-HNE-induced innate immune responses which asso-
ciate with T cells involved in intraepithelial lymphocytes
(IELs) may initially prohibit the oxidative stress-developed
carcinoma.
PHYLOGENETIC GROUPS OF ESCHERICHIA COLI
TO DIAGNOSE URINARY TRACT INFECTION IN
GERIATRIC POPULATION
R.Amarsy1, D.Guret2,3, 1. hopital Lariboisire, Paris,
France, 2. Griatrique Dpartement, APHP Lariboisire
Hospital, Paris, France, 3. IAME- UMR 1137 Facult
Mdecine, Paris, France
Discrimination between urinary tract infection and uri-
nary colonization is a frequent and difficult problem in
geriatric population. E. coli is the most frequently isolated
pathogen in urine in this population. Of the 8 known phylo-
genetic groups in the species, groups B2 and D are the most
virulent and more frequently responsible for extra-intestinal
infections, particularly urinary tract infections. However,
there is no data on the distribution of these phylo-groups in
the geriatric population. We conducted a study that included
clinical data from the host and the phylogenetic group of
E. coli to find criteria to differentiate infection and coloni-
zation. All E.coli-positive urine analysis from patients over
75 years of age and hospitalized at the Lariboisire hospi-
tal from 15 February to 15 May 2016 were included. The
virulent phylogenetic groups (B2 and D) of E.coli are signif-
icantly more frequent in infection than in colonization in ger-
iatric population (Odds Ratio: 3.05 (1.446.86), P=0.005).
However, to the bacterial virulence is added factors of fra-
gility of the host allowing the development of an infection,
such as the presence of altered autonomy (P <0.001), falls (p
<0.001), dementia (p=0.005), malnutrition (p=0.001) and
urinary pathology (p=0.002).
TRANSCRIPTIONAL PROFILING OF HUMAN
FEMORAL MESENCHYMAL STEM CELLS IN
OSTEOPOROSIS AND ADIPOGENESIS
Y.Chung, Y.Choi, Endocrinology, Ajou University School
of Medicine, Suwon, Korea (the Republic of)
Genetic alterations are major contributing factors in the
development of osteoporosis. Osteoblasts and adipocytes
share a common origin, mesenchymal stem cells (MSCs), and
their genetic determinants might be important in the relation-
ship between osteoporosis and obesity. In the present study,
582
we aimed to isolate differentially expressed genes (DEGs) in
osteoporosis and normal controls using human MSCs, and
elucidate the common pathways and genes related to osteo-
porosis and adipogenesis. Human MSCs were obtained from
the bone marrow of femurs from postmenopausal women
during orthopedic surgeries. RNA sequencing (RNA-seq)
was carried out using next-generation sequencing (NGS)
technology. DEGs were identified using RNA-seq data.
Ingenuity pathway analysis (IPA) was used to elucidate the
common pathway related to osteoporosis and adipogenesis.
Candidate genes for the common pathway were validated
with other independent osteoporosis and obese subjects
using RT-PCR (reverse transcription-polymerase chain reac-
tion) analysis. Fifty-three DEGs were identified between
postmenopausal osteoporosis patients and normal BMD
controls. Most of the genetic changes were related to the
differentiation of cells. The NR4A family was identified as
possible common genes related to osteogenesis and adipo-
genesis. The expression level of the mRNA of NR4A1 was
significantly higher in osteoporosis patients than in controls
(p=0.018). The expression level of the mRNA of NR4A2
was significantly higher in obese patients than in controls
(p=0.041). Some genetic changes in MSCs are involved in the
pathophysiology of osteoporosis. The NR4A family might
comprise common genes related to osteoporosis and obesity.
CHARACTERISTICS OF LATE-LIFE DEPRESSION
RELATED WITH THE RISK OF INCIDENT DEMENTIA
J.Park1,2, 1. Psychiatry, Seoul National University School of
Medicine, Seoul, Korea (the Republic of), 2. Seoul National
University Hospital, Seoul, Korea (the Republic of)
Objectives: The incidence rates and risk factors of demen-
tia and Alzheimers dementia were examined, with special
focus on the relationship between baseline depression and
incident dementia.
Methods: The present study assessed elderly individuals
who resided in a rural community in Korea. After the baseline
assessment (2008), there were two schedules for the follow-
up (2009 and 2013). Sociodemographics, lifestyle charac-
teristics, and clinical factors were examined; depression was
evaluated using the Geriatric Depression Scale, Short form
and cognitive diagnoses were determined by a psychiatrist
using the DSM-IV criteria. ACox proportional hazard model
was used to determine the risk factors for dementia and fac-
tor analysis was conducted to classify depressive symptoms.
Results: Among 751 subjects at the baseline, those who
were not diagnosed with dementia at baseline (N = 701)
were followed up with for a mean period of 5.5years. Atotal
of 483 subjects were assessed during this follow-up period
and 40 new cases of incident dementia (16.2 per 1000 PY)
were identified. Baseline depression was not related with the
risk of 5-year incident dementia. However, regarding the
characteristics of depression, higher persistence and severity
increased the incident dementia. Also, depression accompa-
nied with dysexecutive function and the low energy compo-
nent which may imply frontal lobe dysfunction increased the
incidence of dementia.
Conclusion: Different relationship between depression
and dementia according to different quantitative and quali-
tative characteristics of late-life depression suggest that the
Innovation in Aging, 2017, Vol. 1, No. S1
conversion process from depression to dementia may be the
various ones, not the same one.
MODULATION OF HSF-1 LEVELS BY HIGH
CHOLESTEROL AND ITS OXIDIZED PRODUCT
27-HYDROXYCHOLESTEROL
D.A.Jurivich, University of North Dakota, GF, North Dakota
Dietary intake may influence both aging and disease-
related genes that increase Alzheimers Disease risk. Some
diets may improve cognition and people highly adherent to
the Mediterranean diet experience less hippocampal atrophy
over time thAan those less adherent. Conversely, diets rich in
saturated free fatty acids (sFFA) may increase AD risk. The
mechanism of fat induced neurodegeneration includes neu-
roinflammation blood-brain barrier (BBB) disruption, phos-
phorylated Tau, and proteotoxicity. Thus, diets may either
promote or delay aging and AD.
We examined the expression of the longevity and stress
factor, Heat shock transcription factor 1 (HSF1), in a cho-
lesterol fed rabbit model of AD. In this model, we found
that both the mRNA levels and the protein distribution of
HSF1 are significantly decreased in rabbit hippocampi rela-
tive to age matched controls. Because 27-OHC levels are
elevated by hypercholesterolemia, aging and oxidative stress,
we examined in vitro effects of 27-OHC on astrocytes and
found dramatic reductions in HSF1 protein levels in the
absence of cell death.
Collectively, our results suggest that high cholesterol diets
and its oxidized metabolites such as 27-OHC negatively
impact a key longevity and cell protection factor, HSF1.
Dysregulation of HSF1 by cholesterol and/or its oxidative
by-products appears to be at the mRNA or transcriptional
level, suggesting a heretofore unknown mechanism of HSF1
regulation. Because disturbances in cholesterol metabolism,
oxidative stress, and aging are all risk factors for AD, our
results provide new information that disruption of HSF1 may
be a key link by which these factors lead to AD progression.
ABUNDANT NON-PLEIOTROPIC AND PLEIOTROPIC
ASSOCIATIONS WITH AGE-RELATED TRAITS IN
AMODEST SAMPLE
Y.Loika, L.He, J.Huang, K.Arbeev, I.Culminskaya,
A.I.Yashin, A.Kulminski, Social Science Research Institute,
Duke University, Durham, North Carolina
Genome-wide association studies (GWAS) are tradition-
ally based on principles of medical genetics. This strategy
is well adapted for Mendelian disorders. Genetics of phe-
notypes that leave human organisms vulnerable to diseases
in late life (called age-related phenotypes) is, however, more
complex. The fundamental complicating factor is the elusive
role of evolution in fixing molecular mechanism of these phe-
notypes. This complexity implies a special type of an inherent
genetic heterogeneity reflecting sensitivity of genetic associa-
tions with age-related phenotypes to the life course of indi-
viduals in different environments. Here we follow a two-stage
genome-wide approach that leverages this heterogeneity. This
approach is demonstrated by examining non-pleiotropic and
pleiotropic genetic predisposition to 24 age-related pheno-
types (16 biomarkers, 7 diseases, and death) in a modest
sample (N=26,371) from five studies (ARIC, FHS, MESA,
CHS, and CARDIA) from the Candidate Gene Association
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Resource. In Stage 1, we performed the traditional univariate
GWAS for each of 24 phenotypes improved by leveraging
information from longitudinal follow up in each study sepa-
rately. In Stage 2, we used Fishers and two omnibus tests to
combine statistics from Stage 1 leveraging different types of
heterogeneity. Our analyses replicated 212 SNPs in 49 loci at
genome-wide level and identified 53 novel or firstly attained
genome-wide significance non-pleiotropic SNPs in 49 loci
and 202 pleiotropic SNPs in 154 loci in a modest sample
(all loci exclude the Major Histocompatibility Complex).
Our findings demonstrate benefits of more comprehensive
approaches than the currently prevailing ones to gain insights
into the genetics of healthspan and lifespan.
APATHY, NEUROCOGNITION AND FUNCTIONAL
BRAIN CONNECTIVITY IN AMNESTIC MILD
COGNITIVE IMPAIRMENT
A.Aleman, S.Tumati, T.Setiadi, F.Reesink, P.De A(TFAM)] and mitochondrial antioxidant enzyme superox-
Deyn, E.Opmeer, University of Groningen, Groningen,
Netherlands
Amnestic mild cognitive impairment (aMCI) precedes
Alzheimers Disease (AD) and is associated with brain
changes such as reduced gray matter of medial-temporal
lobe areas and hypoperfusion in frontal and occipital areas.
Apathy in MCI is a risk factor for more rapid conversion to
AD. The cognitive and neural basis of apathy in MCI remain
to be elucidated, however. Here, we investigated neurocogni-
tive correlates using standard neuropsychological tests and
functional brain connectivity using resting state BOLD fMRI.
Thirty-one patients with aMCI and 20 healthy con-
trols (HC) were assessed with resting state fMRI. Apathy
was assessed with the AES and neuropsychological assess-
ment included memory, processing speed and executive
functioning.
There were significant associations between AES and two
neuropsychological measures: time to complete Stroop A(r=
.55, p= .002) and performance on Digit symbol substitu-
tion (r= -.40, p= .039). There were no associations with the
other cognitive measures. Moreover, apathy was related to
decreased connectivity between the salience network (SN)
and default mode (DMN) networks and increased connectiv-
ity between two SN components (one including mostly dor-
sal anterior cingulate cortex [dACC] and the other mostly
the insula).
In conclusion, higher levels of apathy were associated with
slower processing speed, but not with memory or executive
functioning. Thus, reduced processing speed may specifically
affect the ability to select, initiate and execute goal-directed
behavior. The association of apathy with aberrant SN con-
nectivity can be understood from the role of salience evalua-
tion as an important component for goal-directed behavior.
LATE-LIFE ENALAPRIL ADMINISTRATION AFFECTS
MITOCHONDRIAL BIOGENESIS IN THE HEART OF
OLD RATS
A.Picca1, V.Pesce2, G.Sirago2, R.Calvani1, A.Lezza2, tial confounders, current smoking was only associated with
E.Marzetti1, 1. Department of Geriatrics, Neurosciences
and Orthopedics, Catholic University of the Sacred Heart
School of Medicine, Teaching Hospital Agostino Gemelli,
Rome, Italy, 2. Department of Biosciences, Biotechnologies
and Biopharmaceutics, University of Bari, Bari, Italy
IAGG 2017 World Congress
583
Inhibition of the renin-angiotensin system has been
shown to ameliorate age-related mitochondrial alterations
in several rat tissues and to increase rodent lifespan. Here,
we investigated the effect of late-life enalapril administra-
tion on mitochondria biogenesis, antioxidant enzymes con-
tent and mtDNA levels in rat hearts and sought to discern
the effects of enalapril mediated by nitric oxide (NO) from
those independent from NO signaling. Fischer 344Brown
Norway rats were randomly assigned to receive enalapril
(n=4), the NO synthase (NOS) inhibitor NG-nitro-L-arginine
methylester (L-NAME; n=4), enalapril + L-NAME (n=4),
or placebo (n=4) from 24 to 27 months of age. Enalapril
in combination or not with L-NAME induced a marked
increase in mitochondrial DNA content. Accordingly, a
higher content of mitochondrial biogenesis proteins [i.e., per-
oxisome proliferator-activated receptor gamma coactivator
1-alpha (PGC-1), and mitochondrial transcription factor
ide dismutase 2 (SOD2) protein have been observed in the
same two groups. Our data indicate that enalapril enhances
mitochondrial biogenesis in the heart of aged rats as a result
of a concerted modulation of NO and angiotensin II signal-
ing. As both mtDNA content and mitochondrial biogenesis
are crucial for preserving cellular respiratory capacity, and
PGC-1 is protective against ROS production and oxidative
damage, our results support the hypothesis that the beneficial
effect of enalapril on the heart is mediated at least partly by
mitigation of oxidative stress.
INCREASED TRABECULAR AND CORTICAL BONE
LOSS IN CURRENT OLDER ADULT SMOKERS: THE
AGES-REYKJAVIK STUDY
E.A.Marques1, M.Elbejjani1, V.Gudnason2, T.Lang3,
G.Sigurdsson2, L.J.Launer1, G.Eiriksdottir2, T.Harris1,
1. Laboratory of Epidemiology and Population Sciences,
National Institute on Aging - National Institute of Health,
Bethesda, Maryland, 2. Icelandic Heart Association
Research Institute, Kpavogur, Iceland, 3. Department
of Radiology and Biomedical Imaging, University of
California, San Francisco, California
Previous studies have reported that smoking is associated
with reduced bone mass in older adults, but no longitudinal
studies have addressed the relationship of smoking behav-
ior and compartmental measures of volumetric bone mineral
density (vBMD).
This study aimed to explore the cross-sectional and longi-
tudinal relationships of several indicators of cigarette smok-
ing (smoking status, pack-years, age of onset and smoking
cessation) with QCT-derived proximal femur bone measures
(trabecular vBMD, integral vBMD and the ratio of cortical to
total tissue volume (cvol/ivol)) and with subsequent change
in these measures over the next five years, in a population-
based cohort of 2633 older adults (55.9% women), aged
6692years.
In multiple linear regression adjusting for several poten-
lower cvol/ivol at baseline, whereas former smoking was
associated with lower trabecular vBMD, integral vBMD and
cvol/ivol. Analyses of change in bone measures revealed that
compared to never-smokers, current smokers had signifi-
cantly greater loss of trabecular vBMD, integral vBMD and
584
cvol/ivol. Full-adjusted models included sex, age, education,
BMI, Creatinine, high-sensitive C-Reactive Protein, coronary
artery calcium score, % weight change from age 50, 25OHD,
physical activity, diabetes, arthritis, and respiratory diseases.
Among former smokers, longer duration since cessation was
related to better bone health at baseline, especially for inte-
gral vBMD and cvol/ivol. Pack-years was associated with
lower cvol/ivol.
In conclusion, smoking has a differential association with
bone health assessed with QCT. Results suggest that, current
smoking, but not former smoking, at older age may aggra-
vate the rate of bone loss.
PATHWAYS ENRICHMENT AND AGE-RELATED
PHENOTYPES: NON-PLEIOTROPIC SNPS VERSUS
PLEIOTROPIC SNPS
I.Kulminskaya, Y.Loika, J.Huang, K.Arbeev, O.Bagley, tion of ROS level which was investigated by MitoSOX Red,
A.I.Yashin, A.Kulminski, Duke University, Durham, North
Carolina
Genetics of age-related diseases is complicated by the elu-
sive role of evolution in fixing molecular mechanism of these
phenotypes. This complexity implies an inherent genetic het-
erogeneity reflecting sensitivity of genetic associations to the
life course. We used the results of a comprehensive analy-
sis of genetic predisposition to 24 age-related phenotypes
(16 biomarkers, 7 diseases, and death) in a modest sample
(N=26,371) from five studies (ARIC, FHS, MESA, CHS, and
CARDIA) from the Candidate Gene Association Resource,
which leveraged this genetic heterogeneity. For bioinformatics
analysis (IPA) we selected 50 non-pleiotropic SNPs (mapped
to 50 genes), which attained genome-wide significance with
albumin in urine, and 122 pleiotropic SNPs (mapped to 99
genes), which attained genome-wide significance by combin-
ing statistics for 16 biomarkers. Five canonical pathways were
genes enriched for non-pleiotropic SNPs at pBH<103 after
Benjamini-Hochberg correction: Epithelial adherens junction
signaling, Hepatic fibrosis, Colorectal cancer metastasis sign-
aling, Molecular mechanisms of cancer, and STAT3 pathway.
Top high-level disease categories for these genes (pBH<108)
included cancer, organismal injury/abnormality, reproductive
system disease, cardiovascular disease (CVD), and respira-
tory disease. All these categories except CVD included cancers
at multiple sites. For the set of pleiotropic genes, we identi-
fied enrichment in two pathways at pBH<103: Leukocyte
extravasation signaling and IL-8 signaling. Accordingly, the
strongest gene enrichment (pBH<1012) for the disease cate-
gory was for inflammatory response. Our findings suggest that
genes for highly pleiotropic SNPs are likely involved in funda-
mental pathways associated with regulation of inflammation
as a risk factor for various chronic illnesses. Non-pleiotropic
variants likely indicate disease-specific pathways.
UNDERSTANDING AGE-RELATED EFFECTS IN
INTESTINAL EPITHELIUM
U.K.Kar, J.Laryea, W.Mustain, J.Mizell, M.Hauer-Jensen, gia is videofleuroscopy, no consensus regarding what the best
D.Zhou, Pharmaceutical Sciences, UAMS, Little Rock,
Arkansas
Ageing leads to a progressive deterioration of structure
and function of all organs over the time. The progressive
accumulation of senescent cells and impairment of Stem
Innovation in Aging, 2017, Vol. 1, No. S1
Cells i.e. decline in their ability to maintain homoeostasis is
well known in aging. Intestinal homeostasis is regulated by
proliferation and differentiation of cycling intestinal stem
cells (ISCs). The ISCs are nested within a niche consisting of
a wide variety of cell types including immune cells, mesen-
chymal fibroblasts & myofibroblasts, and endothelial cells.
Niche-generated signals work in concert with intrinsic stem
cell properties to regulate the stem cell behavior. Senescence of
endothelial cells leading to impairment in vascular function-
ality and neo-angiogenic capability is well documented. In
this study we investigated the biological changes to endothe-
lial cells transformed to senescence by irradiation. HUVEC
Cells were exposed to various doses of irradiation i.e. 2Gy
to 10Gy. The induction of senescence was noted by BrdU
incorporation and senescence-associated galactosidase
(SA-gal) staining. Induction of senescence led to upregula-
peroxidized lipid sensor BODIPY and superoxide anion radi-
cals (DHE MFI). Interestingly these senescent cells also dis-
played components of DNA damage response (DDR) which
was revealed by H2AX detection assay. Our long-term goal
is to investigate whether these senescent endothelial cells can
affect the growth of ISCs using the Ex-Vivo 3D organoid
culture and 2D co-culture methods.
INNOVATION IN PARKINSONS DISEASE
ASSOCIATED DYSPHAGIA IN OLDER ADULTS: AN
INTEGRATIVE REVIEW
C.Edwards, K.Rose, Nursing, University of Oklahoma
Health Science Center, Yukon, Oklahoma
Parkinsons Disease (PD) is the second most common
neurodegenerative disorder in the United States with aspira-
tion pneumonia being a leading cause of hospital admission
and death. Dysphagia is present in most individuals with PD
and significantly increases risk of negative health outcomes,
including death. The purpose of this review was to estab-
lish the state of the science regarding Parkinsons Disease-
associated dysphagia (PD-D). PUBMED, MEDLINE, and
CINHAL were searched through 2016 using MeSh terms
Parkinson(s), dysphagia, swallowing, deglutition,
elderly aged geriatric, cancer, and surgery. All
primary articles written in English, involving individuals
diagnosed with PD-D, and containing pathophysiology, fre-
quency, diagnosis / assessment, treatments, or consequences
were included. Articles pertaining to surgical-, medication-,
intubation-, radiation-, or oncology-induced dysphagia were
excluded, leaving 114 articles. Content were analyzed and
divided into the following categories: dysphagia descrip-
tive factors and pathophysiology, diagnosis and assessment,
treatments, and consequences of PD-D. Within each category,
findings were analyzed based on current knowledge and
implications for future research. Pathophysiology of PD-D
is not well understood and this limits targets for potential
interventions. While the gold standard assessment of dyspha-
practice assessment is available. Although there are many
treatments available, skill retention and further innovation
of treatments are warranted. It is generally accepted that
PD-D has effects on ones physical and mental health, yet
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
lived experiences of those with PD-D and their caregivers are
not fully understood.
GAINING INSIGHT TO THE UNDERLYING NEURAL
MECHANISMS BY WHICH EXERCISE IMPROVES
MOBILITY
C.Hsu1,3, J.Best1,3, S.Wang1,3, M.Voss2, R.G.Hsiung1, is more accepted by family caregivers, as they held more
M.Munkacsy3, T.Handy1, T.Liu-Ambrose1,3, 1.
Rehabilitation Science, University of British Columbia,
Vancouver, British Columbia, Canada, 2. University of
Iowa, Iowa City, Iowa, 3. Aging, Mobility, and Cognitive
Neuroscience Lab, Vancouver, British Columbia, Canada
Impaired mobility is a major concern for older adults and
has significant consequences. While the widely accepted belief
is that improved physical function underlies the effective-
ness of targeted exercise training in improving mobility and
reducing falls, recent evidence suggests cognitive and neural
benefits gained through exercise may also play an important
role in promoting mobility. However, the underlying neural
mechanisms of this relationship are currently unclear. Thus,
our main objective was to investigate whether six months
of progressive aerobic exercise training alters frontoparietal
network (FPN) connectivity during a motor task among
older adults at risk for mobility disability individuals with
mild subcortical ischemic vascular cognitive impairment
(SIVCI)and whether exercise-induced changes in FPN con-
nectivity correlate with concurrent changes in mobility. We
focused on the FPN as it is involved in top-down attentional
control as well as motor planning and motor execution.
Participants were randomized either to usual-care (CON)
or thrice-weekly aerobic training (AT). Functional mag-
netic resonance imaging was acquired at baseline and trial
completion. At trial completion, compared with AT, CON
showed significantly increased FPN connectivity strength
during right finger tapping (p<0.05). Across the participants,
reduced FPN connectivity was associated with greater car-
diovascular capacity (p=0.05). In the AT group, reduced
FPN connectivity was significantly associated with improved
mobility performance, as measured by the Timed-Up-and-Go
test (r=0.67, p=0.02). These results suggest progressive aero-
bic training may improve mobility in older adults with SIVCI
via maintaining intra-network connectivity of the FPN.
PROFESSIONAL AND FAMILY CAREGIVERS VIEWS
ON INVOLUNTARY TREATMENT USE IN PEOPLE
WITH DEMENTIA
A.M.Mengelers1, M.H.Bleijlevens1, H.Verbeek1,
E.A.Capezuti2, J.Hamers1, 1. Maastricht University,
Maastricht, Maastricht, Netherlands, 2. Hunter College of
City University of New York, New York, New York
The number of people with dementia (PwD) living at
home is increasing rapidly and puts great emphasis on family
caregivers, social support and professional home care. This
can lead to situations in which caregivers provide care against
the will of PwD, for example locking a door or forcing people
to eat. Knowledge about attitudes towards involuntary treat-
ment is scarce. This was the first study to investigate profes-
sional and family caregivers attitudes towards involuntary
treatment use in PwD. Across-sectional study was conducted,
in which 230 professional (physicians, nurses, case managers)
and 77 family caregivers of PwD living at home completed
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585
the Maastricht Attitude Questionnaire - Home Care. This
questionnaire measures attitudes towards involuntary treat-
ment (60 items) as well as perceptions of restrictiveness and
discomfort (25 items). Involuntary treatment was divided in
non-consensual care, psychotropic medication and physi-
cal restraints. Findings indicate that involuntary treatment
positive attitudes towards involuntary treatment in gen-
eral (P<0.001), physical restraints (P<0.001), psychotropic
medication (P=0.005) and non-consensual care (P<0.001)
compared with professional caregivers. Furthermore, family
caregivers evaluated physical restraints and non-consensual
care as less restrictive (P<0.001 and P<0.001 respectively)
and experience less discomfort (P<0.001 and P=0.002
respectively) in applying these measures. Both professional
and family caregivers considered physical restraints the most
restrictive and experience most discomfort in applying physi-
cal restraints. Further research is needed to understand the
discordant attitudes. Professional and family caregivers need
to find common ground in order to reduce involuntary treat-
ment use in home care.
GENDER DIFFERENCES IN AN IDEAL EXERCISE
PARTNER FOR THE MENTAL HEALTH OF OLDER
JAPANESE ADULTS
Y.Fujii1, T.Jindo2, N.Kitano2, K.Fujii1,3, J.Seol1, K.Joho1,
T.Okura1, 1. University of Tsukuba, Tsukuba, Japan,
2. Physical Fitness Research Institute, Meiji Yasuda Life
Foundation of Health and Welfare, Hachioji, Japan, 3.
Ibaraki Prefectural University of Health Sciences, Ami,
Japan
Recent studies suggest an association between good men-
tal health and exercise with others, as opposed to by oneself.
However, it is unclear as to whether this association dif-
fers according to the type of exercise partner (e.g., spouse,
friends, or experts).
This study aimed to investigate the relationship between
the type of exercise partner and mental health in older adults.
This cross-sectional study was conducted through a mail
survey on older adults living in Kasama City, Japan. Subjects
were 1914 older adults (mean age: 74.26.6 years; men:
48.4%). Depressive symptoms were assessed through the
Kihon Checklist. Subjects were asked about their exercise
habits (at least once a week) and the presence of an exer-
cise partner, with the following options (multiple answers
allowed) provided: by oneself, with a spouse, with same-
gender friends, with opposite-gender friends, and with exer-
cise experts. A logistic regression analysis adjusted for age,
economic status, and household composition was conducted
for each gender.
Exercise with opposite-gender friends (OR=0.29) and a
spouse (OR=0.50) was significantly associated with a lower
prevalence of depression among men (P < 0.05). For women,
exercise with same-gender friends (OR=0.55) and exercise
experts (OR=0.19) was significantly associated with a lower
prevalence of depression (P < 0.05).Exercise by oneself was
not associated with depression, regardless of gender.
These results suggest that exercise with others is related
to good mental health among older adults. Moreover, there
might be gender differences in terms of a preferred exercise
partner.
586
EXAMINING PHYSICAL FUNCTIONING IN OLDER
ADULTS: ACOMPARISON OF TWO STRETCHING
PRACTICE METHODS
K.Joho1, T.Abe1,2, J.Seol1, Y.Fujii1, K.Fujii1,3, T.Okura1, the referrals were from the Pulmonary Department (21%)
1. University of Tsukuba, Tsukuba, Japan, 2. Japan Society
for the Promotion of Science, Tokyo, Japan, 3. Ibaraki
Prefectural University of Health Sciences, Ami, Japan
While the benefits of stretching are known, there remains
controversy regarding the best methods of stretching practice
for improving physical function in older adults. The aim of
this study is to compare two stretching practices (instructed
stretching practice vs. self-stretching practice using a guide at
home) in terms of their effectiveness in improving physical
function in older adults. Participants comprised 82 Japanese
community-dwelling older adults (instructed group: n=46,
71.24.5 yrs; non-instructed group: n=36, 71.14.9 yrs). J.Heo, M.Tolea, J.E.Galvin, Charles E.Schmidt College of
We provided a guide illustrating stretching exercises for both
groups, and encouraged all participants to stretch at home.
In the instructed group, we also provided a weekly 60-min-
ute stretching class each week for nine weeks. We evaluated
the following physical functions: upper and lower extremity
muscle strength, static and dynamic balance, and normal and
maximum walking speed and flexibility.
In our results, stretching was practiced significantly more
frequently in daily life in the instructed group (6.1 days a
week) than in the non-instructed group (1.1 days a week)
(P<0.05). There was a significant group-by-time interaction
for flexibility (P<0.05), with post-hoc analysis showing sig-
nificant improvements only in the instructed group (P<0.05).
We found a significant group-by-time interaction for maxi-
mum walking speed (P<0.05), with post-hoc analysis show-
ing significant improvements in the instructed group only
(P<0.05). These results suggest that it is necessary to stretch
almost daily to achieve improvements in physical function
over nine weeks. Additionally, we conclude that a visual
demonstration with an instructor is an important addition to
the stretching guide.
INPATIENT REFERRALS TO GERIATRIC CENTER:
INDICATION AND OUTCOMES
J.M.Lubong, Geriatric Center, St. Lukes Medical Center,
Quezon City, Philippines
This study aims to recognize the pattern of referrals to
the Geriatric Medicine specialists.This is a descriptive cross-
sectional study consisted of all admitted patients who were
referred to Geriatric Medicine Specialists/geriatricians from
other departments for a period of June 2013 to March 2015.
The referrals were classified into geriatric co-management
and geriatric evaluation. Details like socio-demographic pro-
file, sources of referral, indication for referral and outcomes
were recorded. The data was analyzed by using descrip-
tive statistical methods.This is a descriptive cross-sectional
study consisted of all admitted patients who were referred
to Geriatric Medicine Specialists/geriatricians from other
departments for a period of June 2013 to March 2015. The
referrals were classified into geriatric co-management and
geriatric evaluation. Details like socio-demographic profile,
sources of referral, indication for referral and outcomes were
recorded. The data was analyzed by using descriptive statisti-
cal methods. Atotal of 67 patients were referred to Geriatric
Innovation in Aging, 2017, Vol. 1, No. S1
Medicine specialists in the Geriatric Center. The youngest
referred was 67years old while the oldest was 101years old.
20% of the referrals were on the age of 8185. Majority of
followed closely by the Cardiology Department (19.4%).
The most common reason for referral was for geriatric
co-management followed by geriatric evaluation using the
comprehensive geriatric assessment. Majority of the condi-
tions being managed were pneumonia followed by dementia.
For the geriatric evaluation, most of the patients are being
referred due to memory lapses. Almost all of the patients
(94%) were discharged improved.
A NEW NON-INVASIVE AND BRIEF CVD RISK SCORE
SYSTEM TO PREDICT COGNITIVE DECLINE
Medicine at Florida Atlantic University, Boca Raton, Florida
The main goal of our study was to assess the impact of
a modified CAIDE risk score on cognitive performance in
community-dwelling older adults. The study evaluated a
multicultural population consisting of 314 participants
enrolled in a cross-sectional aging study with valid measures
on cognitive, physical, functional, and emotional health. The
CAIDE risk score system was modified to: 1)reflect age and
education levels specific to an older adult sample; 2)incor-
porate self-reported high cholesterol instead of total cho-
lesterol level from blood test; and 3)use the Mini Physical
Performance Test (mPPT) as a proxy measure of physical
activity (mPPT:<12 inactive; >=12 active). Using hierarchi-
cal linear regression models, risk of cognitive impairment
(MoCA<26) was assessed based on levels of CAIDE risk score
(low, intermediate, high) using the equations reported by the
authors of the CAIDE risk score. Higher modified CAIDE risk
scores were significantly associated with lower MoCA score
(=-0.447, p<0.001) and with higher Framingham vascular
risk scores (r=0.673, p<0.001). The association was robust
remaining significant after controlling for significant risk
factors (=-0.424, p=0.015) and followed a dose-response
pattern. Likelihood of cognitive impairment increased from
12.1% in the low risk group, to 35.8% in the intermediate,
to 65.5% in the high-risk group. Findings suggest the util-
ity of using the modified CAIDE risk score as an indicator
of increased risk of cognitive impairment and highlight the
need for brief, easy to administer, non-invasive cardiovascu-
lar risk batteries to estimate risk of future cognitive decline
and dementia in later life.
IMPLEMENTATION OF MEDICAL ASSISTANCE IN
DYING (MAID): SCOPING HEALTH CARE PROVIDERS
PERSPECTIVES
J.Fujioka1,2, C.Klinger1,3, R.M.Mirza1,3, M.Sahar1,3,
A.Dillman1,3, D.Akhtar5, L.Tamblyn-Watts4,
L.McDonald1,3, 1. Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, Ontario, Canada,
2. Dalla Lana School of Public Health, University of
Toronto, Toronto, Ontario, Canada, 3. National Institute
for the Care of the Elderly, Toronto, Ontario, Canada, 4.
Canadian Centre for Elder Law, Toronto, Ontario, Canada,
5. University of British Columbia, Faculty of Medicine,
Vancouver, British Columbia, Canada
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
In tandem with increased life expectancy is a growing num-
ber of older adults living longer in discomfort and pain, with
life-debilitating chronic or terminal illness and poor quality-
of-life. With a focus on quality-of-dying and a dignified
death for older adults, medical assistance in dying (MAID)
has gained widespread public and professional popularity as
an end-of-life alternative, leading to legalization in several
countries. However, continued debate about the necessity
and limits of various healthcare professions involvement
persists. Drawing on evidence from regions where MAID has
been legalized, a scoping review was conducted to synthesize
the literature on roles of diverse healthcare professionals in
decision-making and implementation of MAID services for
older adults. An exhaustive database search yielded 1,000+
articles. Abstracts were manually curated, with 35 studies
fulfilling inclusion criteria and integrated in the final review.
Synthesis and analysis of the literature led to five thematic
conclusions being highlighted as relevant to older patients
seeking MAID: Nurses are increasingly involved in MAID
but lack role clarity in decision-making processes; mental
health professionals should always be required to assess
capacity and consent for MAID decision-making; physician
involvement alone is insufficient to manage patient requests;
conscientious objection by physicians leads to a de-medical-
ized framework for MAID; and guidelines/frameworks to
clarify healthcare professionals roles in interprofessional
collaboration. Findings from this review inform policy, prac-
tice and research and demonstrate urgency for a multidis-
ciplinary approach to MAID for older adults that clearly
defines scope of practice for diverse healthcare professionals
to prevent legal, ethical and administrative hurdles.
COGNITIVE MEASURE MAY IDENTIFY ATROPHY
IN BRAIN REGIONS ASSOCIATED WITH POSTERIOR
CORTICAL ATROPHY
E.Couser1, M.Albert2, C.Pettigrew2, A.Soldan2, 1.
University of Maryland, Baltimore, Baltimore, Maryland,
2. Johns Hopkins Hospital - Department of Neurology,
Baltimore, Maryland
Posterior cortical atrophy (PCA) affects a small percent-
age of individuals with Alzheimers disease (AD) pathology
and is characterized by significant visual-perceptual impair-
ment. There are no consensus diagnostic criteria for PCA and
misdiagnosis is common. This study tested whether a sim-
ple ratio score of visual-perceptual performance to memory
performance was associated with MRI measures of visual
association cortices in a subgroup of patients with suspected
PCA. Analyses included 141 patients with AD dementia (M
age = 74.4) from the Alzheimers Disease Neuroimaging
Initiative. Ratio scores, reflecting constructional praxis per-
formance (a measure of visual spatial ability) relative to
immediate recall memory performance, were calculated for
each patient using subscales of the ADAS-Cog. Atrophy was
estimated using structural MRI measures (volume, thick-
ness) of cortical regions involved in visual processing. Using
ADAS-Cog ratio scores, 12 patients were classified as possi-
ble PCA subjects (M age=69.9). Relative to the typical AD
group, the PCA group had smaller volumes and lower thick-
nesses in several posterior cortical regions and a composite
score of these brain regions (p <.05). Several MRI measures
were significantly related to higher scores on the ADAS-cog
IAGG 2017 World Congress
587
based ratio in the PCA subgroup but not in the typical
AD group (p<.05). Additionally, logistic regressions showed
that the degree of atrophy in several regions predicted PCA
group status (p<.05). The results suggest that the ADAS-Cog
based ratio of constructional praxis to memory recall is asso-
ciated with significant atrophy in posterior cortical regions.
This measure may be useful for identifying individuals with
suspected PCA.
FRAILTY PHENOTYPES, FALL, HIP FRACTURE, AND
MORTALITY
O.Zaslavsky1, S.Zelber-Sagi2, N.F.Woods1, 1.
Biobehavioral Nursing and Health Systems, Unversity of
Washington, Seattle, Washington, 2. University of Haifa,
Haifa, Israel
Background: We compared the simplified Womens
Health Initiative (WHI) and the standard Cardiovascular
Health Study (CHS) frailty phenotypes in predicting falls, hip
fracture, and death in older women.
Methods: Participants are from the WHI Clinical Trial.
CHS frailty criteria included weight loss, exhaustion, weak-
ness, slowness, and low physical activity. The WHI frailty
score used two items from the RAND-36 physical function
and vitality subscales, one item from the WHI physical activ-
ity scale plus the CHS weight loss criteria. Specifically, level
of physical function was the capacity to walk one block and
scored as severe (2-points), moderate (1-point), or no limita-
tion (0). Vitality was based on feeling tired most or all of the
time (1-point) versus less often (0). Low physical activity was
walking outside less than twice a week (1-point) versus more
often (0). Atotal score of 3 resulted in frailty classification,
score of 1 or 2 defined pre-frailty, and 0 indicated non-frailty.
Outcomes were modeled using Cox regression and Harrell
C-statistics were used for comparisons.
Results: Approximately 5% of participants were frail
based on the CHS or WHI phenotype. The WHI frailty phe-
notype was associated with higher rates of mortality (haz-
ard ratio (HR)=2.36, p=<0.001) and falls (HR=1.36, p=.03).
Comparable HRs in CHS-phenotype were 1.97 (p<0.001)
and 1.12 (p=0.44), respectively. Neither phenotype pre-
dicted hip fracture. Harrell C-statistics revealed non-signif-
icant differences in HRs between the CHS and WHI frailty
phenotypes.
Conclusion: The simplified WHI phenotype, which is self-
reported and brief, might offer a practical advantage for epi-
demiological and clinical applications.
ADEQUACY OF MICRONUTRIENT INTAKE IN
LONG-TERM CARE RESIDENTS: MAKING THE MOST
OF MEALTIMES (M3)
H.H.Keller1,2, N.Carrier4, C.Lengyel3, S.Slaughter5,
L.Duizer6, C.Steele7,8, J.M.Morrison1, A.M.Duncan6, 1.
Kinesiology, University of Waterloo, Waterloo, Ontario,
Canada, 2. Schlegel-University of Waterloo Research
Institute for Aging, Waterloo, Ontario, Canada, 3.
University of Manitoba, Winnipeg, Manitoba, Canada, 4.
Universite de Moncton, Moncton, New Brunswick, Canada,
5. University of Alberta, Edmonton, Alberta, Canada,
6. University of Guelph, Guelph, Ontario, Canada, 7.
University Health Network, Toronto, Ontario, Canada, 8.
University of Toronto, Toronto, Ontario, Canada
588
Food intake of residents living in long term care (LTC)
is known to be poor. Yet, our understanding of which
micronutrients are inadequately consumed is limited.
The M3 prevalence study included an assessment of food
intake from 639 residents (mean 86.87.8 yrs old) in 32
nursing homes from four provinces (AB, ON, NB, MB) in
Canada. Researchers rigorously collected weighed (main
plate items) and estimated (snacks, beverages, side dishes)
food and beverage intake from three non-consecutive days.
Dietary records were analyzed for energy and micronutri-
ent intakes using the Food Processor Nutrition Analysis
Software (ESHA, version 10.14.1) and usual intakes were
estimated by adjustment for intra-individual variation on
all participants. Micronutrient intakes were compared with
their estimated average requirement (EAR), when available,
using the EAR cut-point method or with their Adequate
Intake (AI) when an EAR was not available. Energy intake
was 1715291 kcal and 1481261 (mean SD) for males dichotic listening tests were all completed. Results: All sub-
(n=197) and females (n=435), respectively. Nutrients where
the prevalence of inadequacy was greater than 50% for
males and females were: vitamin B6, D, E, folate, calcium,
magnesium and zinc. More than 50% of participants were
below the AI for vitamin K and Potassium. These results
document a high prevalence (10 of 20 micronutrients
assessed) of inadequate micronutrient intakes in residents
living in LTC in Canada. Interventions to promote more
nutrient dense foods in LTC menus are required. (Funded
by Canadian Institutes of Health Research)
INDICATIONS OF GAMMA-
GLUTAMYLTRANSFERASE (GGT) AS AMARKER OF
COGNITIVE HEALTH IN LATE LIFE
M.Praetorius Bjork, B.Johansson, University of
Gothenburg, Gothenburg, Sweden
A recently published study suggests an association
between Gamma-Glutamyltransferase (GGT) in midlife
and later risk of dementia. In the present study we explore
the effects of serum GGT on cognitive decline and demen-
tia also in more advanced ages. We tested the role of
GGT in a sample of 452 non-demented individuals, aged
80 years and older at baseline, drawn from the OCTO-
twin study. Abattery of eight cognitive tests was adminis-
tered at five occasions with measurements intervals of two
years. We fitted hierarchical linear models by contrasting
two models of overall cognitive change as a function of
a) time in the study and b) time to death while control-
ling for baseline age, sex, education, stroke, cardiovascu-
lar disease, hypertension, diabetes, and incident dementia.
In separate analyses, the potential association between
GGT and dementia was tested. Our main finding was that
higher levels of GGT were associated with an increased
risk for cognitive decline and dementia in later life. Our
study is the first longitudinal study to report on this asso-
ciation across a broad battery covering several cognitive
domains and diagnoses of dementia. Further research is,
however, needed to validate our findings and to evaluate
the underlying mechanisms of the effects of GGT on age-
related cognitive decline
Innovation in Aging, 2017, Vol. 1, No. S1
DICHOTIC LISTENING IN THE ELDERLY:
INTERFERENCE IN THE ADAPTATION OF BINAURAL
PROSTHESIS
J.Martins, A.Ribas, C.Moretti, Universidade Tuiuti do
Paran, Curitiba, Paran, Brazil
Introduction: Elderly individuals with bilateral hearing
loss often do not use hearing aids in both ears. Because of
this, dichotic tests to assess hearing in this group may help
identify peculiar degenerative processes of aging and hearing
aid selection. Objective: To evaluate dichotic hearing for a
group of elderly hearing aid users who did not adapt to using
binaural devices and to verify the correlation between ear
dominance and the side chosen to use the device. Methods:
A cross-sectional descriptive study involving 30 subjects
from 60 to 81years old, of both genders, with an indication
for bilateral hearing aids for over 6months, but using only
a single device. Medical history, pure tone audiometry, and
jects (100%) of the sample failed the dichotic digit test; 94%
of the sample preferred to use the device in one ear because
bilateral use bothered them and affected speech understand-
ing. In 6%, the concern was aesthetics. In the dichotic digit
test, there was significant predominance of the right ear over
the left, and there was a significant correlation between the
dominant side with the ear chosen by the participant for
use of the hearing aid. Conclusion: In elderly subjects with
bilateral hearing loss who have chosen to use only one hear-
ing aid, there is dominance of the right ear over the left in
dichotic listening tasks. There is a correlation between the
dominant ear and the ear chosen for hearing aid fitting.
CAN DEPRESCRIBING GIVE WHAT POLYPHARMACY
HAS TAKEN AWAY? FEASIBILITY TRIAL IN
RESIDENTIAL AGED CARE
N.Ailabouni1, D.Mangin2, P.S.Nishtala 1, 1. School of
Pharmacy, University of Otago, Timaru, New Zealand, 2.
McMaster University, Hamilton, Ontario, Canada
Polypharmacy, with its resulting negative health outcomes,
is increasing worldwide alongside our ageing population. In
specific, anticholinergic and sedative medicines contribute
to the decline in cognitive and physical functioning of older
people. The Drug Burden Index (DBI) measures the cumula-
tive daily sedative and anticholinergic load. Our aim was to
examine the feasibility of reducing the DBI of older people
living in residential aged care facilities (RACFs). Residents
aged 65 years prescribed one or more anticholinergic or
sedative medicine, were recruited from three RACFs in New
Zealand. A patient-centred approach was implemented;
where a clinically trained pharmacist conducted a resident
interview and a comprehensive medicine review for each par-
ticipant. Deprescribing recommendations were put forward
to the residents general practitioner (GP). We recruited 37
participants with a mean age of 82.88.2. Residents were
followed up three months after their GP deprescribed one or
more of their medicine(s). AWilcoxon Signed-Rank test indi-
cated that post DBI test ranks, were statistically significantly
less than pre DBI test ranks (p= 0.00016) and post-Cognition
Performance Score (CPS) test ranks were statistically signifi-
cantly less than pre-CPS test ranks (p=0.02). In addition, a
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
one-sided paired t-test showed that potential adverse drug
reactions (ADRs) decreased by a mean of 2.92 (p=0.0001).
Therefore, the pharmacists deprescribing intervention
resulted in a statistically significant reduction in both resi-
dents DBI and potential ADRs; as well as an improvement
in residents cognition. This supports existing research that
deprescribing can reverse negative polypharmacy effects and
result in several potential health benefits.
A CROSS-SECTIONAL STUDYTHE RELATIONSHIP
OF MUSCLE MASS AND MUSCLE FUNCTION WITH
AGE
J.Sun, H.Bai, M.Chen, D.Xue, J.Chen, Huadong
Hospital of Fudan University, Shanghai, China
Sarcopenia is characterized by an age-related decline
of skeletal muscle plus low muscle strength and/or physi-
cal performance, it is a strong predictor of falls,physical
disability, morbidity and mortality. The aim of study is to
investigate the relationship of muscle mass and muscle func-
tion with age in Chinese population. Methods: The study
including 414 participants (212 men and 202 women,
mean age 72.48.0 yearsin Shanghai. Upper (UMM)
and lower (LMM) limbs muscle mass and whole body fat
free mass (FFM) were measured by bioelectrical imped-
ance analysis. The appendicular skeletal muscle mass (ASM)
index (ASM/height2) was calculated. Muscle function was
assessed by measuring hand grip strength (HGS) and gait
speed. Results: Low muscle mass using ASM index cutoff
values was higher in women than men (33.5% vs. 23.6%,
p=0.025). In the upper limb, HGS (=-0.809) declined more
rapidly with age than did UMM ( = -0.592) in men, but
not in women ( = -0.389 and = -0.486 respectively). In Francisco, San Francisco, California, 2. San Francisco
the lower limb, gait speed declined more rapidly than LMM
in men ( = -0.683 vs. = -0.442) and women ( =-1.001 University of California, Davis, Davis, California, 4. San
vs. = -0.461). The variance of UMM explained 2829%
of the variance of HGS, and LMM explained 78% of the
variance of gait speed, in women and men respectively. In
addition to the common predictors (BMI and age), the spe-
cific predictors were smoking, exercise and education for
FFM and ASM, and smoking, drinking and exercise for HGS
(p0.05). Conclusions: Loss of muscle function was greater
than the decline of muscle mass particularly in the upper
limbs in men. However, women were more prone to have
low muscle mass than the men. Exercise programs need to be
designed gender specifically.
EARLY LIFE RISK FACTORS FOR DEMENTIA DEATH:
THE HARVARD ALUMNI HEALTH STUDY
T.Russ1, I.Lee2,4, H.D.Sesso2,4, D.Batty3,1, 1. Alzheimer
Scotland Dementia Research Centre/ Centre for Dementia
Prevention, University of Edinburgh, Edinburgh, United
Kingdom, 2. University of Harvard, Boston, Massachusetts,
3. UCL, London, United Kingdom, 4. Brigham and
Womens Hospital, Boston, Massachusetts
Dementia is a growing public health crisis but its aeti-
ology remains incompletely understood. Several risk factors
measured in mid-life, including obesity and hypertension,
have been linked with dementia risk, though the evidence
is not uniform: overweight in mid-life might be protective
against dementia. Neurodegenerative diseases develop over a
long, initially asymptomatic, period. Thus, the possibility of
IAGG 2017 World Congress
589
preclinical dementia affecting risk factors of interest (reverse
causality) is important. The only solution is a cohort study
recruited before the earliest stages of neurodegeneration are
present.
33,319 male participants in the Harvard Alumni Health
Study underwent an interview and physical examination
at matriculation (<30 years) measuring/recording age, BMI
(derived from height and weight), pulse rate, blood pres-
sure, physical activity, smoking status, and alcohol consump-
tion. Causes of death were extracted from death certificates
(meanSD follow up 53.114.3 years). Dementia-related
deaths were identified using ICD-7 codes 3046 and 794. We
constructed Cox proportional hazards models for the asso-
ciation between each baseline variable and dementia-related
death (age included in every model).
We found no association between the risk factors meas-
ured in early life and subsequent dementia-related death,
though the hazard ratio was raised for obesity (1.33, 95%CI
0.901.97) and reduced for alcohol consumption (0.60,
0.311.16). Expected risk factor-CVD death (ICD-7 330
334 and 400446) associations were identified.
In a population free of the earliest stages of dementia,
we found no association between early life cardiovascular
risk factors and dementia-related death. The relationship
between CVD and dementia is potentially more complex
than hitherto considered and requires careful study.
SEX DIFFERENCES IN RESPONSE TO ATARGETED
KYPHOSIS SPECIFIC EXERCISE PROGRAM
W.B.Katzman1, N.Parimi2, A.Schafer1,4, R.Long1,
S.Wong1, N.Lane3, 1. University of California San
Coordinating Center, San Francisco, California, 3.
Francisco Veterans Affairs Medical Center, San Francisco,
California
Hyperkyphosis, an excessive anterior curvature in the
thoracic spine, is associated with reduced health status in
older adults. Hyperkyphosis is highly prevalent, more com-
mon in older women than men. There is no standard inter-
vention to reduce age-related hyperkyphosis. Sex differences
in response to a targeted intervention are not known.
We conducted a waitlist design randomized controlled
trial to determine if a targeted kyphosis specific exercise pro-
gram improved Cobb angle of kyphosis, and whether the
magnitude of change differed between men and women.
112 participants aged 60years with kyphosis 40 were
randomized to exercise or waitlist control. Group interven-
tion was delivered by a physical therapist, 1-hour, twice a
week for 3-months. Controls received the intervention after
3-months. Primary outcome was change in Cobb angle meas-
ured from standing lateral spine radiographs. Secondary out-
comes included change in kyphometer-measured kyphosis,
physical function and quality of life. Groups were combined
and ANOVA was used to test sex by time interaction to eval-
uate treatment effects in men and women.
Participants (67 women, 45 men) were 70.06.2 years
with baseline Cobb 55.6
12.1 degrees. There were no
between group differences at baseline, however men had
higher kyphometer-measured kyphosis. There was no sig-
nificant between group difference in change in Cobb after
590
intervention, p=0.09, but kyphometer-measured kyphosis
differed by 4.8 degrees, p<0.001. There was no significant
interaction between sex and change in Cobb after interven-
tion, p=0.67.
A 3-month targeted exercise program reduced kyphom-
eter, but not radiographic-measured kyphosis. Despite sex
differences in baseline kyphosis, sex did not affect treatment
response.
EFFECT OF FAMILY CAREGIVER SKILLS TRAINING
ON PERCEIVED QUALITY OF CARE AND DEPRESSIVE
SYMPTOMS
C.Van Houtven1, J.Lindquist2, V.A.Smith1, J.Chapman2, energy intake, sex and age, was calculated using brief-type
C.C.Hendrix1, S.N.Hastings1, E.Z.Oddone1, self-administered diet history questionnaire (BDHQ) at base-
M.Weinberger3, 1. Durham VA and Duke University
Medical Centers, Durham, North Carolina, 2. Durham VA
Medical Center, Durham, North Carolina, 3. UNC Chapel
Hill, Chapel Hill, North Carolina
One national strategy to better support family caregiv-
ers in the U.S.is to increase effective training programs. We
conducted a two-arm randomized controlled trial to evaluate
the effectiveness of HI-FIVES, a skills training program for
caregivers of community-dwelling Veterans recently referred
to receive home and community-based services. Caregivers in
the HI-FIVES group received five individually-tailored train-
ing phone calls and four weekly group training sessions deliv-
ered by a RN. Caregivers in usual care received information
about VA Caregiver Support Program services. The perceived
quality measure was: 0 is the worst, and 10 the best, possible
VA healthcare received in the past 3months. The CESD-10
assessed depressive symptoms (030). Linear models with an
unstructured covariance matrix were estimated to test inter-
vention effects on outcomes at 3, 6, and 12months. Among
the 242 dyads, caregivers (patients) mean age was 61 (73)
years, 54% (53%) were Black, and 89% (4%) were female.
Model-estimated mean baseline caregiver perceived quality
of VAHCS care was 8.34 (95% CI: 8.10, 8.57); the modeled
mean difference between HI-FIVES and controls at 3months
was 0.28 (p=.18); 0.53 (p<.001) at 6 months; and 0.46
(p=0.054) at 12 months. Model-estimated mean baseline
patient perceived quality of VAHCS care was 8.43 (95% CI
8.16, 8.70); the modeled mean difference between HI-FIVES
and controls at 3months was 0.29 (p=.27); 0.31 (p=0.26) at
6months; and 0.48 (p=0.03) at 12months. Model-estimated
mean baseline caregiver CESD-10 was 8.96 (95% CI: 8.21,
9.72). No significant differences were observed in CESD-10
scores.
ASSOCIATION BETWEEN PROTEIN INTAKE AND
CHANGE IN RENAL FUNCTION AMONG JAPANESE
GENERAL OLD SUBJECTS
T.Sekiguchi1,2, K.Kamide1, K.Ikebe3, M.Kabayama1,
Y.Arai4, T.Ishizaki5, Y.Gondo6, H.Rakugi1, 1. Osaka nificantly different among the four groups based on cardiac
University Graduate School of Medicine, Osaka, Japan, 2.
Morinomiya University of Medical Sciences, Osaka, Japan,
3. Osaka University Graduate School of Dentistry, Osaka,
Japan, 4. Keio University of Medical Sciences, Tokyo, Japan,
5. Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan, 6. Osaka University Graduate School of Human
Sciences, Osaka, Japan
Innovation in Aging, 2017, Vol. 1, No. S1
Objective: The aim of this study is to clarify the associa-
tion between dietary protein intake and decline in estimated
glomerular filtration rate (eGFR) among Japanese general
old persons.
Method: We analyzed longitudinal data from 1246 par-
ticipants (701 years: 593, 801: 587, 901: 66, male:
48.5%, female: 51.5%) in the SONIC study, population
based cohort study for old persons. Exclusion criteria were
CKD stage G5 (eGFR<15) and dialysis reception in progress.
The outcome variable, change in eGFR was estimated from
serum creatinine measured at baseline and 3-year follow-
up, and exposure variable, protein intake adjusted for total
line. Associations between eGFR change and protein intake
were determined by multiple linear regression analysis. And
we also curried out subgroup analyses for subjects with
eGFR60 and <60, <45, <30.
Result: Mean eGFR change per year was -2.12 (eGFR
at Baseline: 69.7, Follow-up: 64.7) mL/min/1.73m2. Mean
protein intake was 1.52g/kg/day. As results of multivari-
able analyses including almost all subgroup analyses, eGFR
change was not associated with protein intake. However,
only in the subgroup with eGFR<60, high protein intake was
statistically associated with moderate eGFR change ( coef-
ficient: 1.00, 95%CI: 0.11 1.89).
Conclusion: In general, old persons with eGFR<60, pro-
tein intake was positively associated with change in eGFR,
and with eGFR<30 who are recommended restricting pro-
tein intake for chronic kidney disease in recent guidelines.
Thus, dietary protein restriction might be reconsidered for
old persons having reduced renal function as eGFR<30.
THE CORRELATION OF SERUM CATHEPSIN B WITH
AGE-RELATED KIDNEY AND CARDIAC DIASTOLIC
FUNCTION DECLINE
J.X.Bai1, N.Wang1, W.Han1, F.X.Sun2, M.X.Chen2, 1.
Department of Gerontology and Geriatrics, Shengjing
Hospital of China Medical University, Shenyang, China,
2. Department of Kidney, General Hospital of Chinese
Peoples Liberation Army, Beijing, China
Background: The purpose of this study was to longitudi-
nally evaluate the association of serum Cathepsin B (CTSB)
with age-related kidney and cardiac diastolic function decline
in a healthy Chinese community-based population.
Methods: One hundred and ninety five healthy partici-
pants were evaluated at baseline and 3 years later. Serum
CTSB was measured by enzyme-linked immunosorbent
assay (ELISA). Rapid kidney function decline was defined as
annual loss of estimated glomerular filtration rate (eGFR) >
3ml/min/1.73m2. Cardiac diastolic function was assessed by
echocardiography based on mitral inflow patterns.
Results: Baseline serum CTSB concentration were sig-
diastolic function. For the total participants, CTSB was signif-
icantly correlated with cardiac diastolic function. Compared
to the individuals with high CTSB concentration, the individ-
uals with low CTSB concentration had lower risk of cardiac
diastolic dysfunction with the odds of 2.542 [(1.0865.952),
P<0.05]. However, this effect didnt exist after age adjust-
ment. The incidence of diastolic function improvement of the
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
moderate CTSB concentration group was lower than that in
the high concentration group. After adjusting for age and all
other possible confounders, the association remained with
the odds of 0.209 [(0.0600.725), P<0.05]. However, the
association between serum CTSB and kidney function was
not found.
Conclusions: Serum CTSB was correlated with age-
related cardiac diastolic function decline in healthy people.
Measurement of serum CTSB may provide valuable informa-
tion for predicting the decline in age-related cardiac diastolic
function in healthy people.
A ROLE OF MNA-SF AS APREDICTOR FOR
30-MONTH MORTALITY IN ANURSING HOME IN
JAPAN
J.Yasuda, Y.Watanabe, H.Hirano, A.Edahiro, M.Shirobe,
K.Motokawa, S.Awata, Tokyo Metropolitan Institute of
Gerontology, Tokyo, Japan
Background: Japan is a super-aged society. Along with
the aging, the number of dependent elderly has increased.
The Mini Nutritional Assessment-Short Form (MNA-SF)
has been reported to be one of the useful questionnaires to
assess nutritional status in older people. However, studies
reporting with MNA-SF for the dependent elderly are lack-
ing. Therefore, we observed residents in nursing homes in
Japan for 30months to examine whether MNA-SF is use-
ful for assessment of nutritional status. Methods: A total
of 423 residents (333 women; 84.28.6years) in nursing
homes in Japan participated in this investigation. We inves-
tigated the following characteristics of the participants: age,
sex, height, weight, medical history, Barthel index, clinical
dementia rating, and MNA-SF. MNA-SF consists of 6 items:
food intake decline, weight loss, mobility, suffering from
psychological stress or acute disease, Neuropsychological
problems, and BMI. We performed Cox proportional
regression analysis to examine the association of MNA-SF
score with 30-month mortality. Results: Mean MNA-SF
score was 8.92.2. Among the participants, 104 (24.6%)
were malnourished, 250 (59.1%) were at a risk of malnutri-
tion, and 49 (11.6%) were in a normal nutritional status.
After 30-month follow-up, 166 (39.2%) of the participants
died. After adjustment for confounders, MNA-SF score
was significantly associated with 30-month mortality (HR:
0.843, 95% CI: 0.7700.922). Conclusion: MNA-SF score
was significantly associated with 30-month mortality in
Japanese nursing homes, even after adjustment for mortal-
ity-associated confounders. Therefore, the approach based
on MNA-SF can be effective for nutritional assessment of
dependent elderly.
YOUNG EFFORTS FOR OLDER INPATIENTS:
DEVELOPMENT AND ASSESSMENT OF ACLINICAL
POLYPHARMACY PATHWAY
L.Van der Linden, J.Hias, K.Walgraeve, E.Joosten,
J.Flamaing, I.Spriet, J.Tournoy, University of Leuven,
Leuven, Belgium
Background: Pharmacist-led medication reviews per-
formed during hospital stay in very old adults have been
shown to decrease emergency department visits and drug-
related readmissions as well as downstream health care
IAGG 2017 World Congress
591
utilization. Hence, a clinical pathway was developed and
subsequently installed at the acute geriatric wards of a
large referral University Hospital, Leuven, Belgium
Aims: To develop a structured and non-labor intensive
data capture approach within the current framework, which
allows for the following:
To establish the different tasks (i.e. the workload) of the
assigned clinical pharmacists.
To identify the content of the provided recommendations.
To assess the acceptance rate of said recommendation.
Methods: A structured form was developed which
was compatible with the hospitals software system and
allowed for inclusive data registration: e.g. type of inter-
vention, involved drug class and acceptance of the phar-
maceutical recommendation by the treating physician.
Structured data registration was done between April and
December 2016.
Results: Medication reconciliation revealed a mean of 3.3
discrepancies per patient. Pharmacists provided at least 1
intervention for 785 (60%) of 1118 admissions. Medication
review was performed in 50% of all patients resulting in
2159 recommendations Drug discontinuation was mostly
recommended (46%). Cardiovascular drugs (29%), followed
by psychotropic drugs (17%) and gastro-intestinal drugs
(12%) were the main subjects of the pharmaceutical recom-
mendations; Amajority of the recommendations (i.e. 76%),
was accepted by the physicians.
Conclusion: Clinical pharmacists working in multidisci-
plinary geriatric teams provide a clear added value towards
the pharmaceutical care and should be maximally integrated
in geriatric care programs.
EARLY LIFE STRESS AND GENETIC RISK FOR
NEUROTICISM PREDICTING HEALTH OUTCOMES
IN OLDER SWEDISH TWINS
K.Lehto1,2, I.Karlsson1, C.Lundholm1, N.L.Pedersen1, 1.
Dept. Medical Epidemiology and Biostatistics, Karolinska
Institutet, Solna, Sweden, 2. National Institute for Health
Development, Tallinn, Estonia
Better understanding of early risk factors for poor late-life
health and low well-being is crucial for developing more effi-
cient prevention strategies. This study explored how early life
stress exposure (twins separated and adopted; mean age=3)
as well as novel polygenic risk scores for neuroticism (PRSn)
influence psychosocial and health outcomes late in life. Data
were collected over 7 waves of the Swedish Adoption/Twin
Study of Aging (SATSA; 19842010). In total, 2174 individu-
als (older than 50 at baseline) were included in the analy-
ses. Of those, 637 had genotype data available. Outcomes
included psychosocial factors (socioeconomic status, life
stress, family environment) as well as emotional health (neu-
roticism, depressiveness, anxiety symptoms, life satisfaction)
and physical health (self-rated health, disease burden, func-
tionality level). Early stress exposure predicted higher levels
of neuroticism, disease burden and life stress, and lower life
satisfaction and self-rated health in late-life. Out of seven
PRSn created at various p-value thresholds, PRSn consisting
of approximately 10 000 SNPs under p-value threshold of
.01 was the most powerful predictor of measured neuroti-
cism late in life. PRSn also predicted high depressiveness and
592
poor family environment. Interestingly, genetic effects were
more evident in twins not exposed to early life stress, indicat-
ing underlying gene-environment interplays. Results suggest
the importance of early life stress and genetic predisposition
to emotional instability in shaping health and well-being in
old age.
DIETARY PATTERNS AND SELF-REPORTED
INCIDENT DISABILITY IN ELDERLY
P.Agarwal1, Y.Wang1,2, A.Buchman3,4, D.A.Bennett3,4, care. Supragingival plaque and the anterior dorsum of the
M.C.Morris1, 1. Department of Internal Medicine, Rush
University Medical Center, Chicago, Illinois, 2. Department
of Preventive Medicine, Rush University Medical Center,
Chicago, Illinois, 3. Rush Alzheimers Disease Center, Rush
University Medical Center, Chicago, Illinois, 4. Department
of Neurological Sciences, Rush University Medical Center,
Chicago, Illinois
Disability in older adults is associated with low qual-
ity of life and higher mortality. Diet may be a potentially
important public health strategy for disability prevention.
We examined the relations of the Mediterranean, DASH and
MIND diets to functional disability in the Rush Memory
and Aging Project. Atotal of 874 participants without func-
tional disability at baseline were assessed annually over
12years of follow-up using standardized measures for self-
reported activities of daily living, instrumental activities of
daily living and the Rosow-Breslau measure of mobility dis-
ability. The diet scores were computed based on a validated
food frequency questionnaire administered at baseline. We
examined relations between diet and disability using pro-
portional hazard models adjusted for age, sex, education
and total calories. Higher scores of the MIND (HR=0.88,
95% CI 0.830.94), Mediterranean (HR=0.96, 95% CI
0.940.98), and DASH (HR=0.88, 95% CI 0.820.95) diets
were associated with decreased hazard of incident disabil-
ity in activities of daily living. Only the MIND (HR=0.91,
95% CI 0.860.97) and Mediterranean (HR=0.97, 95% CI
0.940.99) diets were associated with reduced hazard of
disability in instrumental activities of daily living. All three
dietary patterns were associated with decreased hazard of
mobility disability (MIND, HR=0.88 95% CI 0.830.94;
Mediterranean, HR=0.88, 95% CI 0.830.94; DASH,
HR=0.88, 95% CI 0.830.94). The findings did not change
after further adjustment for BMI, depression, physical
activity and vascular diseases, except for mobility disability,
which became non-significant. These findings are encourag-
ing that diet may be an effective strategy for the prevention
of functional disability.
ONCE-DAILY MOUTH CARE REDUCES PLAQUE AND
CHANGES ORAL MICROBIOME COMPOSITION IN
NURSING HOME ELDERS
R.A.Jablonski-Jaudon, V. Winstead, C.Jones-Townsend,
A.Azuero, M.Geisinger, C.Morrow, T.Ptacek, The
University of Alabama at Birmingham, Birmingham,
Alabama
Background: Persons with dementia usually receive mouth
care from nursing assistants. Inadequate mouth care causes
poor oral health, a risk for systemic diseases like pneumonia.
Nursing assistants struggle with balancing optimal mouth
care against triggering care-resistant behaviors.
Innovation in Aging, 2017, Vol. 1, No. S1
Purpose: To evaluate the feasibility of a once-daily mouth
care protocol on the outcomes of dental plaque and oral
microbiome composition.
Sample: Six nursing home residents with documented
mouth care-resistant behavior: mean age was 66.3 years,
50% were African-American, and 50% were female. They all
had moderate dementia and significant dental plaque (mean
surface covered=50.7%, sd=20.8%)
Methods: All subjects received 6days of once-daily mouth
tongue were accessed for the microbiome samples, which
were obtained before and after Day 1 and Day 6 mouth care
activities. An intraoral camera (Soprocare) was used to
obtain video recorded images of all new plaque on all denti-
tion before Day 1 mouth care and after Day 6 mouth care.
Data Analysis: Plaque scores were analyzed using an
adaptation of the Planimetric plaque index for 5 participants
(one persons decayed dentition precluded plaque measure-
ments). Microbiome samples were descriptively analyzed at
the genus level.
Results: Mean plaque scores fell from 50.7% to 24%.
Changes in tongue and plaque of at least 6% of the micro-
biome at the genus level were observed for Streptococcus,
Veillonella, Prevotella, Haemophilus, and Rothia.
Conclusion: Once-daily mouth care may be effec-
tive in reducing plaque and changing the oral microbiome
composition.
ATROPHY OF THE ENTORHINAL CORTEX IS
RELATED TO INCREASED DUAL-TASK GAIT COST
AMONG MCI OLDER ADULTS
R.Sakurai1,2,3, M.Montero Odasso2,3, R.Bartha4, 1.
Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan, 2. Gait and Brain Lab, Parkwood Institute, Lawson
Health Research Institute, London, Ontario, Canada, 3.
Schulich School of Medicine & Dentistry, Department of
Medicine, Division of Geriatric Medicine, University of
Western Ontario, London, Ontario, Canada, 4. Center
for Functional and Metabolic Mapping, Robarts Research
Institute, Department of Medical Biophysics, Schulich
School of Medicine & Dentistry, Department of Medicine,
Division of Geriatric Medicine, University of Western
Ontario, London, Ontario, Canada
Background: Lower dual-task gait performance (the slow-
ing of gait speed while performing a cognitive demanding
task) is associated with lower cognitive performance, par-
ticularly in MCI older adults. However, the neural mecha-
nism of increased dual-task cost is still unclear. This study
aimed to examine the relationship between dual-task cost
and regional brain volume, focusing on prefrontal cortex,
hippocampus, and entorhinal cortex, and whether these vari-
ables were associated with future onset of dementia among
MCI older adults.
Methods: Forty-one older adults (mean age 746years,
44% women) with MCI from the Gait and Brain Study
were followed up for up to five years with biannual visits
including cognitive, gait, and medical assessment. Gait veloc-
ity and stride time variability were recorded under simple
and three separate dual-task gait conditions using an elec-
tronic walkway. Regional brain volumes were derived from
automated segmentation using 3T-MRI scanning.
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Innovation in Aging, 2017, Vol. 1, No. S1
Results: Adjusted regression analyses showed that higher
dual-task costs were associated with smaller volume in
the entorhinal cortex but not with the prefrontal and hip-
pocampal volumes. During the follow-up period (mean,
30months), six participants converted to dementia. Alogis-
tic regression analysis showed that future onset of dementia
was associated with smaller volume in the entorhinal cortex
alone (OR=1.005, p=0.034). standardized prevalence measurements of models of care,
Conclusions: Our results suggest that lower dual-task gait
performance is a motor manifestation of entorhinal cortical
atrophy which leads to progression to dementia. Our result
provides an anatomical substrate to the concept that dual-
task gait can be an early motor marker of progression to
dementia.
ASSOCIATION BETWEEN INDIVIDUAL CHRONIC
DISEASES AND POLYPHARMACY AMONG ELDERLY
PATIENTS IN JAPAN
T.Ishizaki1, S.Mitsutake1, T.Yamaoka1, C.Teramoto3,1,
S.Shimizu2, H.Ito1, 1. Tokyo Metropolitan Geriatric
Hospital and Institute of Gerontology, Tokyo, Japan, 2.
Institute of Health Economics and Policy, Tokyo, Japan, 3.
University of Tokyo, Tokyo, Japan
The Japanese government is seeking to establish a com-
munity health program for the management of polyphar-
macy in elderly patients. To explore a community-based
screening strategy for polypharmacy, this study examined the
extent to which certain chronic diseases are strongly associ-
ated with polypharmacy among community-dwelling elderly
adults in Japan. We used anonymized health insurance claims
data from all beneficiaries aged 75years and older in Tokyo,
who received outpatient care between May 2014 and August
2014. We obtained the data from the Tokyo Metropolitan
Association of Medical Care Services for Older Senior
Citizens. The insurance program universally covers all citi-
zens aged 75years or older. The data included 134 categories
of prescribed drugs and seven chronic diseases: hypertension,
dyslipidemia, insomnia, osteoarthritis, diabetes, dementia,
and depression. Polypharmacy was defined as the prescrip-
tion of at least five drugs during a 4-month period. We
estimated age- and sex-adjusted odds ratio (OR) for each
chronic disease, using multivariate logistic regression analy-
sis. The prevalence of polypharmacy among the beneficiaries
(n = 1,308,412) was 34.4%. The prevalence was the high-
est among octogenarians (37.8%), followed by that among
those aged 7579 years (32.0%), nonagenarians (27.9%),
and centenarians (10.9%). We found that the highest OR of
having polypharmacy was 4.98 for diabetes (p < 0.001), fol-
lowed by 4.75 for depression (p < 0.001); the lowest OR was
1.65 for dementia (p < 0.001). These findings emphasize the
importance of identifying individual diseases to screen for
polypharmacy among community-dwelling elderly patients.
THE CONTENT AND FOCUS OF THE SWEDISH
NATIONAL INVENTORY OF HEALTH AND CARE
(SWENIS)
A.Backman1, S.Bjork1, H.Lvheim1, K.Sjgren1, were aggregated across assessments between 2008 and 2012.
A.Skoldunger3, A.Wimo4, P.Sandman1, D.Edvardsson2,1, Multivariable multinomial logistic regressions were used for
1. Umea University, Umea, Sweden, 2. School of nursing
and midwifery, Melbourne, Victoria, Australia, 3. Umea
IAGG 2017 World Congress
593
University, Umea, Sweden, 4. Division of neurogeriatrics,
Stockholm, Sweden
Sweden, like most countries worldwide, faces major
challenges due to a rapidly aging population with increas-
ing need to develop and ensure a high quality aged care for
older people. The SWENIS study has a longitudinal design
and contributes with nationally representative, valid and
organisation and person-centredness, staff working situa-
tion, and resident health such as cognitive impairment, neu-
ropsychiatric symptoms, pain and P-ADL capacity in nursing
homes. The SWENIS research group has developed a valid,
reliable and internationally comparable Swedish nursing
home survey, and baseline data were collected in 2014 from
a randomised Swedish national sample of nursing homes;
residents (n=4831) staff (n=3605), and managers (n =191)
in 188 nursing homes from 35 municipalities. The prevalence
of cognitive impairment among residents was 67%, 56% of
residents were P-ADL-dependent, 48% exhibited pain and
92% exhibited neuropsychiatric symptoms. Baseline meas-
urements showed person-centred care mean 50.0 (SD 7.4),
of a possible total score of 1365, psychosocial climate mean
57.6 (SD 9.1), of a total score of 070, job strain mean 0.71
(SD 0.17), of a total score of 0.213.31, and also leader-
ship mean 108.4 (SD 23.8) of a total score of 24144. The
SWENIS study is novel in several aspects, firstly; it provides
nationally generalizable data that enables analyses of resi-
dent health well-being in relation to different care practices
and organizational structures, and secondly: it enables inter-
national comparison and collaboration on the content and
health outcomes of residents, in nursing home care.
PROSPECTIVE ANALYSES OF PAIN AND PHYSICAL
FUNCTIONING IN THE ENGLISH LONGITUDINAL
STUDY OF AGEING
V.Yiengprugsawan1,2, A.P.Steptoe3, 1. The Australian
National University, Centre for Research on Ageing, Health,
and Wellbeing, Canberra, Australian Capital Territory,
Australia, 2. ARC Centre of Excellence on Population
Ageing Research, Canberra, Australian Capital Territory,
Australia, 3. University College London, Institute of
Epidemiology and Health Care, London, United Kingdom
Pain is often viewed as part of the ageing process and
for many older persons, moderate or severe pain over a long
period can result in lower levels of energy, higher levels of
physical discomfort, and limited mobility. This study inves-
tigates the longitudinal impact of persistent overall and site-
specific pain on physical performance and activities of daily
living among older adults.
Data were analysed from the English Longitudinal Study
of Ageing (ELSA), a representative sample of the population
aged 50 years and older. Face-to-face interview and nurse
records were used from Waves 2 to Waves 6 (20042012)
for analyses. Overall pain and site-specific pain (back, hip,
and knee) were measured biennially from 2004 to 2008
(n=5010). Activities of daily living and physical measures
(chair rise and grip strength) were used as outcomes and
the former and linear regression for the latter, adjusting for
potential covariates.
594
Overall pain (moderate to severe) was prevalent with
close to a quarter of participants reporting pain on at least
two occasions between 2004 and 2008. Multi-site pain was
a strong predictor of subsequent limited activities of daily
living, with more impairment in people who reported pain at
least twice (Adjusted Odds Ratios range from 1.86 to 3.97
for back and hip 2.04 to 4.19 for back and knee, and 2.08
to 5.19 for hip and knee). Persistent pain was also strongly
associated with worse physical performance outcomes.
By using longitudinal data, we are able to confirm the
impacts of both overall and site-specific pain on physical
functioning in older adults, with more pronounced effects
for those reporting persistent pain over the years. These find-
ings could be helpful for practitioners in the monitoring and
management of pain in older adults.
OBESITY AND LONGITUDINAL CHANGES OF
HANDGRIP STRENGTH IN OLDER ADULTS FROM
DIFFERENT CONTEXTS
J.Barbosa1, C.Gomes1, T.Ahmed2, N.Rosendaal3,
R.O.Guerra1, 1. Federal University of Rio Grande do
Norte, Natal, Brazil, 2. Universit du Montreal, Montreal,
Quebec, Canada, 3. University of Hawaii, Honolulu, Haw
aii
It has been suggested that the amount of fat tissue may
contribute to accelerated loss strength with aging. However,
little is known about longitudinal associations between
obesity and low muscle strength. To examine the predic-
tive value of abdominal obesity on longitudinal changes of
handgrip strength (HGS) in older men and women. Data on
803 community-dwelling older adults, between 6574years,
were collected in 2012, 2014, 2016 in Natal (Brazil) and
Saint-Hyacinthe (Canada). Sociodemographic character-
istics, height, weight, waist circumference (WC) and HGS
were assessed. Sex-specific linear mixed models were fitted
to examine the trajectory of HGS according to quartiles of
baseline WC. Among men, mean four year HGS was 2.62kg
(p-value < 0.01). There was a gradient between decline of
HGS and WC, with increasing decline among those with
greatest waist circumference values (6.15kg, p-value <0.001)
after adjustment for age, research site, height and weight. In
women, four year decline in HGS was smaller 1.0kg (p-value
< 0.01) and no association between baseline WC and decline
in HGS was observed. Findings agree with previous cross-
sectional research and emphasize the need for sex-specific
analyses.
LONG-TERM CARE HOME, STAFF, AND DINING
ROOM CHARACTERISTICS ASSOCIATED WITH
RESIDENTS FOOD INTAKE
N.Carrier1, H.H.Keller2, S.E.Slaughter3, C.Lengyel4,
C.Steele6, L.Duizer5, A.M.Duncan5, 1. Food sciences,
nutrition and home economics, Universit de Moncton,
Shediac Cape, New Brunswick, Canada, 2. University of
Waterloo, Waterloo, Ontario, Canada, 3. University of
Alberta, Edmonton, Alberta, Canada, 4. University of
Manitoba, Winnipeg, Manitoba, Canada, 5. University
of Guelph, Guelph, Ontario, Canada, 6. University of
Toronto, Toronto, Ontario, Canada
The Making the Most of Mealtimes (M3) prevalence
study recruited 639 residents from 32 homes in four
Innovation in Aging, 2017, Vol. 1, No. S1
Canadian provinces (AB, ON, NB, MB) to determine factors
associated with food intake (based on three days of weighed
and estimated food records). Mealtime interactions with
staff assessed with the Mealtime Relational Care Checklist
(3 meals/resident), and the length of meals and assistance
received (9 meals/resident) were recorded. Dining environ-
ments were assessed for physical features using the Dining
Environment Audit Protocol, and the Mealtime Scan was
used to record mealtime experience and ambiance. Staff (min-
imum of 10) in each home completed the Person-Directed
Care questionnaire and home managers completed a sur-
vey describing home features and food services. Residents
mean energy and protein intakes were 1572412 kcal/day
and 58.418.0g/day, respectively. Average mealtime length
was 40.213.0 minutes, and residents received more positive
than negative staff interactions at mealtimes (ratio: 2.21.3).
Bivariate analysis showed a negative association (p<0.01) for
energy intake with number of residents to staff ratio during
mealtimes and time since last menu revision (1318months).
Protein intake was positively associated (p<0.01) with dieti-
tian time but negatively associated with the evening meal
(supper) being the main meal of the day, having two food
preparation systems (rethermalization and traditional) and
a longer time (>18months) since last menu revision. This is
the first study to consider home, staff and dining room char-
acteristics and resident food intake, providing new opportu-
nities for interventions. (Funded by Canadian Institutes of
Health Research)
HOW DOES SEX AFFECT THE CARE DEPENDENCY
RISK ONE YEAR AFTER STROKE?
S.Schnitzer1, J.Deutschbein1, C.Nolte2, M.Kohler3,
A.Kuhlmey1, L.Schenk1, 1. Department of Medical
Sociology, Charit Berlin, Berlin, Germany, 2. Center for
Stroke Research, Charit Berlin, Berlin, Germany, 3. Central
Research Institute of Ambulatory Health Care in Germany,
Berlin, Berlin, Germany
The study explores the association between sex and
care dependency risk one year after stroke. The study uses
claims data from a German statutory health insurance
fund. Patients were included if they received a diagnosis of
ischemic or hemorrhagic stroke between 1 January and 31
December 2007 and if they survived for one year after stroke
and were not dependent on care before the event (n=1,851).
Data were collected over a one-year period. Care dependency
was defined as needing substantial assistance in activities of
daily living for a period of at least six months. Geriatric con-
ditions covered ICD-10 symptom complexes that character-
ize geriatric patients (e.g. urinary incontinence, cognitive
deficits, depression). Multivariate regression analyses were
performed. One year after the stroke event, women required
nursing care significantly more often than men (31.2% vs.
21.3%; odds ratio for need of assistance: 1.67; 95% CI:
1.362.07). Adjusted for age, the odds ratio decreased by
65.7% to 1.23 (n.s.). Adjusted for geriatric conditions, the
odds ratio decreased further and did not remain significant
(adjusted OR: 1.18 (CI: 0.901.53). It may be assumed that
women have a higher risk of becoming care-dependent after
stroke than men because they are older and suffer more often
from geriatric conditions such as urinary incontinence at
onset of stroke. Preventive strategies should therefore focus
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
on geriatric conditions in order to reduce the post-stroke
care dependency risk for women.
COGNITIVE STATUS IS ASSOCIATED WITH CCL11 IN
OLDER RURAL DWELLERS: FINDINGS FROM THE
FRAILOMIC STUDY
L.Butcher1, K.Prs2, P.Andr2, S.Walter3, J.Dartigues2, Healthcare System. After 6-months, participants were sur-
L.Rodrguez-Maas3, C.Feart2, J.D.Erusalimsky1, 1.
Cardiff Metropolitan University, Cardiff, United Kingdom,
2. University of Bordeaux, Bordeaux, France, 3. Hospital
Universitario de Getafe, Madrid, Spain
CCL11 (eotaxin-1) is a chemokine classically known to
be involved in allergic responses. More recently, this media-
tor has been implicated in age-related cognitive decline.
However, data available on the relationship between CCL11
and cognitive status in older adults living in the commu-
nity is scarce. The aim of this study was to explore associa-
tions between CCL11 and cognitive status in two cohorts
of community-based older adults recognised for their con-
trasting socio-demographic environments, which partici-
pated in the FRAILOMIC Initiative (www.frailomic.org/):
The 3C-Bordeaux cohort, comprising city dwellers (n= 517),
and the AMI cohort, comprising rural dwellers (n=320), both
from South-Western France. Plasma CCL11 was measured
at baseline by enzyme-linked immunoassay. Baseline Mini
Mental Status Examination (MMSE) scores were used as a
measure of global cognitive status. CCL11 concentration was
significantly higher in AMI than in 3C [median (interquar-
tile range): 146 (115203) pg/ml vs 103 (85129) pg/ml].
In AMI, individuals with cognitive impairment (MMSE23)
had on average higher levels of CCL11 than the others
(MMSE>23) [162 (128219) pg/ml vs 142 (112196) pg/ml,
respectively; p=0.02]. In AMI, multivariate weighted logis-
tic analyses confirmed that higher CCL11 concentrations
(tertile 3)were significantly associated with a higher preva-
lence of cognitive impairment, independently of age, gender,
education and frailty [OR=2.80, 95% Confidence Interval
1.654.75; p=0.0004]. In contrast, no differences were found
in 3C. These results indicated that CCL11 could be a sig-
nificant independent predictor of cognitive function in older
adults residing in a rural environment. The factors that may
account for this association will be discussed.
ENHANCING COMMUNICATION AND SHARED
DECISION MAKING VIA ELECTRONIC HEALTH
RECORDS
S.Dang2,3,1, B.Thavalathil4, D.Ruiz2, C.Gomez-Orozco4,
P.Caralis2, O.Gomez-Marin4, S.Levis2,3,1, R.Rodriguez2,
1. University of Miami Miller School of Medicine, Miami,
Florida, 2. Miami Veterans Affairs Healthcare System,
Miami, Florida, 3. Miami VA Geriatric Research Education
and Clinical Center, Miami, Florida, 4. South Florida
Veterans Affairs Foundation for Research and Education,
Miami, Florida
Background: Shared decision-making (SDM), is a patient-
provider collaborative process for making health decisions,
accounting for both clinical evidence and patients prefer-
ences. Women can benefit from improved SDM regarding
menopause and associated conditions, which affect aging
women.
IAGG 2017 World Congress
595
Purpose: To assess impact of weekly materials related to
womens health sent via secure messaging from an Electronic
Health Record (EHR) on knowledge and SDM regarding
menopause.
Methods: We implemented an educational intervention
for women using the EHR, MyHealtheVet. We enrolled
140 women, ages 4560, from the Miami Veteran Affairs
veyed using a study-specific questionnaire and the validated
SDM-Q-9.
Results: Post intervention survey respondents included 80
women, mean age 534; 76% Non-Hispanic, 24% Hispanic;
44% White, 44% Black; 92% with a college education; and
8% who attended graduate school.
Post-intervention 88% of the women felt more knowl-
edgeable regarding menopause treatment options; 87% rec-
ognized that a treatment decision was necessary, 89% felt
more confident discussing menopause treatment with their
provider, and 77% agreed their ability for SDM improved;
48% stated their doctor asked about their preferred deci-
sion-making involvement, 47% felt their doctors asked
about their preferences, 51% weighed the options together,
48% agreed on treatment options; 27% planned to make an
appointment with provider to discuss hormone therapy.
Conclusions: EHRs represent a novel and practical way
to enhance womens knowledge of menopause and other
age-related conditions, and promote SDM. EHRs promise to
enhance SDM merits further exploration, as it may improve
patient-centered care, adherence, and patient outcomes.
USABILITY TESTING OF AKINECT-BASED SENSOR
SYSTEM TO AUTOMATE THE TIMED UP-AND-GO
TEST
L.J.Phillips, I.Jahnke, M.Skubic, C.Abbott, B.Harris,
F.Demir, Nursing, University of Missouri, Columbia,
Missouri
Understanding older adults preferences for technology is
important for acceptance and adoption of future technologies.
This study tested the operation of a Microsoft Kinect sensor
system programmed to record the Timed Up-and-Go (TUG)
test in sample of seven senior center attendees and three staff,
and solicited their response to using the system and interpret-
ing fall-risk graphics. Participants viewed PowerPoint slides
containing information on falls and TUG instructions, then
performed the TUG test under observation but without addi-
tional prompting. Participants were asked to Think Aloud to
illuminate difficulties encountered during task performance
and were video-recorded with Morae software. Following
two TUG trials, we provided participants paper-based pro-
totypes of the feedback interface with their age-normed TUG
time and estimated fall risk, conducted interviews focused on
user experience, and administered the System Usability Scale
(SUS). Nine of 10 participants performed the test correctly
although six had questions about the instructions. Eight indi-
viduals expressed interest in monthly testing. Eight partici-
pants comprehended the TUG results graphics, but offered
suggestions to enhance clarity. Satisfaction, rated with the
SUS was high at 83.4%. Because deviations from specified
sitting and walking positions resulted in missing data, clear
environmental landmarks will be required for older adults
to perform the TUG independently. Findings from this user
596
experience study suggest that older adults may wish to self-
monitor fall risk in a community setting and can interpret
graphical fall-risk feedback. In addition, automating the sys-
tem for senior center use will require precise configuration of
the constituent equipment to each centers space.
AMYLOID AND TAU PET IN DIABETES-RELATED
DEMENTIA
H.Hanyu1, S.Shimizu1, H.Sakurai1, K.Ishii2, 1.
Department of Geriatric Medicine, Tokyo Medical
University, Tokyo, Japan, 2. Tokyo Metropolitan Institute,
Tokyo, Japan
Type 2 diabetes mellitus (DM) has been shown to
increase the risk for cognitive decline and dementia, such as
Alzheimers disease (AD) and vascular dementia (VaD). In
addition, there may be a dementia subgroup associated with
specific DM-related metabolic abnormalities rather than
with AD pathology or cerebrovascular diseases. This type of
dementia, not showing hypoperfusion in the parietotempo-
ral lobe on SPECT or cerebrovascular lesions on MRI, was
characterized by old age, high hemoglobin A1c level, long
duration of diabetes, high frequency of insulin therapy, low
frequency of apolipoprotein E 4 carrier, less severe medial
temporal lobe atrophy, impaired attention and executive
function, less impaired word recall, and slow progression of
cognitive impairment, and might be referred to as diabetes-
related dementia. We studied PiB (amyloid) and PBB3 (tau)
PET imaging in 20 subjects with diabetes-related dementia to
assess amyloid and tau accumulations in the brain. We found
that only 40% of subjects showed positive PiB, whereas
91% showed positive PBB3. Some patients showed PBB3
accumulation restricted to the medial temporal lobe, while
some showed PBB3 accumulation in the widespread cerebral
cortices beyond the medial temporal lobe in the negative PiB,
indicating tauopathy. We concluded that diabetes-related
dementia may be more associated with tau pathology rather
than amyloid pathology, and with non-specific neuronal
injury due to DM-related metabolic abnormalities.
LONGITUDINAL CHANGES IN NUTRITIONAL
STATUS; SARCOPENIA PROGRESSION IN
COMMUNITY-DWELLING OLDER ADULTS
S.P.Yew1, W.Lim1,4, M.Chong1,2, A.Yeo1, C.Tan1, male SD rats were used as control group. Compared with
N.Ismail5, L.Tay1,3, 1. IGA, Tan Tock Seng Hospital,
Singapore, Singapore, 2. Ministry of Health, Singapore,
Singapore, 3. Sengkang Health, Singapore, Singapore,
4. Geriatric Medicine, TTSH, Singapore, Singapore, 5.
Continuing and Community Care, TTSH, Singapore,
Singapore
While cross-sectional studies have demonstrated the
importance of nutritional status on sarcopenia, its impact
on longitudinal progression of sarcopenia status remains
unclear. This prospective cohort study sought to examine
how longitudinal changes in nutritional status impact sarco-
penia progression.
We studied 144 community-dwelling older adults who
completed 2-year follow-up with repeat DEXA imaging
using Asian cut-offs, participants were categorized as (i)no
sarcopenia, (ii)pre-sarcopenia and (iii)sarcopenia. Sarcopenia
Innovation in Aging, 2017, Vol. 1, No. S1
progressors were defined as participants who progressed
from non-to pre-sarcopenia, non-or pre-sarcopenia to sar-
copenia, or remained sarcopenic at year-2. We collected
longitudinal data for cognitive, functional and physical per-
formance; mood(Geriatric Depression Scale, GDS); physi-
cal activity level; and nutritional status(Mini Nutritional
Assessment, MNA). We compared participants whose nutri-
tional status improved or remained normal at 2years, versus
their counterparts whose nutritional status declined. Logistic
regression was performed to examine the independent effect
of change in nutritional status on sarcopenia progression.
Nutritional status declined in 15(10.5%) participants.
They were significantly older(72.308.50 vs 67.507.90,p=
0.028), more likely female(93.3% vs 63.6%,p=0.021), and
exhibited an increase in GDS score over 2years(0.0161.68
vs 1.80 3.30,p=0.057). Sarcopenia progressors were
more likely to decline rather than improve/remain stable
in nutritional status(93.3% vs 51.9%,p=0.002). In logis-
tic regression adjusting for age, ethnicity and GDS scores,
decline in nutritional status was an independent risk factor
for sarcopenia progression in women(OR=12.2, 95% C.I
1.38108.60,p=0.025).
Tracking changes in nutritional status is clinically relevant
in identifying older adults at risk of sarcopenia progression,
especially in women. Clinicians should pay attention to
mood in patients with decline in nutritional status.
PROTECTIVE EFFECTS OF GLUCAGON-LIKE
PEPTIDE-2 ON INTESTINAL MUCOSAL BARRIER
FUNCTION IN AGED RATS
R.Ying, Zhongshan Hospital, Fudan University, Shanghai,
Shanghai, China
Age-associated derangement of intestinal permeability
could permit increased systemic absorption of lumen anti-
gens and contribute to concomitant inflammatory status,
closely associated with many age-related diseases. GLP-2 can
improve the function of the intestinal barrier in patients with
gastroenterological diseases and critical illnesses. However,
the mechanism, by which GLP-2 influences intestinal barrier
function during ageing, still remains unclear. In this study,
twelve 26-month-old male Sprague-Dawley rats were ran-
domized to old group and old+GLP-2 group. 3-month-old
young rats, the old rats had a significantly thinner intesti-
nal mucosa and shorter, rare villi. The ileum villi of old rats
were significantly thicker after GLP-2 treatment. By using
fluorescein isothiocyanate (FITC)-labeled dextran, the intes-
tinal permeability in GLP-2 treated old rats were decreased.
The plasma GLP-2 levels were negatively correlated with the
FITC levels (r=-0.610, P<0.01). The tight junction of intes-
tinal epithelial cells, as detected by transmission electron
microscopy, was clearer in the old+GLP-2 group than that in
old rats. Moreover, GLP-2 treated rats showed the increased
mRNA and protein expression of Zonula Occludens-1 (ZO-
1) and Occludin. These results indicated GLP-2 improve
the small intestinal epithelial barrier function in aged rats
by alleviating an increasing permeability and morphological
changes through up-regulation of the tight junction protein
ZO-1 and Occludin.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
DEPRESSION, SEX, AND GENDER ROLES IN AN
OLDER BRAZILIAN POPULATION
A.Freire1, A.Vafaei2, C.Gomes1, J.Barbosa1, R.O.Guerra1, to community. Findings suggest that the workflow approach
1. Universidade Federal do Rio Grande do Norte, Natal,
Brazil, 2. Queens University, Kingston, Ontario, Canada
Methods: Cross-sectional survey of a population of adults
65 years and older (n=256) in Natal (northeast of Brazil).
Depression was defined in the Center for Epidemiologic
Symptoms Depression Scale (CES-D 16). We used a 12
items validated version of the Bem Sex Role Inventory (BSRI)
to classify participants in four gender roles (Masculine,
Feminine, Androgynous and Undifferentiated). Poisson
regressions were fitted to estimate the prevalence ratios (PR)
of depression for each gender role compared with the mas-
culine role, and adjusting for sex, age, sufficiency of income,
self-rated health and chronic conditions. Results: Almost all
participants (n=237, 93%) were able to answer the ques-
tions in spite of low literacy. Gender roles were not asso-
ciated with sex. 50% were classified as masculine, 19% as
feminine, 32% as androgynous and 27% as undifferenti-
ated. Depression prevalence was high (39.7%). Gender roles
remained associated with depression prevalence after adjust-
ment for covariates. Those endorsing the feminine role had
a depression prevalence ratio (PR) of 2.2 (95% CI: 1.24.1)
times higher relative to those endorsing the masculine role.
Corresponding figures for those undifferentiated were 1.9
(95% CI: 1.03.5). Those endorsing androgyny were not
different from masculinity PR=1.4 (95% CI: 0.752.7).
Conclusions: Gender roles were associated with depression,
independently from being a man or a woman, suggesting that
certain aspects of gender as reinforced by society may con-
tribute to the social production of depression.
THE USE OF WORKFLOW ANALYSIS TO
CHARACTERIZE PATTERNS OF OLDER ADULTS
DAILY ACTIVITIES
J.Chung1, M.Ozkaynak3, G.Demiris2, 1. University of
New Mexico, Albuquerque, New Mexico, 2. University of
Washington, Seattle, Washington, 3. University of Colorado
Denver, Aurora, Colorado
Aging is often associated with disruptions in the per-
formance of daily activities. Despite considerable efforts to
accurately assess older adults functional abilities, there is a
lack of methods to characterize the ordered tasks performed
by individuals to achieve a particular goal within a home
environment. Workflow analysis has the potential to exam-
ine procedural aspects of daily activities and detect early
changes in activities that may indicate functional deteriora-
tion among older adults. We aimed to apply the workflow
analysis to older adults daily activity data to examine the
patterns of and variability in their activities. Six community-
dwelling older adults filled out an activity diary for 14 con-
secutive days on which they recorded the location and type
of activities performed inside and outside the home every 30
minutes. The EventFlow, a novel visualization tool, was used
to analyze daily routine based on 1453 events. The analysis
revealed great variability in activity types, levels, and tim-
ing of performing certain activities across individuals.
Normal day-to-day variation in the same individual was also
detected, including sleep time, time to go to bed, and time
to get up from bed. When applied to the spatial information
IAGG 2017 World Congress
597
of activity, the analysis suggested variability related to indi-
viduals mobility in different level of life spaces from home
can allow researchers to observe lifestyle alterations and to
detect changes indicating deteriorating health before these
changes significantly affect older adults quality of life.
APPLICATION OF ECHO TELEMEDICINE TO
NURSING HOMES TO HELP STAFF ADDRESS
PROBLEMATIC BEHAVIORS
B.Humel, M.Hasselberg, E.Enfield, J.Karuza, Psychiatry,
University of Rochester, Clarence Center, New York
ECHO (Extension for Community Healthcare Outcomes)
is a collaborative model of medical education and care man-
agement that uses telemedicine to empower clinicians. Inter-
disciplinary specialists mentor and share their expertise across
a virtual network via case-based learning, enabling primary
care clinicians to treat patients with complex conditions in
their own communities. University of Rochester has devel-
oped and implemented an innovated an ECHO program for
nursing homes. The mission of ECHO is to educate nursing
home staff by presenting challenging patient cases along with
educational sessions. Clinics occur two times a week and
participants are given a baseline survey of their knowledge
followed by a 6month follow-up survey. 55 patient cases and
4 follow up cases have been presented. The ECHO project
covers 13 rural and urban counties and enrolled 52 nurs-
ing homes. Over the past year 1,888 staff participated and
614 CME credits awarded within the past year. Since this
is a new program, evaluation data is critical to fine-tuning
the curriculum to ensure it meets the needs of the nursing
homes. Preliminary evaluations indicate high staff satisfac-
tion with ECHO. Post surveys found gaps in knowledge and
use of non-pharmacological approaches (e.g., sensory rooms,
music therapy, doll therapy) to treat difficult behaviors and
lack of appropriate staff training on how to handle behavior
problems. The initial evaluation data provide strong evidence
for the feasibility of applying the ECHO model to nursing
homes. Next steps include the development and dissemina-
tion of a novel curriculum on behavioral problems tailored
to nursing homes.
PREDICTORS OF AND BARRIERS ASSOCIATED WITH
HIV TESTING AMONG OLDER ADULTS IN THE
UNITED STATES
O.Sims1, Y.Guo2, 1. The University of Alabama at
Birmingham, Birmingham, Alabama, 2. The University of
Alabama, Tuscaloosa, Alabama
Older adults are the fastest growing segment of people liv-
ing with HIV and unfortunately many are unaware of their
HIV status. Many providers are reluctant to ask older adults
about their sexual histories, evaluate their risk factors, and
test for HIV, and older adults have low perception of HIV
risk. Using data from the 20132014 National Health and
Nutrition Examination Survey, this study assessed the preva-
lence of recent HIV testing among older adults in the United
States (n=1,056) and identified predictors and barriers to
recent HIV testing. To achieve these objectives, the analysis
was guided by the Systems Model of Clinical Preventive Care
(SMCPC). A binominal logistic regression model was used
to determine the odds of HIV testing uptake adjusting for
598
predisposing factors, enabling resources, reinforcing factors,
and situational factors. The prevalence of recent HIV testing
was 28%. Recent HIV testing was associated positively with
male gender, education level, having public insurance, hav-
ing same sex sexual behavior, African and Hispanic ethnicity;
whereas, age, income-to-poverty ratio, and Asian ethnicity
were associated negatively with recent HIV testing. Public
health social workers are advised that targeted HIV testing
for Asian, economically disadvantaged, female older adults
is needed to increase HIV awareness and detection and to
decrease late diagnosis of HIV. Provided public insurance
was identified as a predictor of recent HIV testing, facilitat-
ing economically disadvantaged older adults eligibility for
public insurance will likely improve access to HIV testing
services and increase HIV testing rates.
COMPARISON OF FOUR RISK SCORING SYSTEMS
FOR OLD PATIENTS: APROSPECTIVE MULTICENTER
STUDY IN CHINA
F.Liu1, J.Qin1, X.Liang1, J.Wang1, P.Chan3,2,4, 1. cognitive reserve from early-, mid-, and late-life.
Department of Emergency, Xuanwu Hospital of Capital
Medical University, Beijing, China, 2. Department of
Neurobiology, Beijing Institute of Geriatrics, Xuanwu
Hospital of Capital Medical University, Beijing, China, 3.
Department of Geriatrics, Beijing Institute of Geriatrics,
Xuanwu Hospital of Capital Medical University, Beijing,
China, 4. Department of Neurology, Beijing Institute of
Geriatrics, Xuanwu Hospital of Capital Medical University,
Beijing, China
Objective: There are a few scoring systems in emergency
departments (ED) to establish critically ill patients quickly
and properly and to predict in-hospital death. We aim to com-
pare the efficacy of National Early Warning Score (NEWS),
Modified Early Warning Score (MEWS), Rapid Emergency
Medicine Score (REMS) and quickSOFA (qSOFA) on in-
hospital mortality in general older ED patients in different
areas of China.
Methods: This is a prospective, multicenter and observa-
tional study. The study included general patients admitted to
the EDs of nine teaching hospitals between 1st October, 2013
and 31 May, 2014. The primary outcome of the study is in-
hospital mortality. Accuracy in predicting outcome measures
was assessed by calculating the area under receiver operating
characteristic curve (AUC).
Results: Total patients were 1528 (51.6% male,
48.4% female). The mean age was 75.86 8.46. Fifty-
eight patients were dead in-hospital; the NEWS AUC for
predicting in-hospital death was 0.834(0.778~0.890),
the MEWS AUC was 0.753(0.679~0.827), the REMS
AUC was 0.718(0.638~0.799) and the qSOFA AUC was
0.780(0.714~0.846). NEWS was found to have a better pre-
dictive strength than MEWS (p<0.001), REMS (p=0.002),
qSOFA (p=0.020) in terms of predicting in- hospital mor-
tality of patients presenting to ED, while the differences
between MEWS, REMS and qSOFA were not significant.
Conclusions: The efficiency of NEWS was found to be
superior to MEWS, REMS and qSOFA as a predictor of in-
hospital mortality in older ED patients. The qSOFA, a score
developed for predicting sepsis patients in-hospital mortal-
ity, can also be used as a predictor of in-hospital mortality in
older ED patients.
Innovation in Aging, 2017, Vol. 1, No. S1
ASSOCIATION OF LIFELONG EXPOSURE TO
COGNITIVE RESERVE-ENHANCING FACTORS WITH
DEMENTIA RISK
H.Wang1, S.W.MacDonald2, S.Dekhtyar1, L.Fratiglioni1,
1. Karolinska Institutet, Stockholm, Sweden, 2. University
of Victoria, Victoria, British Columbia, Canada
Background and aims: We examined the association of
cognitive reserve-related factors over the lifespan with the
risk of dementia in a community-based cohort of older
adults.
Methods: Information on early-life education, socioeco-
nomic status, work complexity at age 20; mid-life occupa-
tion attainment; and late-life leisure activities was collected
in a cohort of non-demented community dwellers (n=602)
aged 75+ residing in Stockholm, Sweden in 19871989. The
cohort was followed up to 9 years (until 1996) to detect
incident dementia cases. Participants who developed demen-
tia three years after the baseline were excluded. Structural
Equation Modelling was used to generate latent factors of
Results: Areduced risk of dementia was associated with
early (RR: 0.6; 95% CI: 0.40.9), adult (RR: 0.6; 95% CI:
0.40.9), and late life (RR: 0.5; 95% CI: 0.40.7) reserve-
enhancing latent factors in separate multivariable Cox mod-
els. Late life (RR: 0.7; 95% CI: 0.50.9) and partially, midlife
factors (RR: 0.7; 95% CI: 0.51.06) preserved their associa-
tion, but the effect of early life factor was attenuated (RR:
0.8; 95% CI: 0.51.2) in mutually adjusted model. The risk
declined progressively with cumulative exposure to reserve-
enhancing latent factors, and having high reserve scores in all
three periods was associated with the lowest risk of dementia
(RR: 0.40; 95% CI: 0.200.81). Similar associations were
detected among APOE 4 allele carriers and noncarriers.
Conclusions: Cumulative exposure to reserve-enhancing
factors over the lifespan is associated with reduced risk of
dementia in late life, even among individuals with genetic
predisposition.
HEART DISEASE, DIABETES AND DEMENTIAS
ASSOCIATION WITH FUNCTIONAL TRAJECTORIES
OVER 5 YEARS
J.MacNeil Vroomen1, L.Han1, J.Monin2, H.Allore1, 1.
Yale School of Medicine, New Haven, Connecticut, 2. Yale
School of Public Health, New Haven, Connecticut
Prevalence of functional disability related to chronic dis-
eases are expected to increase as the population ages. Given
that multimorbidity is common in older adults, we focus on
heart disease, diabetes, both require complicated self-care,
and dementia, which may make self-care more difficult, asso-
ciations with functional disability over five years. Participants
were a nationally representative sample of Medicare benefi-
ciaries ages 65years from 20112015 (N=7,609) from the
National Health and Aging Trends Study. Annual in-person
interviews included sociodemographic information, self-
reported, physician-diagnosed chronic conditions, activi-
ties of daily living (ADL) and cognitive status. Trajectories
of functional decline and attrition over 5years were jointly
estimated using group-based trajectory modeling and gener-
alized to national estimates. Associations between ADL tra-
jectory membership and diabetes, heart disease and dementia
were examined using multinomial logistic regression, while
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Innovation in Aging, 2017, Vol. 1, No. S1
generalizing to national estimates and adjusting for patient
characteristics. Three distinctive functional disability tra-
jectories were identified in the overall sample and applied
to national sample weights; 75.6% had no disability, while
14.7% had mild and increasing disability and 9.7% had
severe and increasing disability. Persons with probable
dementia had the highest odds ratios of functional disability.
We found that approximately 25% of the US community-
dwelling population 65 is likely to have functional disabil-
ity over 5-years. Persons with dementia only had the highest
odds of functional disability over a 5-years. Interventions
targeting the dementia population are needed to prolong
functional independence.
SARCOPENIA: PREVALENCE AND PROGNOSIS IN
OLDER PATIENTS WITH CARDIOVASCULAR DISEASE
K.Kamiya1, N.Hamazaki2, R.Matsuzawa3, N.Kohei3,
S.Tanaka2, A.Matsunaga2, T.Masuda2, J.Ako1, 1.
Kitasato University, Sagamihara, Kanagawa, Japan, 2.
Kitasato University Graduate School of Medical Sciences,
Sagamihara, Japan, 3. Kitasato University Hospital,
Sagamihara, Japan
To date, no study has systematically investigated the
prevalence of sarcopenia in cardiovascular disease (CVD)
according to the international consensus definition. The aim
of this study was to investigate the prevalence and prog-
nostic value of sarcopenia in older patients with CVD. The
study population consisted of 1929 admitted patients aged
60years and older (72.37.3years, 633 females) with CVD.
Sarcopenia was defined according to the recommended diag-
nostic algorithm of the Asia Working Group for Sarcopenia
(AWGS). Handgrip strength was measured with a handheld
dynamometer, and gait speed was measured by a 10-m walk-
ing test. Using the cut-off points from the AWGS consensus,
low hand grip strength was defined as <26kg for men and
<18kg for women, and slow gait speed was defined as <0.8
m/sec. The muscle mass was estimated according to a pre-
viously validated anthropometric equation in Asian popula-
tion. The endpoint was all-cause mortality. The prevalence
of sarcopenia was 26.8% (male:17.6%, female:45.7%) and
increased with age (<75years: 16.5%, 7584years: 40.3%,
85 years: 62.6%, P for trend <0.001). During follow-up
(2.32.2years), 203 deaths occurred. Patients with sarco-
penia had a higher risk of all-cause death compared with
non-sarcopenic patients (age-sex adjusted hazard ratio: 2.00,
95% confidence interval: 1.46 - 2.73, P < 0.001). The pre-
sent study suggests that sarcopenia is highly prevalent among
older patients with CVD and it is associated with increased
mortality.
HIGH-DENSITY LIPOPROTEIN CHOLESTEROL
LEVEL AND COGNITION IN OLD AGE: THE ROLE OF
COGNITIVE RESERVE
A.Ihle1, E.R.Gouveia2, B.R.Gouveia3, D.L.Freitas2, tively and discussed.
J.Jurema4, M.A.Tinco5, M.Kliegel1, 1. Center for the
Interdisciplinary Study of Gerontology and Vulnerability,
University of Geneva, Carouge, Switzerland, 2. University
of Madeira, Funchal, Portugal, 3. Saint Joseph of Cluny
Higher School of Nursing, Funchal, Portugal, 4. Amazonas
State University, Manaus, Brazil, 5. Federal Institute of
IAGG 2017 World Congress
599
Science and Technology Education of Amazonas, Manaus,
Brazil
It remains unclear so far whether the negative relation of
critically low high-density lipoprotein cholesterol (HDL-C)
level to cognitive functioning in old age may be reduced in
individuals with higher cognitive reserve accumulated during
the life course. Therefore, the present study set out to inves-
tigate the relation of HDL-C level to cognitive performance
and its interplay with key markers of cognitive reserve (edu-
cation, cognitive level of job, and cognitive leisure activity) in
a large sample of older adults. We assessed tests of working,
short-term, and long-term memory in 701 older adults (mean
age=70.4years) from Fonte Boa, Apu, and Manaus, Brazil.
HDL-C level was derived from fasting blood samples. In
addition, we interviewed individuals on their education, past
occupation, and cognitive leisure activity. Results showed
that critically low HDL-C level (< 40mg/dl) was significantly
related to lower performance in working memory (r=-.28,
p < .001), short-term memory (r=-.24, p < .001), and long-
term memory (r=-.24, p < .001). These relations were sig-
nificantly moderated by education, cognitive level of job, and
cognitive leisure activity (s >= .08, ps < .05). Subsequent
analyses revealed that the relation of HDL-C level to cogni-
tive performance was negligible in individuals with longer
education, higher cognitive level of job, and greater engaging
in cognitive leisure activity (s < .07, ps > .05). In conclusion,
cognitive reserve accumulated during the life course may
reduce the detrimental influences of a low HDL-C level on
cognitive functioning in old age.
ALTERNATIVES TO ACUTE HOSPITAL CARE FOR
THE OVER 65S AT RISK OF UNPLANNED ADMISSION
A.Huntley1, M.Chalder1, A.Heawood1, C.Metcalfe1,
W.Hollingworth1, J.Benger2, S.Purdy1, 1. University of
Bristol, Bristol, United Kingdom, 2. University of the West
of England, Bristol, United Kingdom
Some older patients are deemed to be at the decision
margin at the time of potential hospital admission. We con-
ducted a systematic review to understand:
- what are the defining characteristics of those individu-
als for whom the decision to admit to acute hospital may be
unclear?
- what alternatives to admission exist?
- how acceptable, safe, effective and cost-effective are
each of these options?
Any controlled studies and systematic reviews of people
>65years who were at risk of an unplanned admission and
offered an alternative care pathway which were published
between April 2005 and December 2016 were included in
our systematic review. Our outcomes of interest were reduc-
tion in secondary care use, safety, patient preferences and
costs. All eligible studies were assessed using the Cochrane
risk of bias tool whilst relevant reviews were assessed using
the AMSTAR checklist. The results were presented narra-
A total of 19 studies and 7 reviews were identified. These
recruited patients with both specific and mixed chronic or
acute conditions. Alternatives to acute admission fell into
four distinct categories: paramedic/emergency care practi-
tioners (n=3), emergency department-based interventions
(n=3), community hospitals (n=2), and hospital-at-home
600
services (n=11). The factors underpinning uncertainty
around the decision to admit were age >75 years, co- and
multi-morbidities, dementia, home situation, availability of
social support and individual coping abilities.
Data suggest that alternatives to acute hospital admission
appear safe and effective, with potential to reduce secondary
care use, length of time that care is needed and reliance on
community resources. However, there is a lack of available
information about the patient-related outcomes and costs of
such interventions.
FOSTERING NURSES WHO CAN TAKE ON THE
CHALLENGE OF ASUPER-AGING SOCIETY IN
URBAN AREAS
Y.Yokoi, H.Fujino, M.Mitou, M.Murata, Toho very likely to recommend the session to a colleague.
University, Tokyo, Japan
We established an instructional lab (IELABO) in Tokyo,
and then creating an environment in which nurses, nursing
students and caregivers can actually put themselves in the
shoes of a (fictional) elderly resident, and always being aware
that the recipients of nursing care are individuals with their
own lives. In this educational program, nurses and caregivers
learned together. As they progressed through the program,
they learned each others strengths, thereby building the
framework for collaboration. We shared the IELABO learn-
ing outcomes with residents in Tokyo. We place great stock
in the motivational value of such civic pride in work.
Major points of outcome are summarized as follows:
1. By learning in a home setting, learners could place
themselves next to the elderly persons in their care and their
family members, and devise and implement a realistic care
plan centered on the daily lives of said persons.
2. By enabling communication in a daily-life setting (i.e.,
the home), care providers could discuss daily life-oriented
care with care providers working in other care provision set-
tings, leading to mutual understanding.
The IELABO became the hub of this program. In the pres-
entation, the outline of the IELABO project as well as its
details is presented with special emphasis on the collabora-
tion framework among the nurses, caregivers, and local com-
munities. This will provide a new perspective to the practical
and conceptional studies of comprehensive care for elderly
citizens.
USING MAINTENANCE OF CERTIFICATION TO
PROMOTE ADVANCE DIRECTIVE DISCUSSIONS IN
PRIMARY CARE
E.Duthie1, J.Myers1, D.Simpson2, K.Denson1, S.Denson1, (=.01, p=.015) for verbal ability. In conclusion, individuals
1. Medical College of Wisconsin, Milwaukee, Wisconsin, 2.
Aurora UW Medical Group, Milwaukee, Wisconsin
Background: Physicians and patients agree that primary
care visits are the appropriate place to discuss advance direc-
tives (AD) with geriatric patients as it normalizes the discus-
sion. Yet barriers are known to keep AD completion rates
low.
Methods: An interprofessional team designed and imple-
mented a three-health care system approved AD focused
Maintenance of Certification (MOC) Part IV activity for
primary care physicians (PCPs) to meet American Board
of Medical Specialists (ABMS) requirements. The activity
focuses on PCPs initiation of brief (23min) AD conversations
Innovation in Aging, 2017, Vol. 1, No. S1
with geriatric patients. The activity was launched at a state-
wide PCP meeting using a workshop that employed interac-
tive educational strategies (quiz, video analysis, role play).
Retrospective post-post evaluation focused on workshop
processes and outcomes.
Results: Eight PCPs completed the session reporting
that at baseline the modal number of conversations PCPs
initiated each week about ADs was < 1/week (range 0 to >
10). All participants targeted a minimum 25% increase in
AD conversations as the improvement goal. Post workshop
evaluation analysis found: 1) improvement among four lit-
erature-based barriers to AD discussions in the aggregate of
responses; 2)all participants were more likely to initiate con-
versations with patients about ADs; and 3)88% (7/8) were
Conclusion: Experienced PCPs perceive AD discussions
as fraught with barriers. This brief (90min) interactive AD
discussion focused MOC activity minimized perceived bar-
riers and increased primary care physician commitment to
increase AD discussions with geriatric patients.
COGNITIVE RESERVE AND COGNITION IN OLD
AGE: THE MEDIATING ROLE OF CHRONIC DISEASES
A.Ihle, M.Oris, D.Fagot, C.Chicherio, B.W.van der
Linden, J.Sauter, M.Kliegel, Center for the Interdisciplinary
Study of Gerontology and Vulnerability, University of
Geneva, Carouge, Switzerland
The present study is the first so far in empirically testing
the recent conceptual view that the number of chronic diseases
may mediate between the build-up of cognitive reserve (e.g.,
by educational attainment and cognitive level of job) on the
one hand and cognitive performance on the other. We assessed
Psychometric tests on processing speed and verbal ability in
2812 older adults (mean age=77.9years) from Switzerland.
Individuals were interviewed regarding their education, occu-
pation, and chronic diseases. Results showed that higher edu-
cational attainment and higher cognitive level of job were
significantly related to better performance in processing speed
(rs >= .15, ps < .001) and verbal ability (rs >= .27, ps < .001).
These relations were significantly mediated via the number
of chronic diseases. Mediation effects of the relation of edu-
cational attainment to cognitive performance were 5.3%
exerted indirectly (=.01, p=.007) for processing speed and
1.5% exerted indirectly (=.01, p=.014) for verbal ability.
Mediation effects of the relation of cognitive level of job to
cognitive performance were 7.3% exerted indirectly (=.01,
p = .004) for processing speed and 1.8% exerted indirectly
with higher educational attainment and higher cognitive level
of job in early and midlife may suffer from fewer chronic dis-
eases later in life. This may finally preserve their performance
in verbal ability and processing speed in old age.
ASSOCIATION BETWEEN FRAILTY AND
POSTOPERATIVE COMPLICATIONS IN PATIENTS
UNDERGOING ABDOMINAL SURGERY
M.Smietniansky, E.Gonzalez Zalazar, B.Boietti, V.Ardiles,
M.Cal, E.Riggi, L.Camera, E.De Santibaes, Internal
Medicine - Geriatrics, Hospital Italiano de Buenos
Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires,
Argentina
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Innovation in Aging, 2017, Vol. 1, No. S1
Background: Although several studies relate frailty with
poor postoperative outcomes, trials with specific intraab-
dominal surgery cohorts are scarce.
Objetives: To evaluate the association between frailty
and 1 month postoperative complications, and 3 months
mortality
Materials and Methods: Observational, descriptive and
analytical study of a prospective cohort. Patients older than
70years who underwent elective surgery were evaluated in
the preoperative area of Italian Hospital from Buenos Aires,
with the Edmonton Frail Scale. Data were collected between
June 4, 2014 and February 1, 2017. We estimated mortal-
ity risk and complication risk with a logistic regression.
We reported OR and 95% confidence intervals. A multi-
variate logistic regression analysis was performed to control
confounding
Results: We included 85 patients, 18% (15) were frail,
mean age 80.3years old (SD 7.1). The non frail group was
younger 76.4 (SD 5.5). Overall 3 months mortality was
20% (3) for frail and 1.4% (1) for non frail patients, OR
17.2 (IC95% 1.65179.9, p 0.02). After adjusting for sex,
age, comorbidity and oncologic surgery this association per-
sisted statistically significant, OR 36.8 (IC95% 2.4543.9,
p 0.01). 53.3% (8) of frail patients and 17.1% (12) of non
frail patients had complications within 1month postopera-
tively, OR 5.5 (IC95 % 1.618, p 0.01) and after adjusting
for confounders this association persisted statistically signifi-
cant OR 5.71 (1.4322.7, p0.01).
Conclusion: In this population, the presence of frailty was
associated with a significant increase in overall posoperative
complications and death.
COMPARISON SURVEY ON FAMILY CAREGIVERS OF
ELDERLY PEOPLE IN THAILAND AND JAPAN
C.Greiner1, D.Tamdee2, N.Okamoto3, P.Tamdee2,
T.Isowa4, W.Booonchiang2, H.Ryuno1, A.Kitagawa4, 1.
Kobe University, Kobe, Japan, 2. Chiang Mai University,
Chiang Mai, Thailand, 3. Sophia University, Chiyoda-ku,
Japan, 4. Mie University, Tsu, Japan
Purpose: The purpose of this study was to clarify the situ-
ations of and differences between family caregivers of elderly
people in Thailand and Japan, and obtain basic data that
can be used for constructing family support systems in both
countries through collaboration and the applying of each
countrys strengths.
Methods: A cross-sectional exploratory descriptive
research design was employed. Participants were family
members taking care of elderly people at home. Data were
collected in the Kanto, Kinki, and Tokai areas of Japan, and
three districts in Chiang Mai in Thailand. This research was
approved by the first presenters Institutional Review Board.
Results: Of a total of 114 family caregivers in Japan, 82
(71.9%) were female and mean age was 64.811.1years. In
Thailand, 76 (73.8%) of 103 family caregivers were female
and mean age was 49.113.3 years. Family caregivers in
Thailand felt more healthy both mentally and physically (p
=.000, p =.000). Specifically, they felt a lighter care burden
and less loneliness (p =.000, p =.000) compared to those in
Japan, which relate to family caregivers in Thailand having
more social connections and informal support than those in
Japan (p =.000, p =.000).
IAGG 2017 World Congress
601
Conclusion: Despite there being a long-term care insur-
ance system in Japan and not Thailand, the condition of
family caregivers was better in Thailand than in Japan. We
conclude that social connection and informal support are
important factors of well-being for family caregivers.
CONTRIBUTING FACTORS FOR AVOIDABLE
HOSPITALIZATION IN SWISS NURSING HOMES
F.Zuniga1, T.Brunkert1, M.Giger1, M.Simon1,2, 1. Basel
University, Basel, Switzerland, 2. Nursing Research Unit,
Inselspital University Hospital Bern, Bern, Switzerland
The reduction of avoidable hospitalizations from nursing
homes (NHs) is a high priority because of the high human
and financial costs. Common hindering factors range from
the lacking diagnostic services and trained personnel in the
NH to patient and family wishes and the lack of individ-
ual advanced care plans or do-not-hospitalize orders. This
study reports the systematic assessment of barriers and facil-
itators of avoidable hospitalizations in a group of 20 pri-
vate NHs in Switzerland. The results are embedded in the
ProQuaS study, an implementation science project guided by
the Consolidated Framework for Implementation Research
(CFIR).
In a cross-sectional questionnaire survey in summer 2016,
20 NH directors, 34 ward supervisors and 61 registered
nurses (RNs) assessed the current situation. Over 70.6%
(95%-confidence intervals (CI): 0.52- 0.84) of the ward
supervisors considered it important to implement changes to
reduce hospitalizations, and 29.4% (CI: 0.16- 0.48) reported
to never or seldom have do-not-hospitalize orders discussed
with admitted residents. Moreover, 70.6% (CI: 0.52- 0.84)
agreed that emergency physicians lack of familiarity with the
resident at night or weekends is a central factor for hospitali-
zations. Similarly, only 67.8% (CI: 0.54- 0.79) of RNs state
that the assigned physician can be reached in time in emer-
gency situations. Overall, critical factors related to avoidable
hospitalizations include the clarification of residents wishes,
do-not-hospitalize orders and the availability of physicians.
Insights from this survey will guide the development of a
locally adapted intervention to reduce hospitalizations.
CURRENT STATUS OF DENTAL INTERVENTION
AND SAFETY MANAGEMENT IN THE DEMENTIA
WARD
A.Yamaguchi, S.Nozue, Y.Maruoka, T.Tsuneoka,
S.Hironaka, Y.Sato, K.Takahashi, Showa University,
Tokyo, Japan
Safety management in psychiatric medical care includes
issues of suicide, self-injurious behavior, accidents, medi-
cation errors, escape from the hospital, and unauthorized
overnight stays. Additionally, preventing asphyxia is a chal-
lenge in the dementia ward of our hospital. Dentists have
conducted intraoral examinations and evaluation of inges-
tion/swallowing function in patients, and have performed
dental interventions. As a result of the safety management
by the team medical care, the ward maintains 0 asphyxia.
Therefore, the oral function and dental intervention of recent
patients for higher safety management will be present. The
subjects were 229 hospitalized patients in the dementia ward
between April 2014 and December 2016. Using the medical
records, age, sex, primary disease, oral function, and details
602
of dental intervention were extracted. The subjects were
aged 5999years, and the ratio of men to women was 10:13.
Alzheimer type dementia was the most common disease,
accounting for 60% of the total. There were 66% of the all
patient who needed oral hygiene control and were able to
intervene. The patients who did not have occlusal support
in molars accounted for 47% of the total. Seventeen of the
80 patients who needed dental treatment were difficult to be
treated. The types of dental treatment were denture adjust-
ment / repair, denture construction, conservative treatment,
and teeth extraction under intravenous sedation. Extraction
was performed for prevention of accidental biting, ingestion,
and aspiration. The examining the background of patients
who experienced difficulties with dental intervention may
lead to improved safety management in future.
FACET JOINT OSTEOARTHRITIS INCIDENCE IS
ASSOCIATED WITH BACK PAIN IN OLDER ADULTS:
FRAMINGHAM STUDY
L.J.Samelson1, M.Jarraya2, D.P.Kiel1, M.S.Yau3,
T.Travison1, P.Suri4, A.Guermazi5, 1. Harvard Medical
School/Inst for Aging Research, Hebrew Rehab Ctr,
Boston, Massachusetts, 2. Mercy Hospital, Philadelphia,
Pennsylvania, 3. Hebrew SeniorLife, Boston, Massachusetts,
4. University of Washington, Seattle, Washington, 5. Boston
University Medical Center, Boston, Massachusetts
Back pain in older adults is a major public health prob-
lem, and facet joint osteoarthritis (FJOA) is commonly
treated as the source of this pain. Despite the clinical impor-
tance, little is known about the relation between longitudinal
changes in FJOA and pain symptoms. The purpose of this
study was to determine the association between incidence
of FJOA over 6yr, evaluated by CT, and self-reported back
pain in a community-based cohort. Participants included 885
cohort members of the Framingham Study: 491 women, 394
men, 4085 yr (mean=63 yr, SD=+8 yr). FJOA was graded
by a musculoskeletal radiologist (MJ) bilaterally from T4/
T5 to L4/L5 on baseline and follow-up CT images as: grade
0=normal, 1=mild, 2=moderate, or 3=severe. Incidence of
moderate/severe FJOA was defined as an increase at any spi-
nal level from grade 0 or 1 at baseline to grades 2 or 3 at fol-
low-up. During the follow-up period, participants reported
frequency of back pain (no, some, most, or all days/month
in the past year). 6-year incidence was 33% for moderate/
severe FJOA. 23% of participants reported having back
pain on some days/month, 7% on most days/month, and
13% on all days/month. Incidence of moderate/severe FJOA
increased with frequency of back pain: OR=1.00 (no back
pain), OR=1.06, 0.741.51 (some days/month), OR=1.24,
CI=0.722.14 (most days/month), OR=1.64, CI=1.072.50
(all days/month); trend, p=0.03. Our results suggest that CT
based findings of incident moderate/severe FJOA may have
clinical importance for prevention and treatment of back
pain in older adults.
A NEW APPROACH TO BENCHMARK CARE
PRACTICE BASED ON COSTS AND QUALITY OF
CARE: THE IBENC METHOD
H.G.van der Roest1, L.van Lier1, G.Onder3, V.Garms-
Homolova4, H.Finne-Soveri5, P.V.Jonsson6, J.Bosmans2,
H.van Hout1, 1. VU University Medical Center,
Amsterdam, Netherlands, 2. VU Amsterdam, Amsterdam,
Innovation in Aging, 2017, Vol. 1, No. S1
Netherlands, 3. Universit Cattolica del Sacro Cuore, Rome,
Italy, 4. Hochschule fr Technik und Wirtschaft, Berlin,
Germany, 5. National Institute for Health and Welfare,
Helsinki, Finland, 6. Landspitali, Reykjavik, Iceland
To achieve sustainability of our health care system, care
should be delivered more efficiently in the future to serve
the rapidly ageing population. Evidence-based restructuring
of systems should build on reliable benchmarks of the com-
bination of quality and costs of care. These currently lack.
A novel benchmark method on organizational efficiency in
home care was developed.
Longitudinal data were collected in the European IBenC
project among 2884 home care clients from 38 home care
organizations (six countries). Data-collection capitalized on
the comprehensive geriatric assessment instrument interRAI-
HC. Quality was expressed by the 11-point Independence
Quality scale (IQS) and Clinical Balance Quality scale
(CBQS), respectively reflecting quality of care aimed at func-
tional independence and engagement, and on functional
improvement. Higher scores indicating better quality. Cost
of care over six months were estimated by valuing resource
utilization with Dutch standard costs. Case-mix adjustments
were applied.
Quality varied between poor to good: IQS scores varied
between 2 and 7, CBQS between 4 and 8. Mean adjusted
costs were 21,004 (range 14,300-24,209). Per organiza-
tion outcomes were combined in the IQS-index and CBQS-
index. Index values of 1 indicate average quality against
average costs, higher values reflect better organizational
efficiency. IQs-index ranged between 0.49 to 1.74 and
CBQS-index between 1.00 and 1.66. The indexes had high
face-validity compared to the plotted costs and quality, and
discriminated between organizational efficiency.
The indexes permit for a new way of benchmarking,
opening up possibilities for unexplored areas of research and
knowledge in organizational performance and restructuring
care systems.
QUALITY INDICATORS RELATED TO MEAL
SATISFACTION AND ADEQUATE NUTRITIONAL
STATUS IN ELDERLY CARE
M.Skinnars Josefsson1, M.Nydahl1, I.Persson2,
Y.Mattsson Sydner1, 1. Department of Food, Nutrition
and Dietetics, Uppsala University, Uppsala, Sweden, 2.
Department of Statistics, Uppsala University, Uppsala,
Sweden
Studies of organizational prerequisites for nutritional care
practice and their effect on meal satisfaction and nutritional
status of older adults in residential care homes are scarce.
Guided by Donabedians model of quality of care, the aim
was to explore structure and process quality indicators of
nutritional care practice that predict residents meal satisfac-
tion and adequate nutritional status according to MNA-SF,
in Swedish elderly care. Data at municipal level from i) a
national questionnaire, ii) records from a quality registry
and iii) a benchmarking survey, were merged. Logistic and
multiple regression analyses included 117 municipalities
(of 290 in Sweden). Residence in rural and urban munici-
palities predicted meal satisfaction over city municipalities.
Independent structure indicators of meal satisfaction were
local food policy, cooking on-site and private meal provid-
ers, and independent process indicators were choice of meals
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Innovation in Aging, 2017, Vol. 1, No. S1
and residents possibility to influence the menu. Adequate
nutritional status was positively predicted by the structure
indicator availability of clinical/community dietitian and
the process indicator calculation of nutritional content of
meals. To conclude, a locally adapted organization adjusted
to residents choices, and availability of dietitians, benefit
meal satisfaction and nutritional status among older adults
in residential care homes. The results from this study can
benefit future interventions aiming to improve nutritional
care practice and serve as guidance for leaders in elderly care
organizations.
NEIGHBORHOOD FACTORS RELATED TO
FUNCTIONAL LIMITATIONS AMONG OLDER
ADULTS IN MEDICARE ADVANTAGE
D.H.Jung1, E.DuGoff1, W.Buckingham3, A.J.Kind2, 1. seasonal, and longitudinal factors. For instance, participants
Department of Population Health Sciences, School of
Medicine and Public Health, University of Wisconsin,
Madison, Wisconsin, 2. Department of Medicine, School
of Medicine and Public Health, University of Wisconsin,
Madison, Wisconsin, 3. Applied Population Laboratory,
Department of Community and Environmental Sociology,
University of Wisconsin, Madison, Wisconsin
Over 90% of older adults in the US report that they wish to
age in place. Preventing and mitigating functional limitations
is important for maintaining independence, but identifying
those who needs services and supports to remain independ-
ent is challenging for health plans. The Area Deprivation
Index (ADI) is a validated neighborhood-level measure of
socioeconomic disadvantage that has been associated with
mortality and hospital readmissions. The ADI could poten-
tially be harnessed to target those at risk for functional limi-
tations, yet the relationship between the ADI and functional
limitations has not previously been examined. This study
includes 182,796 Medicare Advantage beneficiaries aged 65
or older who participated in the Medicare Health Outcome
Survey in 2013. We used a multivariate linear probability
model accounting for the complex survey design to exam-
ine the association of high neighborhood-level disadvantage
(defined as ADI85th percentile) and any functional limita-
tions (1 or more difficulty with an activity of daily living
(ADL) or an instrumental ADL). We also examined whether
health, measured by number of chronic conditions, mediated
this relationship. In 2013, 1.3 million Medicare Advantage
beneficiaries were living in a high-disadvantaged neighbor-
hood, and these individuals were significantly more likely to
report any functional limitation compared to individuals liv-
ing in a less-disadvantaged neighborhood. Among individu-
als in high-disadvantaged neighborhoods, the probability of
reporting a functional limitation was significantly greater in
individuals with multiple chronic conditions, but the neigh-
borhood-level affect attenuated somewhat as the number of
reported chronic conditions increased. Health plans should
consider using a neighborhood-level measure of disadvan-
tage to target independent living interventions.
SPATIAL POLYGAMY IN LATER LIFE: THE MANY
GEOGRAPHIES OF AGING
J.Finlay, University of Minnesota, Minneapolis, Minnesota
Older adults lives are increasingly negotiated in, trans-
formed by, and informed through a broad range of physical,
IAGG 2017 World Congress
603
social, and emotional settings. Seated and mobile interviews
with community-dwelling older adults (n=125, mean age
71years) explored everyday contexts of aging in three dis-
tinct case studies of the Minneapolis (USA) metropolitan
area. Qualitative thematic analysis revealed that partici-
pants inhabited overlapping past and present contexts. They
exhibited spatial polygamy by being attached and exposed
to multiple contexts across space and time. Nested contexts
operated at the scale of the body, dwelling, surveillance zone
(watchful spaces visible and/or audible from the home),
neighborhood, and beyond spaces (meaningful distal loca-
tions such as past employment sites and travel destinations).
These dynamic, multi-scalar spaces provided both change
and stability over time. Temporal context importantly
shaped participant experiences of aging, such as diurnal,
demonstrated differing perceptions of neighborhood safety
in the day versus night; climactic variation posed seasonal
challenges and vulnerabilities; and objects around the home
evoked rich imaginative connections to the past. Participants
everyday lives were bimodal in time and space, with clusters
of activity spent in distinct locales at specific times. The find-
ings enrich environmental gerontology by attending to over-
lapping socio-physical contexts that range from the intimate
scale of the body to broader community settings. Analyses
integrate often-overlooked temporal elements that frame
and calibrate spatial experiences of aging. The observations
illustrate aging as a complex geographic process that evolves
dynamically through time and space.
PROVIDING CARE TO PARENTS IN KOREA:
FILIAL PIETY, RECIPROCITY, AND PARENT-CHILD
RELATIONSHIP QUALITY
K.Ko, A.Chapman, University of Missouri-Columbia,
Columbia, Missouri
Adult childrens attitudes towards caring for aging par-
ents are important to predict their caregiving behavior.
Using 2006 EASS (East Asian Social Survey), this study
examined how caregiving activities in South Korea can be
explained by three major factors: filial piety, reciprocity,
and parent-child relationship quality. The result of multi-
ple logistic regression showed that adult children who were
given more support from parents and who had better rela-
tionship quality with parents were more likely to provide
caregiving. However, filial piety representing traditional
value of supporting parents was not significantly related
to adult childrens caregiving behaviors. These results have
great implications for contemporary South Koreans. First,
emphasizing the importance of filial piety may not be inef-
fective for adult children to care for their parents. This can
imply that the traditional norm of piety has weakened as
South Korea has experienced rapid social changes under
the influences of economic growth and globalization.
Second, reciprocity, a concept rooted in social exchange
theory, may be more popular rationale of exchanging inter-
generational support between parents and adult children,
which can be regarded as westernization. Third, parents
should be encouraged to develop and maintain good rela-
tionships with their adult children, which can increase the
possibility to get supported too.
604
CHARACTERISTICS OF OPINION LEADERS AND
BOUNDARY SPANNERS IN LONG-TERM CARE
W.B.Berta1, J.Keefe2, L.Cranley1, D.Taylor3, E.McAfee2, two rural communities in Jeju to collect qualitative data. The
G.Thompson4, J.Baumbusch5, J.Profetto-McGrath6, 1.
University of Toronto, Toronto, Ontario, Canada, 2. Mount
Saint Vincent University, Halifax, Nova Scotia, Canada,
3. Interior Health, Kelowna, British Columbia, Canada,
4. University of Manitoba, Winnipeg, Manitoba, Canada,
5. University of British Columbia, Vancouver, British
Columbia, Canada, 6. University of Alberta, Edmonton,
Alberta, Canada
The Advice Seeking Networks in Long Term Care Study
used social network analysis to understand the informal
advice networks of senior leaders in Canadian long term care
(LTC), with the goal of using this knowledge to inform future
efforts to more effectively disseminate quality improvement
innovations. In this abstract we describe one main compo-
nent of the study, a qualitative analysis of interviews con-
ducted with 39 opinion leaders, boundary spanners, and
advice seekers identified in interpersonal advice networks in
the sector. At each of the 958 LTC facilities spanning 11 of
Canadas 13 provinces and territories, we asked one senior
leader to complete a survey identifying individuals who were
informal sources of advice about quality improvement. The
survey data from 482 respondents was then used to iden-
tify and interview network advice seekers by their out-degree
scores, opinion leaders by their in-degree scores, and bound-
ary spanners by their betweenness centrality scores. Results
from thematic analysis of the interviews indicated that
advice seekers tend to seek advice from those with whom
they deem trustworthy and knowledgeable and with whom
they share similar professional backgrounds and care philos-
ophies. Opinion leaders possess an appetite for change and
a strong sense of responsibility for improving care through-
out the LTC system. They often have career trajectories that
move them from clinical to administrative or oversight roles.
Advice seeking relationships often endure over many years,
transcending roles and even care sectors, and can evolve into
reciprocal relationships.
BARRIERS OF CREATING AGE FRIENDLY
ENVIRONMENTS
E.Hwang1, S.Lee2, S.Koh2, 1. Virginia Tech, Blacksburg,
Virginia, 2. Jeju Development Institute, Jeju, Korea (the
Republic of)
The purpose of this study was to understand barriers and
supporters of creating age friendly environments. WHOs
Age Friendly Cities (AFC) initiative has highlighted the
importance of eight aspects including three built environ-
mental features (i.e., housing, outdoor spaces and buildings,
and transportation); five social environmental features (i.e.,
social participation, respect and social inclusion, and civic
participation and employment, communication and health
services, and community support and health services).
To understand how these AFC aspects affect seniors
wellbeing in Jeju, South Korea, we used a mixed method
approach and collected both quantitative data on seniors
perception on AFC (n=500) and qualitative data asking bar-
riers creating AFC. In our quantitative data analysis, seniors
perceived that respect and social inclusion, social par-
ticipation, and outdoor space and buildings as the most
Innovation in Aging, 2017, Vol. 1, No. S1
important aspects. After quantitative data collection, we con-
ducted six focus group interviews (n=43) in four urban and
qualitative data showed that the most frequently stated bar-
riers of creating AFC were related to the built environmental
aspects both in urban and rural communities. The emergent
themes based on qualitative data analysis were involved with
sidewalk design, pedestrian safety, traffic lights, bus drivers
attitude and bathroom design. Our findings are integrated to
explain supporters and barriers in creating AFC.
THINKING GLOBALLY, ACTING LOCALLY FOR AGE-
FRIENDLINESS: THE AGE-FRIENDLY DC INITIATIVE
M.Rosenberg1, G.Kohn2, N.Kushner2, 1. Centre for
Health Development, World Health Organization, Kobe,
Hyogo, Japan, 2. District of Columbia Office of the Deputy
Mayor for Health and Human Services, Washington,
District of Columbia
Ageing and urbanization are among the most trans-
formative demographic dynamics of the 21st century. In
order to ensure that urban environments are responsive
to the needs of residents across their life course, the World
Health Organization (WHO) promotes the creation of Age-
Friendly Cities and Communities. During 20122015, WHO
conducted research to develop a set of core indicators of
age-friendliness which measure the physical and social envi-
ronment, quality of life, and equity. As part of this project, a
study was conducted to measure these indicators in 15 com-
munities worldwide. Washington, DC was one of the test
sites. Some of the key findings from the indicator assessment,
which was led by Age-Friendly DC staff with the coopera-
tion of the Mayor-appointed Task Force and several govern-
ment agencies, were that when inequities could be analysed
there were profound differences across race and income.
Importantly, this focus on equity revealed the need for more
disaggregated data by age and geography at the local level.
Subsequently, the WHO core indicators informed the devel-
opment of the Age-Friendly DC Livability Survey, which
was conducted in 2016 to track progress in implementing
the Age-Friendly DC Strategic Plan. The survey found that
progress was being made in home internet access while
improvement is still necessary in the wheelchair accessibil-
ity of homes. The Age-Friendly DC initiative is exemplary of
how the outcomes of the global project to develop metrics
for age-friendliness were translated into local strategic plans
and actions to create an age-friendly urban environment in
the nations capital.
WORK OR WALK? ANATIONAL MIXED-METHOD
STUDY OF MATURE AGE WORKERS AND RETIREES
J.Irving, C.Kulik, School of Business, University of South
Australia, Stirling, South Australia, Australia
The economic challenges of an aging population have led
to many countries introducing policies intended to reduce
older peoples dependency upon the state and the age pension,
through accumulation of superannuation (and other assets)
and encouragement to remain in the labor force longer. The
Work, Care, Health and Retirement project is a three year
government and industry funded mixed-method study that
explores the implications of these policies, while identifying
how men and women can be supported to remain in paid
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
work while enjoying high levels of health and wellbeing.
Selected findings from the national cross-sectional survey (n=
2,100) and qualitative interviews (n=100) with Australian
men and women age 45 years and over will be presented.
This poster will describe the main triggers to initiating vol-
untary retirement, factors associated with retirement age
(such as gender, health, assets, industry and occupation) and
what conditions may have delayed the decision to withdraw
permanently from paid employment. This poster will also
discuss dominant characteristics of older workers (65years
and over) including the type of work they undertake, how
they work, and why they continue to participate in paid
work past the traditional retirement age.
CONTRIBUTION OF WISDOM TO CHINESE ELDERS
WELL-BEING
E.O.Chow, J.Cheung, City University of Hong Kong, Hong
Kong, Hong Kong
Wisdom is an important asset of elders and has been
shown to be related to wellbeing, but it is not clear whether
wisdom affects wellbeing or wellbeing affects wisdom. The
relationship between wisdom and wellbeing has not be
largely researched in an Asian cultural context and this study
is the first of its kind. To clarify the relationships, this study
utilized baseline data from a questionnaire of 142 Chinese
community dwelling older adults aged 60 and above, invited
in all the 18 districts in Hong Kong. The analysis controlled
for the elders mastery, social support received, and a num-
ber of background characteristics. Results show that wisdom
derived from inspirational engagement social relations can
contribute to older adults self-esteem; whilst wisdom derived
from emotional management dealing with life situations
can contribute to life satisfaction. Social support continued
to play an important role in Chinese older adults wellbeing,
the primary caregivers support contributed to the elders life
satisfaction unconditionally, whilst non-caregivers support
indicated a contribution to life satisfaction contingent on the
elders instrumental dysfunction. The results thus imply that
helping older adults to make social contributions and man-
age life situations can improve wellbeing in later life
THE AGE-FRIENDLY NEIGHBORHOOD STRATEGY
APPLIED IN MOOCA (SO PAULO, BRAZIL)
B.Graeff, M.Bestetti, M.A.Domingues, University of So
Paulo, So Paulo, Brazil
In So Paulo, Mooca is a traditional Italian immigra-
tion neighborhood where 19% of the inhabitants are 60+
years, a high percentage compared to the Brazilian popu-
lation. This qualitative research was intended to mobilize
workers and elderly inhabitants from Mooca, and to ana-
lyze their perceptions about the neighborhood through Age-
friendly cities program method proposed by the World Heath
Organization (2007). Acommittee composed by researchers,
representatives of the public administration, and civil society
followed the implementation of the project, and assisted in
the organization of 8 focal groups: 2 groups of elderly aged
6075 years, 2 groups of elderly aged 76+ years, 2 groups
with professionals, and 2 groups of elderly people of vary-
ing ages, totaling 44 participants (29 women and 15 men).
About living in Mooca being an older person, the partici-
pants highlight as positive aspects the identity and tradition
IAGG 2017 World Congress
605
of the neighborhood, where people still know each other. As
negative points, they mention: irregular sidewalks, flooding
areas, the presence of homeless people, lack of green areas
and non-adaptation of residential buildings for the needs of
the elderly. Difficulties in obtaining participants aged 76+
years suggest that older adults have more difficulty par-
ticipating in activities outside their homes. Many of them
revealed they were caring for other elderly or grandchildren.
Elderly participants demonstrated satisfaction in collaborat-
ing with the research, proposing that meetings should be per-
manent, revealing a demand for greater social interaction.
FINDING RABBIT HOLES WITHOUT FALLING
IN: NAVIGATING PALLIATIVE CARE POLICY IN
CANADIAN LONG-TERM CARE
D.Taylor1,2, J.Keefe2, L.Tay2, B.Parker1, K.Delaney2,
H.Cook1, 1. Research, Interior Health Authority, Kelowna,
British Columbia, Canada, 2. Mount Saint Vincent
University, Halifax, Nova Scotia, Canada
Canada has one of the most regulated policy-laden long-
term care (LTC) systems in the world. While there is noble
intent, the high volume of policies creates ambiguity for
knowledge users on how to provide quality end of life care
for residents. More importantly, the desires of residents and/
or their families for quality of life often get lost in the jun-
gle of rules and regulations. Our research team titled SALTY
(Seniors: Adding Life to Years) is assessing the complex inter-
play of LTC policies that influence palliative care. To date,
we have collected 275 LTC related policies and influencing
documents in four Canadian provinces and by using a policy
analysis framework from NCCHPP (National Collaborating
Centre for Healthy Public Policy), we plot each in a logic
model (NCCHPP) according policy function, sphere of influ-
ence (e.g., health authority, provincial, federal) and geogra-
phy. Using a hermeneutics content analysis approach, each
policy is examined using Kanes (2006) 11 domains for meas-
uring quality of life. This iterative process reveals both the
extent to which policies have residents quality of life at the
forefront and its intended and unintended effects on other
factors in the logic model. In this poster, we describe the duel
framework used to structure the policy analysis aimed at
adding life to years within a palliative approach. We present
our preliminary results of palliative care exemplary policies,
gaps, and tensions between what should be done (system)
and what is preferred (resident choice) depending on the cir-
cumstances and geography.
OLDER PERSONS AND MEDICAL CANNABIS USE
J.Bobitt1, B.P.Kaskie2, K.Arora2, K.Shannon2,
G.Milavetz2, 1. Interdisciplinary Health Sciences,
University of Illinois at Urbana-Champaign, Champaign,
Illinois, 2. The University of Iowa, Iowa City, Iowa
While researchers have begun to illuminate critical public
health issues concerning the increasing availability of can-
nabis, there have been few glimpses into the use of medical
cannabis among older persons. The extent to which persons
over 65 take medical cannabis has not been documented,
nor have any of the associated outcomes. Do older adults
who take medical cannabis for managing pain substitute
cannabis for prescription opioids? Do older adults who take
medical cannabis experience any negative side effects? This
606
research sought to close the gap in what is known about
the use of medical cannabis among older persons and learn
more about how cannabis impacts quality of life. In analyz-
ing information provided by 80 purposively selected focus
group participants across 4 Midwestern states, we found
that approximately 3.7% reported taking recreational can-
nabis, 12.5% reported taking medical cannabis, and 18.7%
reported taking cannabis for both medical and recreational
purposes. While the majority of respondents, 65%, reported
no cannabis use in the past year, most indicated they would
consider taking cannabis for medical purposes, especially
if other means of controlling pain or other medical condi-
tions were not effective. Additional information provided
by the focus group participants highlighted the critical role
that health care professionals play in providing information
about the use of medical cannabis.
INTEGRATIVE GROUP MOVEMENT FOR PEOPLE
WITH DEMENTIA AND CARE PARTNERS: INITIAL
QUALITATIVE FEEDBACK
J.J.Casey1, K.L.Harrison1,2, W.Mehling1,2, D.E.Barnes1,2, with LGBT people, adjustment to recent coming out, and
1. Mental Health, San Francisco VA Medical Center, San
Francisco, California, 2. University of California, San
Francisco, San Francisco, California
Paired PLI (Preventing Loss of Independence through
Exercise) is a behavioral intervention that integrates physical,
mental and social activities into a multi-modal, group move-
ment program for pairs of people with dementia and care part-
ners. This process evaluation aimed to examine care partners
observations and reactions to the Paired PLIE Program as part
of a larger RCT. Three pairs completed up to 24 in-person
classes and home practice (weekly handouts with themes for
reflection and practice). Data included care partners daily
written logs, weekly responses to home practice handouts, and
emails received after program completion. Themes were cat-
egorized as physical, cognitive, and social/emotional based on
prior work, and sub-themes were identified through an itera-
tive, collaborative process. Physical functioning: care partners
observed functional improvement and less symptomatic dis-
comfort in both partners (e.g., dyad 3, week 9: He could get up
even without optimal chair and cushion.) Cognitive function-
ing: care partners observed heightened engagement and focus
in affected individuals (e.g., dyad 2, week 4: He finished two
crosswords completely (this was never done prior).) Social/
emotional functioning: care partners observed greater connec-
tion to the affected individual and lower stress in both partners
(e.g., dyad 1, week 2: helped me relax and feel less stress.)
Two care partners noted that the PLIE program, especially the
home practice component, added burden (e.g., dyad 3, week
9: Neither of us was into doing more than [a] short time.)
For future groups, the home program will be revised and de-
emphasized to maximize benefits and minimize burdens.
LONELINESS AND THE HEALTH AND WELL-BEING
OF LGBT SENIORS
M.Hughes, School of Arts and Social Sciences, Southern
Cross University, Coolangatta, New South Wales, Australia
Recent research has identified higher rates of loneliness
among older lesbian, gay, bisexual, and transgender (LGBT)
people than one would usually expect to find in the gen-
eral population. In an Australian survey of the health and
Innovation in Aging, 2017, Vol. 1, No. S1
wellbeing of 312 LGBT people aged 50 and over, loneliness
was associated with living alone, not being in a relationship,
higher psychological distress, and lower mental health. Those
who experienced the greatest degree of loneliness were much
more likely than those who were less lonely to want to par-
ticipate in social and health promoting activities with other
LGBT people. This poster presents the most recent detailed
analysis of a subset of 18 people in this study who reported
the highest degree of loneliness, and explores their qualita-
tive responses to questions on their connections with friends
and family, participation in community groups, and interest
in participating in future social and health promoting activi-
ties. While facing many challenges, most of these participants
reported that they have a friend they can rely on in a crisis
and that they are engaged in some social activities, as well as
activities to promote their health and wellbeing. Nonetheless,
many wanted to socialise more, have more companionship,
experience an intimate relationship, develop their spiritual-
ity and exercise more. Barriers to engaging in these activities
included anxiety, depression, not knowing how to connect
physical health issues.
IMPACT OF INFORMAL CARE, TRAVEL DISTANCE,
AND STRESS ON RETIREMENT DECISION MAKING
S.Vasireddy2, I.Sanidad3, L.H.Nitz1, 1. University of
Hawaii at Manoa Departmeent of Political Science,
Honolulu, Hawaii, 2. University of Hawaii Department
of Economics, Honolulu, Hawaii, 3. University of Hawaii
Department of Sociology, Honolulu, Hawaii
Established literature informs us that caring for the elderly
living over a distance can be a stressful for the caregivers. We
add to this literature by showing the impact of distance on
reported physical, emotional and financial stress levels, and
further show that this distance can have a negative impact
on the retirement decision-making of care providers. Using
data from the Caregiving in the United States, 2015 sur-
vey conducted by the National Alliance for Caregiving and
AARP Public Policy Institute, we find that increased distance
between the care-giver and the recipient living outside the
household significantly increased the burden of care-giving
stress on the provider. This is especially significant for those
over fifty years of age and providing care. However, those
who are caring for elderly inside their household also report
high stress levels.
Our findings indicate that among women, those with par-
ents residing within 20 minutes of travel are least likely to be
stressed out emotionally and financially, and are less likely to
report care-giving as a reason for retirement than those with
parents living further away. The likelihood of early retire-
ment among women seems to increase substantially with an
increase in their travel-time to elderly care recipients and is
negatively related to income levels, possibly due to improved
access to transport and paid-care services.
INTERGENERATIONAL FORUM TO ENHANCE
STUDENTS ENGAGEMENT AND ELDERS
LEARNING OUTCOMES
O.Lee, University of North Carolina Charlotte, Charlotte,
North Carolina
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
The Intergenerational Forum (IF) was an innovative inter-
vention that engages college students in conducting commu-
nity-based participatory research (CBPR). This set of guided
learning opportunities was designed to improve college
students understanding of aging and health issues in their
communities. In this study, a total of 252 mentoring hours
were provided in kind by 78 students. The majority of these
youth volunteers were aspiring health professionals who had
received intensive academic and field training to strengthen
their interpersonal skills and ability to build meaningful one-
on-one relationships. Fifty five low-income older adults (with
mean age of 73)participated in the six-session IF tutorials.
Findings revealed that as a result of IF, students were able
to improve their knowledge and attitudes toward work-
ing with older people measured by Facts on Aging Quiz.
(t=8.28, p<001). Students were able to combined ideas from
courses when completing this IF assignment. Particularly,
levels of active and collaborative learning were enriched by
engagement with people representing different economic
backgrounds (t =4.46, p<001 and religious beliefs (t =3.91,
p<.001). Major themes emerged in students narrative data
revealed their learning outcomes in the areas of self-aware-
ness, empathy, empowerment, and new perspectives about
ageism.
Older adults presented significant improvement between
pretest and posttest in various outcomes such as ehealth lit-
eracy (t=-4.61, p<001)). anxiety about technology (t=2.37,
p<.01), self-efficacy (t=-7.52, p<.001), self-confidence (t=-
3.11, p<.001), and social connections (t=7.53, p<.01). Hence,
the IF produced synergistic effect by improving older adults
utilization of health information and strengthening cultural
competency among youths.
AGING IN THE ERA OF AIR TRAVEL: IMPROVING
THE ACCESSIBILITY OF AIRPORTS FOR TRAVELERS
WITH DEMENTIA
M.T.OReilly1,2, N.Shepherd2,3, H.Edwards3, J.Franz3,
L.Willmott3, E.Fielding2,3, E.R.Beattie2,3, 1. Occupational
Therapy, CQUniversity, Bundaberg, Queensland, Australia,
2. Dementia Collaborative Research Centre: Carers &
Consumers, Brisbane, Queensland, Australia, 3. Queensland
University of Technology, Brisbane, Queensland, Australia
Many older people enjoy travelling for leisure, air travel
included. To increase the self-determination and independ-
ence of people living with dementia we need to reduce the
barriers to participation in all areas of life, including leisure.
We used an exploratory, mixed method research design to
learn about the experiences of people with dementia when
they travel. This included online surveys with 82 people (7
people with dementia, 41 travel companions, 21 flight crew
and 13 security staff). Ten of the companions who completed
the survey volunteered to participate in a qualitative tel-
ephone interview. This was followed by an assessment of the
physical environment of an airport in a major Australian city
using the Dementia Friendly Communities Environmental
Assessment Tool (DFC-EAT) (Fleming & Bennett, 2015).
The survey results showed that people with dementia and
their travelling companions found navigating airport pro-
cesses and designs the most challenging part of air travel,
in particular security and immigration procedures. Using the
DFC-EAT we identified problematic design features such
IAGG 2017 World Congress
607
as poor signage and blurred boundaries between retail and
travel spaces that contributed to confusion at the airport.
Efforts have been made to modify built environments to
promote accessibility for people with physical disability, yet
there has been comparatively little done for those with cogni-
tive impairments. People with dementia need to have access
to physical spaces that allow them to participate in a wide
range of social activities. Improving the accessibility of trans-
port hubs, such as airports, is an important way to facilitate
social inclusion.
WHO AGE-FRIENDLY CITIES AND COMMUNITIES:
THE KOREAN EXPERIENCE
J.Woo, M.Choi, Korea Advanced Institute of Science and
Technology (KAIST), Daejeon, Korea (the Republic of)
In 2010, the World Health Organization (WHO) cre-
ated the WHO Global Network of Age-Friendly Cities and
Communities, a global network of cities that are commit-
ted to using the WHO guidelines to make their community
more age-friendly. For the last seven years, the Network has
grown to include 380 cities in 37 countries; however, little
has been known about how the guidelines have been adopted
and implemented in Asian countries given that the majority
of cities and communities in the Network are in the Western
world. This study aims to explore the social, political, and
cultural forces that have led the cities in South Korea, the
fastest aging country and also one of few developed coun-
tries in Asia, to join the Network. Aseries of interviews with
stakeholders such as the public administrators of the four cit-
ies in the NetworkSeoul, Jeongeup, Suwon, and Busan
have been conducted and subjected to a content analysis in
January/February 2017. The primary findings are threefold:
(1) Among the three factors analyzed, political motivation
held the greatest sway; (2) the driving force behind the politi-
cal motivations took several forms, from election year plat-
forms to a new local government department needing to find
work projects for itself; (3) Finally, implementation patterns
showed great variability between the metropolitan cities and
the self-governing cities. This study contributes to closing the
knowledge gap in age-friendly initiatives in Asia, and future
research needs to compare factors affecting the participa-
tion in the Network between countries within and across
continents.
AGING IN CUBA AND PUBLIC POLICY RESPONSES:
ANALYZING NEWLY RELEASED SURVEY MATERIALS
B.Destremau, CNRS/ Iris / EHESS, Paris, France
Quantitative data recently released on various facets of
Cubas aging process allows to draw new analyses on sev-
eral demographic and socioeconomic dimensions of the phe-
nomenon, as well as policy responses and their effects. This
new data will be put in relation with results of sociological /
ethnographic qualitative surveys conducted in Cuba (mainly,
but not exclusively Habana) since 2009 and until 2016.
With a view on gender gaps, the poster will thus articulate
new quantitative and qualitative data concerning:
-The extent and facets of Cubas aging process, namely
life expectancy, fertility, epidemiology/morbidity, demo-
graphic growth and population structure.
-The sociodemographic profile of the care issue, especially
aging persons household composition, migration, caregivers
608
aging, elders isolation, public care supply, and the socioeco-
nomic biases of the incipient care market.
-The components of the elderlys socioeconomic condition
public problem, contrasting a high level of access to public
health and social services and informal community and fam-
ily support, on the one hand, and a widespread monetary
and material destitution, and its public policy responses, on
the other.
These innovative results will demonstrate the specificity
of the challenges posed to public policies by Cubas aging
process, and assess the responses brought by institutions and
social / community organisations. The poster will finally dis-
cuss research results in terms of public policy options and
models.
SESSION 1075 (SYMPOSIUM)
PREDICTORS OF HEALTH EXPECTANCY ACROSS
MULTIPLE COHORTS FROM THE U.S. AND EUROPE
Chair: S.Stenholm, University of Turku, Turku, Finland
Discussant: J.Robine, Inserm
Health expectancy is a useful summary measure that
captures both the quantity and quality of life. This con-
cept takes into account both morbidity and mortality and is
therefore useful in comparing the health of different popu-
lations and population sub-groups. The objective of this
symposium is to discuss the predictors of health expectancy
using data from large cohort studies from Europe and the US.
The cohorts included are the English Longitudinal Study of
Ageing, Finnish Public Sector Study, French GAZEL cohort,
Swedish Longitudinal Occupational Survey of Health and
the US Health and Retirement Study. Partial health expec-
tancy from ages 50 to 75 is estimated in each cohort by using
multiple repeat measures of self-rated health and chronic dis-
eases. Dr. Head will open the symposium by introducing the
methodology used in estimating health expectancy, namely
multistate life tables and micro-simulation. She will also
present results related to social inequalities in health expec-
tancy across cohorts. Dr. Zaninotto will show associations
of health expectancy with lifetime socio-economic status. Dr.
Stenholm will present the independent and combined effect
of health behaviors on health expectancy. Finally, Dr. Platts
will describe differences in health expectancy in relation to
physical and psychosocial work exposures. Taken together,
this symposium demonstrates the importance of socio-
economic status, health behaviors and work exposures in
midlife on health development in advancing age.
SOCIOECONOMIC DIFFERENCES IN HEALTHY
LIFE EXPECTANCY: EVIDENCE FROM FOUR
PROSPECTIVE COHORT STUDIES
J.Head1, H.Chungkham2, M.Hyde3, P.Zaninotto1,
S.Stenholm4, M.Zins5, J.Vahtera4, H.Westerlund6, 1. UCL,
London, United Kingdom, 2. Indian Statistical Institute,
Tezpur, India, 3. University of Manchester, Manchester,
United Kingdom, 4. University of Turku, Turku, Finland,
5. INSERM, Paris, France, 6. University of Stockholm,
Stockholm, Sweden
There are striking socioeconomic differences in life
expectancy, but less is known about inequalities in health
Innovation in Aging, 2017, Vol. 1, No. S1
expectancies. We estimated differences in healthy life expec-
tancy and chronic disease-free life expectancy using data
from four European longitudinal studies for two health
indicators: (i) sub-optimal self-rated health and (ii) having
a chronic disease Socioeconomic position was measured by
occupational position and grouped into high, medium and
low grade occupations. Multistate life table models were used
to estimate healthy life expectancy and chronic disease-free
life expectancy from ages 50 to 75 by occupational position
and sex. In all four cohorts, we found inequalities in healthy
life expectancy between ages 50 to 75 according to occu-
pational position such that men and women in the higher
occupational positions had higher healthy life expectancy
compared to those in low occupational positions. Similarly,
there were occupational differences in chronic disease-free
life expectancy in all four cohorts.
SOCIOECONOMIC INEQUALITIES IN HEALTHY
LIFE EXPECTANCY AT OLDER AGES: COMPARING
ENGLAND WITH THE U.S.
P.Zaninotto1, D.Batty1, H.Westerlund2, M.Goldberg3,
J.Vahtera4, S.Stenholm4, J.Head1, 1. Epidemiology
and Public Health, UCL, London, United Kingdom, 2.
Stockholm University, Stockholm, Sweden, 3. Inserm, Paris,
France, 4. University of Turku, Turku, Finland
This study uses data from the Health and Retirement
Study (HRS) in the US and the English Longitudinal Study of
Ageing (ELSA) in England, to describe health life expectancy
by lifetime socioeconomic status. Multistate life table mod-
els were used to estimate sex-specific health expectancy from
ages 50 and over using longitudinal data from 2002 to 2012
and mortality up to early 2013. Three measures of health
life expectancy are used: healthy life expectancy defined
as excellent, very good and good health; disability-free life
expectancy defined using no limitations with activity of daily
living and instrumental activity of daily living and chronic
disease-free life expectancy. We used fathers socioeconomic
position in childhood and wealth, income and social class at
older age to construct a measure of life-time socio-economic
status. We also explore which of the socio-economic measure
is more strongly associated with health life expectancy in the
UK and US.
SMOKING, PHYSICAL INACTIVITY, AND OBESITY
AS PREDICTORS OF HEALTH EXPECTANCY:
AMULTICOHORT STUDY
S.Stenholm1, J.Head2, M.Kivimaki2,7, I.Kawachi3,
V.Aalto4, M.Goldberg5, H.Westerlund6, J.Vahtera1, 1.
University of Turku, Turku, Finland, 2. University College
London, London, United Kingdom, 3. Harvard T.H. Chan
School of Public Health, Boston, Massachusetts, 4. Finnish
Institute of Occupational Health, Turku, Finland, 5. Inserm,
Villejuif, France, 6. Stockholm University, Stockholm,
Sweden, 7. University of Helsinki, Helsinki, Finland
This study examined the extent to which smoking, physi-
cal inactivity and obesity individually and in combination
predict health expectancy in four European cohort stud-
ies. Data were drawn from repeated waves of the Finnish
Public Sector Study, GAZEL (France), Swedish Longitudinal
Occupational Survey of Health, and Whitehall II (UK).
Multistate life table models were used to estimate sex-specific
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Innovation in Aging, 2017, Vol. 1, No. S1
healthy life expectancy and chronic disease-free life expec-
tancy from ages 50 to 75years. Compared to men and women
with at least two behavior-related risk factors, those with no
behavior-related risk factors could expect to live on average
eight years longer in good health and six years longer free of
chronic diseases between ages 50 and 75. Having any sin-
gly risk factor was also associated with reduction in healthy
years. Of the individual behavior-related risk factors, physi-
cal inactivity was associated with the greatest reduction in
healthy years and obesity with greatest reduction in chronic
disease free years.
HEALTH EXPECTANCY BETWEEN AGES 5075 IN
RELATION TO PHYSICAL AND PSYCHOSOCIAL
OCCUPATIONAL EXPOSURES
L.G.Platts1, L.L.Magnusson Hanson1, J.Head2, GSA report and Summit, Maslow will discuss the KAER
S.Stenholm3,4, H.Singh Chungkham5, M.Zins6,7, 1. Stress toolkit developed for use and dissemination at the Summit,
Research Institute, Stockholm University, Stockholm,
Sweden, 2. University College London, London, United
Kingdom, 3. University of Turku, Turku, Finland, 4. Turku
University Hospital, Turku, Finland, 5. Indian Statistical
Institute, North-East Centre, Tezpur, India, 6. Inserm,
Villejuif, France, 7. Versailles St-Quentin University, UMS
011, Villejuif, France
While poor working conditions increase morbidity, no
studies have quantified how much poor psychosocial and
physical working conditions reduce health expectancy. We
examined this using four cohorts: Finnish Public Sector
Study (Finland), GAZEL (France), Swedish Longitudinal
Occupational Survey of Health (Sweden), and Whitehall II
(UK). Data on job strain (high demands combined with low
control) were available for 64,533 individuals across the
cohorts. Physical occupational exposure data (ergonomic
strain, physical danger, night work, company records of
workplace accidents and a job-exposure matrix of chemical
exposures) were obtained for 13,393 male GAZEL cohort
members. Partial health expectancies (age 5075) relating to
1) self-rated health and 2) chronic health conditions were
estimated using multistate life tables. Job strain was related
to shorter healthy life expectancy and less consistently with
shorter chronic disease-free life expectancy. Physical occupa-
tional exposures apart from night working were associated
with shorter healthy and chronic disease-free life expectancy.
SESSION 1080 (SYMPOSIUM)
GERONTOLOGICAL SOCIETY OF AMERICAS
COGNITIVE IMPAIRMENT DETECTION AND
EARLIER DIAGNOSIS INITIATIVE
Chair: R.H.Fortinsky, University of Connecticut, Old
Lyme, Connecticut
Discussant: J.Simmons, Eli Lilly and Company,
Indianapolis, Indiana
In January, 2015, the Gerontological Society of America
(GSA) released a report by an expert Workgroup aimed at
increasing detection and diagnosis of cognitive impairment
in older adults by primary care practitioners. This report
included recommendations in the form of a 4-step process to
help improve the detection and diagnosis rate and spur refer-
rals of older adults and their families to dementia-capable
IAGG 2017 World Congress
609
community resources that are widely available but little
known to primary care practitioners. The process, known
as KAER, includes: Kick-starting brain health conversation,
even among asymptomatic older patients; Assessing for cog-
nitive impairment using tools that are brief, validated, no
cost, and easily available; Evaluating for dementia diagno-
sis by referring to clinical specialists or following clinical
practice guidelines; and Referring diagnosed patients and
families to community resources for further education and
support. The report also recommended a national Summit of
primary care practitioners and health system representatives
to develop action plans for disseminating and implementing
the KAER process in primary care practices. This national
Summit is scheduled for August, 2016. In the proposed
Symposium, Fortinsky will provide greater detail about the
and Kobylarz will present on the usefulness and impact of
the Summit and KAER materials on Summit attendees based
on surveys they will complete before and after the Summit.
Discussant Simmons will place this GSA KAER initiative
within the broader context of efforts to improve dementia
care for older adults.
OVERVIEW OF THE GSA KAER REPORT,
RECOMMENDATIONS, AND NATIONAL SUMMIT
R.H.Fortinsky, UConn Center on Aging, University of
Connecticut, Old Lyme, Connecticut
This presentation will provide a synopsis of the
Gerontological Society of America (GSA) report and recom-
mendations to promote cognitive impairment detection and
earlier diagnosis of dementia in the primary care setting in
the United States. The health policy context for this report
in the form of the Medicare Annual Wellness Visit (AVW)
will be explained, along with a summary of the Workgroups
activities to gather evidence about cognitive impairment
assessment tools to recommend in the report. The reports
recommended 4-step KAER framework will be explained
as a guide for primary care practitioners as they navigate
the challenging process of discussing and clinically evaluat-
ing cognitive health and impairment with older patients and
their families. Finally, proceedings from and action plans
developed at the national Summit of health care providers
and health to help implement the KAER framework will be
summarized.
TOOLKIT TO ASSIST PRIMARY CARE
PRACTITIONERS WITH THE RECOMMENDED
4-STEP KAER PROCESS
K.Maslow, Gerontological Society of America, Washington,
District of Columbia
The GSA Workgroup created a compendium of tools and
procedures to help PCPs implement the 4 steps in the KAER
process: Kick-start the conversation about brain health;
Assess for cognitive impairment, Evaluate for dementia,
and Refer for community resources. The toolkit is includes
a selection of tools and procedures so that PCPs in single-
person offices, multi-physician practices, and health care sys-
tems will be able to choose the tools and procedures that fit
best with their existing primary care practices. This presen-
tation will discuss the structure and content of the toolkit,
610
the topics for which appropriate tools were more and less
difficult to find, and responses to the toolkit from PCPs and
administrators of health plans and health care systems who
participated in the GSA KAER Summit.
RESULTS OF THE KAER SUMMIT SURVEY:
CHALLENGES AND SUCCESSES
F.Kobylarz, Rutgers Robert Wood Johnson Medical School,
New Brunswick, New Jersey
The detection of cognitive impairment is a required ele-
ment of the Medicare Annual Wellness Visit (AWV). Limited
data is available regarding the operationalization of the
detection of cognitive impairment in the primary care setting.
Nevertheless, efforts to evaluate this have not been described.
A pre and post survey of participants attending the KEAR
Summit will examine features of the program at baseline
and various intervals for one year. This qualitative study
will focus on responses to survey questions to ascertain indi-
vidual practices and understand processes of care for brain
health. Aparticular focus of the survey will be on attitudes
towards the KAER process, how pertinent and useful was the
materials presented during the program, and challenges and
barriers to implementing action plans. The KAER process
can facilitate practice change and guide a quality improve-
ment process for the detection of cognitive impairment.
COGNITIVE IMPAIRMENT DETECTION AND
EARLIER DEMENTIA DIAGNOSIS: THE KAER
PROCESS APPLIED TO PRACTICE
J.Chodosh, NYU School of Medicine, Langone Medical
Center, New York, New York
Physicians frequently do not recognize cognitive impair-
ment in their older adult patients and do not conduct an
evaluation to diagnose dementia. This presentation will pro-
vide case examples of older persons with cognitive impair-
ment, emphasizing the unique characteristics and situation of
each case and the need for primary care providers to individ-
ualize procedures for detection and assessment of cognitive
impairment and dementia to match the individuals situation
and needs. It will provide information, insights, and tips to
achieve earlier detection, improve diagnosis, and build and
maintain a strong, trusting relationship between the older
person and the primary care provider.
SESSION 1085 (SYMPOSIUM)
CONSENSUS IN MEASURES OF GAIT AND
COGNITION: FROM THE CANADIAN CONSORTIUM
IN NEURODEGENERATION AND AGING
Chair: M.MonteroOdasso, University of Western Ontario,
London, Ontario, Canada
Co-Chair: L.Middleton, University of Waterloo, Waterloo,
Ontario, Canada
Discussant: L.Bherer, University of Montreal, Montral,
Quebec, Canada
Extensive epidemiological evidence supports interrela-
tionships between mobility and cognition in aging. However,
until recently, clinicians and researchers have evaluated
and treated cognitive and mobility dysfunction in older
Innovation in Aging, 2017, Vol. 1, No. S1
individuals as separate problems. This approach has led to
gaps in our understanding of the cognitive-motor interac-
tions and of the potential underlying mechanisms that can
affect pathways to disability in aging. Thinking and mov-
ing share behavioral and etiological factors that can drive
new insights into prevention and treatment. Mechanistically,
brain networks, which control movement, overlap with net-
works involved in cognitive performance.
Therefore, there is a need of a common framework among
clinician and researchers to i) better characterize the rela-
tionship between cognitive and motor changes with aging,
comorbidities and neurodegeneration, ii) standardize clinical
and research methodologies to measures and assess mobility
and cognition in older adults iii) agree upon a core of set of
measures to assess cognitive-mobility interaction.
The Canadian Consortium on Neurodegeneration and
Aging is a Pan-Canadian Initiative funded by Canadian
Institute of Health and Research (CIHR), which aims to bet-
ter understand neurodegenerative process in aging. As part
of this initiative, the Gait and Cognition team has estab-
lished by consensus a set of common measurements to assess
motor-cognitive interactions. Results of the Delphi process
carried on in during 2015 and the consensus meeting which
involved 15 researchers from eight lead centers in Canada
will be presented with the core-set and minimum set
of measures selected. Having common and standardized
measures will positively contribute to the prevention, man-
agement, and rehabilitation of the cognitive and mobility dis-
ability in older adults.
EPIDEMIOLOGICAL EVIDENCE OF THE
BIDIRECTIONAL RELATIONSHIP BETWEEN
MOBILITY AND COGNITION
R.Camicioli, University of Alberta, Edmonton, Alberta,
Canada
An update on the evidence regarding the role of central
nervous systems (CNS) in mobility in addition with estab-
lished multifactorial causes connected to age related changes
in the cardiopulmonary, musculoskeletal, and central and
peripheral nervous systems will be presented. Research
done on patients with neurological diseases consistently
demonstrates that the CNS is a key contributor to gait and
motor function. Stronger associations have been detected for
information processing and executive functions, which are
important for rapid and efficient planning of goal-oriented
mobility. Emerging evidence shows changes in gait that pre-
cede and predict cognitive decline and Alzheimers disease
dementia, and other dementias. Similarly, cognitive changes
also adversely affect gait and cognitive deficits paired with
slowed gait in those without dementia may represent a dis-
tinct clinical syndrome.
TEMPORAL AND SPATIAL MEASURES OF
GAIT AND DUAL-TASK GAIT IN AGING AND
NEURODEGENERATIVE DISEASES
Q.Almeida, Wilfrid Laurier University, Waterloo, Ontario,
Canada
This presentation will review the evidence linking spa-
tial and temporal characteristics of gait including gait
speed, pace, rhythm and variability, with global cognitive
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
ability, executive function, verbal fluency and memory in
non-demented older adults and in neurodegenerative condi-
tions including Parkinson Disease and dementia syndromes.
The influence of neurological medications will also be con-
sidered. The value of dual-task gait, a divided attention task
that requires individuals to walk (motor component) while
simultaneously performing a cognitively demanding task
(reciting words, mental calculations, etc.) will be reviewed
as a potential brain stress test to unmasks latent gait distur-
bances and for detecting impending functional and cognitive
decline. Results from longitudinal studies showing that dual-
task gait can help identify older adults at a higher risk of
developing cognitive and mobility decline, and, potentially,
progression to dementia will also be presented. Finally, the
role of the dual-task cost will be evaluated.
COGNITIVE MEASURES SENSITIVE TO MOBILITY
DECLINE, GAIT IMPAIRMENTS AND FALLS
K.Z.Li, Concordia University, Montreal, Quebec, Canada
This presentation will highlight recent findings on cogni-
tive measures shown to be associated with indices of gait,
mobility, and risk of falling in older adults. These associations
are based upon the theoretical principle of neural overlap,
i.e., the common brain regions or networks that underpin
cognitive processes and motor behaviors such as walking and
balancing. Evidence will be presented involving standardized
neuropsychological measures of executive functioning that
are suitable for the assessment of healthy and frail elderly
adults. The use of experimental methods such as cognitive-
motor dual-task designs will also be presented.
ON-LINE ASSESSMENTS OF MOTOR-COGNITIVE
INTERACTIONS, WHAT CAN NEUROIMAGING WITH
FNIRS TELL US?
S.Fraser, University of Ottawa, Ottawa, Ontario, Canada
FNIRS or functional near infra-red spectroscopy is an
emerging neuroimaging technique that can be applied to
situations that involve movement (i.e., walking/exercise).
Recent technological advances have allowed for the develop-
ment of portable devices which measure cerebral oxygena-
tion changes of over ground walking in real-life ecological
conditions. Advantages and disadvantages of this technique
are discussed and their sensitivity to detect motor-cognitive
interaction will be summarized. In conclusion, future appli-
cations of this technique to clinical settings will be presented.
A PROPOSED CORE SET OF MOBILITY AND
COGNITIVE MEASURES
M.MonteroOdasso, University of Western Ontario,
London, Ontario, Canada
A core-set of measures based on their clinical utility,
feasibility, and evidence for sensitivity to mobility-cognitive
interactions will be presented. Advantages and disadvantages
of each measure evaluated and their sensitivity to detect
motor-cognitive interaction will be summarized. A mini-
mum set of measures to be used in large epidemiological
or population studies will be also presented including four
candidate measures, which can be performed in 15 minutes.
IAGG 2017 World Congress
611
SESSION 1090 (SYMPOSIUM)
PRESIDENTIAL SYMPOSIUM: EVALUATION
AND IMPLEMENTATION OF GERIATRIC
CO-MANAGEMENT MODELS FOR HOSPITALIZED
FRAIL OLDER PATIENTS
Chair: M.Deschodt, Leuven, Belgium
Discussant: H.Javedan, Brigham and Womens Hospital
Geriatric co-management has been described as the
most far-reaching model of shared care between a general
treating physician and a geriatrician since they manage the
patient together from admission until discharge and are both
responsible for the process and outcome of provided care.
(Kammerlander, 2010) A key difference with consultation
models is that patient care is co-managed together with an
acute medical care discipline instead of solely making non-
mandatory recommendations based on a consultation request.
(Deschodt et al. 2015) This approach is now considered the
standard for managing older hip fracture patients, but might
also be beneficial in other frail populations. In this symposium
we will discuss 1) the development and evaluation of two
European geriatric co-management programs, i.e. a program
for cardiology patients in Belgium and a program for surgical
and internal patients in the Netherlands, and 2)the implemen-
tation of two North-American geriatric co-management mod-
els, i.e. a ward-based model in Highland Hospital, Rochester
NY and a team-based model in Rhode Island hospitals.
GERIATRIC CO-MANAGEMENT FOR CARDIOLOGY
PATIENTS IN THE HOSPITAL (G-COACH) IN
BELGIUM
B.Van Grootven, KU Leuven, Leuven, Belgium
G-COACH aims to develop and evaluate an in-hospital
cardio-geriatric co-management model using a mixed-meth-
ods multi-phase methodology. First, a systematic review and
meta-analysis determined the intervention components and
potential value of geriatric co-management on patient and
system outcomes. Next, a two-round international Delphi
study determined appropriate and feasible structure, pro-
cess and outcome indicators for the evaluation of geriatric
co-management programs. We integrated this data in a first
program theory that details how the G-COACH interven-
tion will affect the desired change in outcomes. Focus groups,
interviews and participant observations were then used to
translate this theoretical framework to a consensus-based
stakeholder-developed care model. This model will be imple-
mented on two cardiology units of the University Hospitals
Leuven. A before-and-after study (September 2016
2017)including patients aged 75years or older will evaluate
the effectiveness, process and participants experiences. Data
will be used to refine the program theory and scaling-up of
co-management programs.
INNOVATIVE TEAM-BASED GERIATRIC
CO-MANAGEMENT FOR FRAIL OLDER PATIENTS IN
THE NETHERLANDS
H.Habets, 1. Zuyderland Medical Center, Sittard-Geleen,
Netherlands, 2. Zuyd University, Faculty of Health,
Heerlen, Netherlands
612
In Zuyderland Medical Center we conducted a study
aiming to prevent complications and functional decline dur-
ing hospital stay. Main conclusion: comprehensive geriatric
assessment at admission and delivery of advices by a geriatric
consultation team was not sufficient: the recommended inter-
ventions were often not executed. This led to a new model:
co-management for frail elderly at risk for functional loss.
This model is currently being implemented and evaluated
in a surgical, internal medicine and pulmonary ward. Main
components of the program are: Comprehensive Geriatric
Assessment, systematic medication review, a personalised
nutrition and mobility program, specific role of the geriatric
resource nurse, a physiotherapist (specialization Geriatrics),
daily rounds of the geriatric team and participation in mul-
tidisciplinary rounds, the Transitional Care Bridge Program
and continuity of care after discharge and follow up at the
polyclinic geriatric medicine. In this presentation structure,
process and first results of this approach will be presented.
GERIATRIC CO-MANAGEMENT AS ASERVICE
LINE: SPREADING CO-MANAGEMENT WITHIN AN
INSTITUTION
L.McNicoll, Alpert Medical School of Brown University,
Providence, Rhode Island
The Alpert Medical School model of co-management
focuses on creating co-management service line working with
multiple groups within an organization which include frac-
ture, elective joint replacement, trauma, colorectal, and urol-
ogy. Geriatricians are aligned with one surgical specialty for
5085% of their time assisting with high risk patients within
that group. In addition to providing patient care aligned
with co-management principles, co-managers also lead teams
within the groups to discuss and agree upon protocols of
care for geriatric patients, such as delirium assessment and
management, pain protocols, bowel regimen protocols, and
ERAS (Early Recovery After Surgery) protocols. Education is
also a major part of each program as well as data collection
in order to document improvement in outcomes for patients
with the addition of the co-management program. At the
symposium, we will be able to share our process as well as
outcomes for this model of co-management.
GERIATRICS ORTHOPAEDICS CO-MANAGEMENT
OF FRAGILITY FRACTURES IN ROCHESTER, NEW
YORK, AND THE USA
D.Mendelson, 1. University of Rochester School of
Medicine & Dentistry, Rochester, New York, 2. Highland
Hospital, Rochester, New York
The Geriatrics Fracture Center (GFC) at Highland
Hospital developed an innovative co-management model for
fragility fracture care in 2004. Each patient is assigned both
an orthopaedics surgeon and a geriatrician who share respon-
sibility for insuring high quality care throughout the patients
entire hospitalization. Standardized protocols and consult
notes are used to decrease unwarranted variability. Lean pro-
cess and continuous quality and performance improvement
techniques are used to maintain or improve person-centered
and system-based outcomes. The center is a model for value-
added geriatrics. The GFC has sustained improvements in
mortality, complications, length of stay, readmission rates,
Innovation in Aging, 2017, Vol. 1, No. S1
and cost. The GFC, in collaboration with Brown University
and the American Geriatrics Society, is working on a dissemi-
nation program to spread the model with generous funding
from the John A.Hartford Foundation. In this presentation,
the structure of the GFC and outcomes will be discussed as
well as the potential to replicate the program.
SESSION 1095 (PAPER)
GERONTOLOGY AND GERIATRICS EDUCATION TO
IMPROVE OUTCOMES
HEALTH PROMOTION OF UNDERSERVED OLDER
ADULTS USING AN ACADEMIC-COMMUNITY
PARTNERSHIP MODEL
L.White, J.Styron, C.Gubler, University of South Alabama,
Mobile, Alabama
Interprofessional collaborative practice has been shown
to improve healthcare and reduce care-related costs in older
adult populations. While many health profession programs
have adopted formalized interprofessional education (IPE)
curriculum delivered in a didactic setting, models of IPE
in which students engage in interprofessional collaborative
practice are needed to ensure health professions graduates
are prepared to deliver team-based care when entering the
geriatric healthcare workforce. Community-based models of
interprofessional collaborative practice may be particularly
advantageous because faculty and students can address the
vast need for health and wellness services in underserved
older adult populations. This presentation will provide a
framework for designing interprofessional collaborative
practice experiences using an academic-community part-
nership model. The University of South Alabama Colleges
of Nursing, Allied Health, and Medicine developed a three-
year initiative in which health and wellness services were
delivered by faculty-supervised health profession students to
older adults living in an urban low-income senior residential
community in Mobile, Alabama. First- and second-year stu-
dents in medicine, nursing, physician assistant studies, and
physical therapy participated in the project. The authors will
explain how the interprofessional initiative was developed,
including goals of the team, strengths, and limitations of the
project. Academic outcomes assessed included interprofes-
sional core competency attainment, readiness for interprofes-
sional learning, and student perceptions of interprofessional
clinical education. Community-based outcomes included the
number and type of health and wellness activities designed
to engage, educate, and evaluate participants and improve
health conditions of individuals. Processes for establishing,
maintaining, and evaluating academic-community partner-
ships will also be discussed.
URINARY INCONTINENCE AMONG OLDER
INDIANS: ASSESSMENT AND IMPACT ON QUALITY
OF LIFE
N.N.Prem, P.Chatterjee, A.Chakrawarty, A.B.Dey,
Geriatric Medicine, All India Insititute of Medical Sciences,
New Delhi, Delhi, India
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Innovation in Aging, 2017, Vol. 1, No. S1
Urinary incontinence is a common problem in old age.
Little research has been carried on this genito-urinary health
issue in India as the symptom goes often under-reported.
Urinary incontinence is associated with significant impact on
the individual, their carers and the wider healthcare system.
Management of urinary incontinence is often difficult.
In this cross sectional observational study, 608 patients
were recruited from Geriatric Medicine OPD and Ward.
They were subjected to a predesigned semi quantitative ques-
tionnaire to determine the frequency of urinary incontinence
in older people and its impact on various aspects of their life.
Stress incontinence was most common in females and
urge incontinence was common in males. Certain patients
also had mixed incontinence. There was significant impact
on quality of life due to incontinence and this was measured
with the help of the Incontinence quality of life. Majority had
Indian type of toilets.Stress type had maximum patients with
severe IQOL and urge type had maximum with mild IQOL.
(p<0.0001).Incontinence had a significant correlation with
age type,sex, social status, depression and number of drugs.
Diaper use was acceptable for (>90%) of the elderly.
Urinary incontinence detection is essential, as it can lead
to increased dependence. It can be treated with appropriate
interventions varying from exercises, modifying medications,
altering fluid intake and interdepartmental interventions.
The interventions vary according to the type. Urinary incon-
tinence is an important geriatric syndrome. Early detection
and intervention can help in improving quality of life of the
elderly
PERIOPERATIVE CARE OF THE ELDERLY:
AEUROPEAN ANSWER TO EDUCATIONAL NEEDS IN
THE FIELD
G.Bettelli, D.Cucinotta, G.Ghironzi, C.Renzini, older adults, and the intervention is associated with positive
G.Zuliani, 2nd Level Master in Geriatric Medicine,
University of San Marino and Ferrara, San Marino, Italy
Appropriate care in geriatric surgery requires multidis-
ciplinary approach combining geriatric, surgical, anesthe-
siological and nursing knowledge, resulting in ability of the
team to manage complex situations in coordinated ways.
To provide knowledge, skills, values and attitudes in the
professional spheres of the surgical care of older patients, a
multidisciplinary University Master on Perioperative Care
of the Elderly is implementated at the San Marino and
Ferrara University (Italy). Its aim is creating an inter-profes-
sional culture.
To reach this goal, the following Entrustable Professional
Activities (EPAs) of geriatric medicine become common
assets for the whole team:
provide patient-centered care by optimizing function and
well-being, in accordance with patients functional status and
needs, as evaluated by CGA
manage the surgical care by integrating the patients goals
and values with comorbidities and reasonably expectable
prognosis
assist patients and families in decision-making
provide thoughtful medication reconciliation
prevent and manage postoperative delirium and other
geriatric syndromes
coordinate post-discharge care transition.
IAGG 2017 World Congress
613
Allthesame, geriatricians will be educated in perioperative
medicine and made familiar with some surgical and anesthe-
siological issues such as:
pre-habilitation as a strategy to increase functional
reserves preoperatively
the endocrine-metabolic reaction to surgical aggression,
its consequences on the surgical course, and ways to mini-
mize it
context-sensitive and multimodal postoperative pain
management
techniques of Enhanced Recovery After Surgery (ERAS).
Both acquisition of competencies and capacity to perform
the tasks involved in the daily work are implemented in the
educational plan.
DO PHOTOGRAPHS AND OLDER ADULTS
NARRATIVES FOSTER ANTICIPATORY REFLECTION
IN MEDICAL STUDENTS?
C.Etherton-Beer1,2, G.Brand2, 1. Royal Perth Hospital,
Perth, Western Australia, Australia, 2. University of Western
Australia, Perth, Western Australia, Australia
In changing higher education environments, medical edu-
cators are increasingly challenged to prepare health workers
to care for ageing populations. We have developed the Depth
of Field: Exploring Ageing reflective learning resource that
uses photographs, reflective questioning prompts, older
adults narratives and collaborative dialogue to foster antici-
patory reflection or preflection among diverse learners.
Using mixed method evaluations, we now have data from
Australian medical students comprising attitudes (pre and
post responses) and qualitative analysis of individual writ-
ten reflections of 128 second year medical students, explor-
ing their perceptions toward older adults. Quantitative data
reveal students self-report positive perceptions towards
shifts in attitudes. However the written reflections expose
some negative attitudes and unexplored assumptions. The
qualitative reflections were captured in four main themes:
Preflecting on older adults; Creating Tension; Deconstructing
Assumptions, and Seeing the Person. These findings support
the use of visual and narrative methodologies to foster pre-
flection that surfaces and challenges medical students per-
ceptions and assumptions around ageing and how these may
influence their care of older adults.
DEMENTIA WORKFORCE EDUCATION: DOES IT
CHANGE PRACTICE?
S.Hirst1, S.Gordon2, 1. University of Calgary, Calgary,
Alberta, Canada, 2. Mt Royal University, Calgary, Alberta,
Canada
Health-care professionals are well positioned to recognize
dementia in older adults. However, barriers to implementing
quality care include their limited knowledge. Consequently
educational programs have been designed to promote the
knowledge and skills of the dementia workforce. The ques-
tion that emerged is whether or not education changes health
care practice? Asystematic review of the literature was con-
ducted to identify approaches to providing dementia work-
force education. The review was conducted using databases
searched from 2000 to 2015. Two researchers screened each
title and abstract for inclusion. Discrepancies between them
614
were resolved by a third team member. A matrix was used
for analysis including: type of research, participants, study
design, type of education activity, outcome measures, and
perceived effectiveness.
The review included 144 studies, from an initial list of
3432, which met the inclusion criteria. Descriptive data was
obtained from the matrix. In addition, thematic analysis was
conducted to answer the original research question. Results
identify that educational activities are primarily face to face,
evaluated by participants satisfaction with the activity or
changes in their knowledge levels, and usually conducted
with facility staff. The exception to facility staff is physician
education. Limited examination of the effect of the activity
on practice have been conducted. In addition, there is no long
term evaluation (> than 1year) of the outcomes of the edu-
cational activity.
There is limited evaluation of the effectiveness of edu-
cational activities on the quality of care provided to older
adults living with dementia.
SESSION 2000 (PAPER)
PALLIATIVE CARE FOR OLDER ADULTS
WISHFUL THINKING: AN EXAMINATION OF
PALLIATIVE HOME CARE CLIENTS WHO EXPRESSED
AWISH TO DIE NOW
S.Freeman1, E.Neufeld2, T.Frise Smith3, K.Fisher4,
S.Ebihara5, 1. School of Nursing, University of Northern
British Columbia, Prince George, British Columbia,
Canada, 2. Laurentian University, Sudbury, Ontario,
Canada, 3. Nipissing University, North Bay, Ontario,
Canada, 4. McMaster University, Hamilton, Ontario,
Canada, 5. Toho University Faculty of Medicine, Tokyo,
Japan
PURPOSE: To provide the highest quality of person cen-
tered palliative care clinicians should prioritize understand-
ing of client needs and preferences at end of life to inform
tailored care planning. During clinical assessments, clients
may voluntarily express a wish to die either directly to the
clinician or it may be indirectly reported second-hand to the
clinician through an informal caregiver or family member.
METHODS: This study examined 4,840 interRAI
Palliative Care assessments from community dwelling pallia-
tive home care clients in Ontario, Canada (20062011). The
interRAI PC gathers a wide range of information on physi-
cal, cognitive, and social domains, as well as demographic,
health service utilization, and care preferences which is then
used by the clinician to inform the care planning process
RESULTS: 308 palliative home care clients (6.7 %)
voluntarily expressed a wish to die now. In multivari-
ate analyses predicting expression of a wish to die strong
independent variables included not being married/widowed,
a shorter estimated prognosis, depressive symptoms, func-
tional impairment, excessive amount of sleep, feeling com-
pletion regarding financial/legal matters, and struggling with
the meaning of life. Of clients who expressed a wish to die
now, clients who exhibited depressive symptoms (23.8 %)
Innovation in Aging, 2017, Vol. 1, No. S1
were also more likely to exhibit cognitive impairment and
recent cognitive decline, weight loss, psychological distress.
DISCUSSION: Not all clients who expressed a wish to
die exhibited depression, pain and psychological distress.
Findings promote the need for an individualized approach
to care management. Clinicians should strive to embrace not
fear discussing with the client their preferences for death.
INTERPROFESSIONAL PALLIATIVE CARE
WORKFORCE: ASURVEY OF TOMORROWS
HEALTHCARE TEAMS
J.M.Sautter1, N.Boucher2, A.Franzione3, 1. Behavioral &
Social Sciences, University of the Sciences in Philadelphia,
Philadelphia, Pennsylvania, 2. Duke Center for the Study of
Aging & Human Development, Durham, North Carolina,
3. Rutgers University, New Brunswick, New Jersey
Recent assessments of the current palliative care workforce
recommend increased training and exposure for all health
care providers to manage symptoms and improve quality of
life during serious illness. To assess the future workforce in
palliative care, a multi-institution team conducted an online
survey of students pursuing professional degrees in medicine,
nursing, occupational therapy, pharmacy, physical therapy,
physician assistant, and public health.
Preliminary results from 360 advanced professional
students at five institutions describe the healthcare work-
force currently in training. Approximately 80% of students
reported personal or professional experience with people
who are seriously ill and 68% reported some educational
experience with death and dying. More than 90% of stu-
dents reported that people in their profession can play an
important role in patients end-of-life care; 25% of students
reported a desire to provide patient care for end-of-life issues
and 41% were neutral. Medicine and physician assistant
students reported stronger recognition of their professions
importance in end-of-life care and stronger interest in work-
ing in end-of-life care compared to other professions. Across
professions, students with professional and/or personal expe-
rience reported stronger interest in providing palliative care.
These results are useful to inform professional curricula
and public health planning. As need grows, it is important
to expose students to palliative and end-of-life care through
interprofessional experiential learning. These experiences
can influence future leaders in medicine and public health to
emphasize prevention and palliation of suffering, especially
among older adults with serious life-limiting illness.
EFFECT OF APERSON-CENTERED INTERVENTION
ON PATIENT EXPERIENCE WITH CARE IN SERIOUS
CHRONIC ILLNESS
N.Shippee1, T.P.Shippee1, P.Mobley2, K.Fernstrom2,
H.Britt2, 1. University of Minnesota, Minneapolis,
Minnesota, 2. Allina Health, Minneapolis, Minnesota
Patients with serious chronic illness face multiple chal-
lenges in managing conditions to reduce ongoing risk,
while increasingly moving toward issues and decisions sur-
rounding end of life. Meanwhile, broad overmedicalization
leaves patients at risk for overly invasive treatment and
self-management routines and a depersonalized experience
of care. However, most studies of patient experience and
tools designed to measure it are not well suited to addressing
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
patients with serious illness in late life. This study evaluates
a new patient-centered approach to care for patients with
serious chronic illness. LifeCourse is focused on understand-
ing the whole person and ongoing, cross-setting assistance
by layperson care guides, supported by a clinical team. We
test whether participation in LifeCourse improves patient
experience compared to usual care (n=110 intervention and
93 comparison patients). The outcome variable is 6-month
change the LifeCourse experience tool, a multi-item self-
report experience tool designed specifically to emphasize
key domains of the intervention, including listening, access
and time, trust, frustration, and patient goals. In multivari-
ate analyses, LifeCourse had a significant positive effect on
change in patient experience versus usual care. Domain-
specific analyses indicated that the primary driver of this
effect was time/access for patients. Overall, our findings
show that LifeCourse has a positive impact on QOL when
compared to usual care patients. These trends indicate that
whole-person, supportive care approaches like LifeCourse
may offer modest benefits in improving experience with care
as patients require more services for chronic illness in later
life.
CHRONIC AND INCURABLE DISEASE IN ETHIOPIA:
AN ASSESSMENT OF OUTPATIENT PALLIATIVE
CARE NEEDS
R.Anderson1,2, E.Gudina4, N.Ayers3, W.Tigineh5,6,
Y.Mamo Azmera3, 1. Emergency Medicine, Yale University
School of Medicine, New Haven, Connecticut, 2. London
School of Hygiene and Tropical Medicine, London, United
Kingdom, 3. Ethiopian Ministry of Health, Addis Ababa,
Ethiopia, 4. Jima University College of Health Sciences,
Jima, Ethiopia, 5. Addis Ababa University College of Health
Sciences, Addis Ababa, Ethiopia, 6. Tikur Anbessa Hospital
Department of Oncology, Addis Ababa, Ethiopia
Palliative care reduces physical suffering and the emo-
tional, spiritual and psychosocial distress of life-threatening
illness. It can be offered at any time, including concurrently
with life-prolonging therapies. Palliative care is a human
right, yet there are significant disparities in its provision: of
the 40 million people globally in need of palliative care, just
14% receive it, largely in high-income countries. There is
a particular paucity of data on palliative care needs in the
African context.
We recruited 98 adults (mean age: 43.714 yrs, 64%
female) at three outpatient clinics (Oncology, HIV, Non-
Communicable Disease) and hospice patient homes in
Ethiopia. Four internationally validated survey tools assessed
physical symptoms, psychosocial distress and disability.
In-depth interviews gauged poverty level, costs of care, and
end-of-life preferences. Qualitative data was analyzed by the-
matic content, quantitative data by standard descriptive and
frequency analyses.
In Oncology, 95.5% of the population endorsed moder-
ate-to-severe pain and 100% were unaware of their termi-
nal diagnoses. Across sites, there was an inverse relationship
between pain and peace, while anxiety and depression mir-
rored pain. Widespread, enormous costs for medical care and
transportation were reported. To cope, livestock, homes, and
gold were sold, and children pulled from school. Oncology
withstanding, the majority of subjects wished to die at home.
IAGG 2017 World Congress
615
Oncology patients cited pain control as the top reason they
preferred to die in hospital.
These results reveal extensive unmet palliative care
needs. In addition to untreated pain, costs of illness are the
major contributor to psychosocial distress in this Ethiopian
population.
SESSION 2005 (SYMPOSIUM)
A FINANCIALLY SUSTAINABLE APPROACH TO
OPTIMAL OUTCOMES IN ACOMPREHENSIVE
GERIATRIC SPECIALTY CLINIC
Chair: P.S.Reed, University of Nevada, Reno, Reno,
Nevada
Twenty years ago, Zeiss and Steffen (1996) described
interdisciplinary healthcare teams as the basic unit of
geriatric care. Despite long-standing recognition that the
complexity of elder needs extends far beyond basic medi-
cal requirements and warrants the involvement of multiple
perspectives, many barriers persist to successful integration
of care and services. In November 2015, the Sanford Center
for Aging at the University of Nevada Reno launched a com-
prehensive, community-based, interdisciplinary geriatric
specialty clinic to serve elders across Northern Nevada. This
launch followed an 18-month needs assessment, planning and
development process to identify the most appropriate clinical
model for filling the geriatric service gaps of the region. This
collaborative planning process, including representatives
from more than 15 disciplines within the University Health
Sciences Division and community members, determined a
need for integrated assessment, planning and care coordi-
nation services, including the following: 1) comprehensive
geriatric assessment; 2) psychosocial assessment; 3) medi-
cation therapy management; 4)advance care planning; and
5)chronic care management. Further, these clinic-based ser-
vices are being extended via telemedicine to support primary
care providers and their patients in rural communities. This
symposium, intended for geriatric clinical providers of any
discipline, will highlight each dimension of the new inte-
grated clinical approach, detail the financial structure for this
viable model, and report on the patient status and follow-up
data. The various talks will walk audience members through
the development and delivery of this new approach, as well
as use financial and quality metrics to demonstrate the clin-
ics viability and impact.
COLLABORATIVE PLANNING TO FACILITATE
INTERDISCIPLINARY GERIATRIC CLINICAL
APPROACHES
P.S.Reed, Z.Gibb, S.Phillips, K.R.Macmillan, University
of Nevada, Reno, Reno, Nevada
This presentation will provide an overview of the col-
laborative planning process used to engage multiple health
disciplines and community members in developing and
launching a new community-based comprehensive geriatric
specialty clinic. It will outline results of the key elements of
the process, such as the national environmental scan of clini-
cal geriatric models, the regional needs assessments, the col-
laborative committee structure and disciplinary engagement
616
strategies. It will conclude with an overview of the final clinic
model that was implemented.
LEADING ACOMPREHENSIVE GERIATRIC
ASSESSMENT IN AN INTERDISCIPLINARY TEAM-
BASED CLINICAL MODEL
S.Phillips, K.R.Macmillan, Z.Gibb, P.S.Reed, University
of Nevada, Reno, Reno, Nevada
This presentation will describe the details of the compre-
hensive geriatric assessment being conducted by the geriatri-
cian on the clinics inter-disciplinary team. It will highlight
the key dimensions of the assessment, with particular focus
on how these elements can be successfully integrated into a
collaborative care plan along with the results of the assess-
ments being conducted by providers in other disciplines. It
will also highlight innovative uses of the clinics EMR system
to maximize care planning and reimbursement.
COMPREHENSIVE PSYCHOSOCIAL ASSESSMENT TO
IDENTIFY CLIENT SOCIAL NEEDS AND AVAILABLE
RESOURCES
K.R.Macmillan, Z.Gibb, S.Phillips, P.S.Reed, University
of Nevada, Reno, Reno, Nevada
This presentation will describe the key elements of the
comprehensive geriatric psychosocial assessment and life-
story review being offered in the clinic. By conducting this
in-depth assessment, the inter-disciplinary team is able to
identify potential social risk factors that may compromise
the clients abilities to effectively manage chronic conditions
and receive needed care in the most efficient / cost-effective
manner. This presentation will further describe the impor-
tance of the social work perspective as a key element of the
clinics inter-disciplinary approach.
CLIENT OVERVIEW: BASELINE STATUS AND 1-YEAR
OUTCOMES OF COMPREHENSIVE GERIATRIC
SPECIALTY CARE
Z.Gibb, S.Phillips, K.R.Macmillan, P.S.Reed, University
of Nevada, Reno, Reno, Nevada
This presentation will report on the data collected from
clinics patients, documenting their baseline status in terms
of: quality of life, well-being, physical status, emotional
status, ADLs, chronic conditions and more. Further, it will
provide one-year follow up on these metrics to determine
the extent to which the clinic is achieving its desired clinical
outcomes, such as reducing re-hospitalization and delaying
long-term care placement. Finally, in addition to reporting
key quality metrics, this presentation will conclude with a
review of financial metrics and clinic viability, demonstrating
that it is possible to navigate the current reimbursement sys-
tem to successfully offer truly comprehensive services.
SESSION 2010 (SYMPOSIUM)
FACTORS AFFECTING HIP FRACTURE RECOVERY:
FRAILTY, PHYSICAL FUNCTION, COGNITION,
NUTRITION AND SEX
Co-Chair: J.S.Magaziner, University of Maryland Baltimore
Discussant: M.Crotty, Flinders University, Adelaide, South
Australia, Australia
Innovation in Aging, 2017, Vol. 1, No. S1
Hip fractures are a common public health problem among
older adults. People who experience a hip fracture are often
frail with physical and/or cognitive impairment and may
have compromised nutritional status. Further, most research
on hip fracture recovery has focused on females. With grow-
ing numbers of hip fractures among males, it is important to
determine whether the two sexes differ with respect to recov-
ery in multiple domains. This symposium brings together
international researchers from the Fragility Fracture Global
Networks Special Interest Group of Research on Recovery
after Hip Fracture. The goal of this Special Interest Group
is to promote international discussion and collaboration to
expedite research focused on improving outcomes after hip
fracture.
In this symposium, presenters will provide an overview
of the state of the evidence on the impact of frailty, physical,
cognitive and nutritional impairment on recovery after hip
fracture. Recent findings from the United Kingdom on the
impact of physical impairment on recovery after hip frac-
ture will be presented. Current assessment and management
approaches and how they can be incorporated into patient
care will also be discussed. In addition, emerging evidence
from the United States will discuss the differences in recov-
ery and the trajectory of recovery experienced by men and
women after hip fracture. Finally, presenters will discuss
identified knowledge gaps and suggest future directions for
research, including multi-modal approaches and interna-
tional collaborations.
DOES KNOWING ABOUT FRAILTY MAKE
ADIFFERENCE IN THE CARE OF HIP FRACTURE
PATIENTS?
I.Cameron, University of Sydney, Sydney, New South
Wales, Australia
People with hip fracture are frequently frail and frailty sta-
tus appears to influence outcome after hip fracture. Whether
frailty is an independent predictive factor for adverse out-
come is currently unclear. Many evidence based clinical prac-
tice guidelines are appropriately applied to frail people with
hip fracture. In particular, those related to mobility training
and optimal nutrition have relevance for the hip fracture
patient population. The principles of geriatric evaluation and
management should also be applied to patients after hip frac-
ture. Currently, sarcopaenia (rather than frailty) has been a
treatment target for nutritional and pharmacological trials
in hip fracture patients. Detecting and treating frailty in hip
fracture patients may improve recovery after hip fracture,
although this is not currently confirmed based on interven-
tion studies.
PHYSICAL IMPAIRMENTS AFTER HIP FRACTURE
S.Lamb, Univesity of Oxford, Oxford, United Kingdom
Modern surgical management of hip fractures leads, in
most instances, to successful restoration of skeletal integrity
of the femur and the possibility for resumption of weight
bearing and early locomotion. However, studies of other
organs involved in locomotion reveal substantial impair-
ments that may not recover completely, or take much longer
to recover and impact many essential facets of locomotion,
including ability and speed of walking, chair standing, and
stair climbing. This presentation will use data collected
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
between 1 and 3 months after hip fracture surgery, includ-
ing muscle force generating characteristics of injured and
uninjured limbs, postural sway, functional balance capabili-
ties, and pain to characterise recovery of locomotion and the
pathway between organ impairments, functional limitation,
and disability in older people with hip fracture. The pres-
entation will highlight potential avenues for new effective
adjuncts to hip fracture management and consider both
research and practice implications.
COGNITIVE IMPAIRMENT AFTER HIP FRACTURE
S.Kurrle, University of Sydney, Sydney, New South Wales,
Australia
The presence of cognitive impairment (i.e. delirium and/
or dementia) in hip fracture patients is very common. This
presentation will discuss the evidence for how delirium can
be prevented and/or managed for these patients in the acute
hospital setting. Management of delirium post operatively
through the use of non-pharmacological methods such as
special delirium units, proper attention to hydration, man-
agement of medical comorbidities, and early mobilisation,
has been shown to be effective in reducing length of delirium
and improving recovery. We will also discuss how the pres-
ence of dementia in an older person recovering from hip frac-
ture can make rehabilitation more difficult and in some cases
may lead to exclusion from rehabilitation. We will discuss
the evidence that these patients can benefit from rehabilita-
tion that takes a simple, functional exercise based approach
and will present examples of how these approaches can be
delivered.
NUTRITIONAL IMPAIRMENT AFTER HIP FRACTURE
E.F.Binder, Washington University in St. Louis, St Louis,
Missouri
Hip fracture patients are often undernourished at the
time of the fracture event as measured by serum albumin
levels and/or standardized dietary assessments. Reduced
food intake, particularly during the acute recovery period,
further contributes to poor recovery after hip fracture. This
presentation will discuss the evidence related to the impor-
tance of nutritional status on recovery and the effectiveness
of nutritional supplementation after hip fracture to improve
patient outcomes. The limitations of research to date in this
area will be presented and discussed. Finally, potential strate-
gies to mitigate the risk of malnutrition after hip fracture will
be presented in the context of multimodal interventions that
include nutritional supplementation.
SEX DIFFERENCES IN RECOVERY TRAJECTORIES
AMONG HIP FRACTURE PATIENTS
D.Abraham, D.L.Orwig, M.Hochberg, J.S.Magaziner,
University of Maryland, Baltimore, Maryland
With hip fractures increasing among men, determin-
ing whether recovery differs between sexes is important.
Recovery and outcome trajectories in function (physical, cog-
nitive, affective), disability, body composition, and strength
were assessed at baseline, 2, 6 and 12months post hip frac-
ture in 168 men and 171 women. Men had more comorbidi-
ties, were more likely to live with spouses and to die during
follow-up than women. Changes in outcomes were signifi-
cantly different between men and women for gait speed,
IAGG 2017 World Congress
617
depressive symptoms, and lower extremity physical activities
of daily living. Men and women both improved to six months
but only men continued to improve out to 12months. There
were absolute sex differences for most body composition
measures and strength. Baseline sex differences, selective sur-
vival among males, or the influence of depressive symptoms
on rehabilitation may explain differential recovery. Further
studies are needed to determine the underlying reasons for
sex-differences in recovery.
SESSION 2015 (PAPER)
DETECTING AND MEASURING FRAILTY I
FRAILTY AND USE OF HEALTH SERVICES IN
INJURED SENIORS: APOPULATION-BASED STUDY
M.Sirois1,2, V.Fillion1,3, S.Jean3, 1. Centre dExcellence
sur le Vieillissement de Qubec, Qubec, Quebec, Canada,
2. Universit Laval, Qubec, Quebec, Canada, 3. Institut
National de Sant Publique, Qubec, Quebec, Canada
Currently, most information on frailty in seniors comes
from cohort or trials studies. Methodologies to identify frail
seniors within secondary care data, both at patient and pop-
ulation level, are current surveillance priorities. Objectives:
to measure frailty using health administrative databases and
examine the association between frailty and medical ser-
vices use among non-institutionalized seniors with a minor
fracture. Methods: Population-based cohort built from the
Quebec Integrated Chronic Disease Surveillance System,
including seniors 65years, non-institutionalized in the pre-
fracture year. Frailty was measured using the ERA index.
Multivariate Poisson analysis were used to examine the asso-
ciation between frailty level and use of emergency depart-
ment (ED) and general practitioner (GP) services 1 year
post-fracture, adjusting for confounders. Results: The cohort
included 179,734 individuals (mean age 76.3 years, 74 %
women). There were 13 % and 4.7%, frail and non-frail sen-
iors, respectively. Our Poisson regression analyses show that,
in the post-fracture year, ED and GP visits were significantly
higher in frail VS non-frail seniors: adjusted relative risk
(RR)= 2.95: 95% CI: 2.833.08 for ED visits and RR=1.24:
95% CI: 1.211.28 for GP visits. Conclusion: This study
suggests that it is possible to characterize seniors frailty at
a population level using health administrative databases.
Furthermore, this study shows that non-institutionalized
frail seniors require more health services after an incident
minor fracture. Screening for frailty in seniors should be part
of clinical management in order to identify those at high risk
of needing more health services.
COMPARING SUBJECTS EWGSOP SARCOPENIC
STATUS AND THEIR CLINICAL FRAILTY SCALE
LEVEL
A.Juby, C.Davis, S.Minimaana, University of Alberta,
Edmonton, Alberta, Canada
The European Working Group of Sarcopenia in Older
People (EWGSOP) classifies normal, presarcopenia, sarcope-
nia, and severe sarcopenia depending on lean muscle mass,
grip strength and gait speed. The Clinical Frailty Scale (CFS)
618
has 9 classifications. Prevalence of sarcopenia and frailty
increase with age. Are they two sides of the same coin?
Seniors participating in an exercise study were evaluated
for sarcopenic status. Blinded to this information, they were
evaluated using the CFS and classified accordingly.
Data was obtained from 39 participants (6 men), average
age 75.7years (6790). Average MMSE 29.1 (2230), MoCA
26.4 (1830). 11 were normal, 11 were obese, the remain-
der various stages of sarcopenia. 24 were CFS 3 or higher.
Poor correlation was found between EWGSOP sarcopenic
status and CFS (R=0.43), lean muscle mass (appendicular
lean mass/height2) and CFS (R=0.21 in women), EWGSOP
grip strength cut-offs and CFS (R=0.46). However, good cor-
relation was found between CFS and 6m absolute walk time
(R=0.82) and gait speed (R=-0.61). This study is limited by
fewer individuals in the sarcopenic or frail spectrum.
This study suggests there is poor correlation between sar-
copenic status (as defined by EWGSOP criteria), absolute
muscle mass or grip strength and CFS. However, there was
good correlation with gait time and speed, suggesting that
functional measures of muscle are more important than abso-
lute muscle mass in the development of frailty. Sarcopenia, as
defined by EWGSOP does not equate to frailty as defined by
CFS. The use of standardized definitions has important impli-
cations for research into potential therapeutic interventions.
FRAILTY INDEX BASED ON CLINICAL LABORATORY
MEASURES (FI-LAB) ASSOCIATES WITH TELOMERE
LENGTH
E.Dent1, E.O.Hoogendijk2, M.Moldovan3, 1. Centre
for Research in Geriatric Medicine, The University of
Queensland, Woolloongabba, Queensland, Australia,
2. Department of Epidemiology and Biostatistics, VU
University Medical Center, EMGO+ Institute for Health
and Care Research, Amsterdam, Netherlands, 3. University
of South Australia, Adelaide, South Australia, Australia
With ageing, there is a reduction in genomic telomere
length (TL), and accordingly, TL is used as a biomarker for
biological age. This study determined whether a recently
developed Frailty Index based on clinical laboratory meas-
ures (FI-LAB) was related to TL. The NHANES 19992002
dataset was used for all analyses. A standard 23-variable
FI-LAB was constructed using systolic and diastolic blood
pressures, and routinely collected biomarkers indicating
renal function, complete blood cell count, electrolytes, as well
and thyroid and liver function. For comparison purposes, a
standard 10-variable Allostatic Load score was developed,
and included: markers of organ dysfunction (creatinine),
inflammatory makers (albumin, CRP), metabolic markers
(Body Mass Index (BMI) and glycated haemoglobin), car-
diovascular markers (systolic and diastolic bold pressures,
total cholesterol, triglycerides and homocysteine). A stand-
ard Frailty Index based on clinically observable cumulative
health deficits (FI-CD) was also derived. Multiple regression
analyses, controlling for sex and education-level were per-
formed. 1725 adults aged 50years were included. Results
showed that higher frailty level classified by the FI-LAB inde-
pendently associated with shorter TL [ (95% CI)=0.18,
0.030 to 0.07, P=0.002], as did higher Allostatic Load [ associated with diverse stressors in mid-life and late-life. In
(95% CI)=0.07, 0.14 to 0.01, P=0.003]. The FI-CD did Paper 1, analyses of a longitudinal data of community-dwell-
not associate with TL. Findings from this study suggest that
Innovation in Aging, 2017, Vol. 1, No. S1
whilst FI-LAB and Allostatic Load are indicators of biologi-
cal age, the FI-CD was not. Thus the FI-CD may be more of
a measure of frailty than of biological age per se.
OPTIMIZED UPPER EXTREMITY FRAILTY
PARAMETERS FOR ASSESSING FRAILTY IN TRAUMA
PATIENTS
H.Lee1, B.Joseph2, B.Najafi1, 1. Interdisciplinary
Consortium on Advanced Motion Performance (iCAMP),
Department of Surgery, Baylor College of Medicine,
Houston, Texas, 2. Department of Surgery, The University
of Arizona, Tucson, Arizona
Recently, an innovative upper extremity frailty (UEF)
meter was developed and validated based on two inertial
wearable sensors and combination of sensor-derived kinemat-
ics/kinetics and patients demographics including age, height
and body mass. This study presents an optimized model to
predict frailty status based on a single wearable sensor and
without demographic/anthropometrics information. Adata-
set of 100 trauma patients (49 frail and 51 nonfrail) were
retrospectively analyzed in which two inertial sensors were
attached to elbow and forearm to quantify motor perfor-
mance during a 20-second repetitive elbow flexion-extension
task. The test protocol included performing elbow flexion/
extension as fast as possible in supine position for 20-second.
The classification accuracy of new algorithm was compared
with previous method as well as Trauma-Specific Frailty
Index as gold standard. We extracted totally 34 UEF sensor-
derived parameters indicators of slowness, exhaustion, flex-
ibility, and weakness. Amultivariate linear regression model
was used to identify independent predictors. Bootstrap tech-
nique was employed for generating training and validation
dataset randomly with 1000 iterations. ANOVA statistic and
recursive feature elimination technique were used for reduc-
ing and optimizing the UEF parameters. After training the
model, 5 independent parameters were selected. Using the
model, sensitivity of 85.3%, specificity of 78.5% and accu-
racy of 81.6% were achieved in the validation dataset. While
new results were comparable with previous method, it allows
identifying frailty using a single sensor and independent of
subjects demographic/anthropometrics information and
thus making it a more practical tool for busy clinics without
the need of specific training or additional measurements.
SESSION 2020 (SYMPOSIUM)
SLEEP PROBLEMS AND DIVERSE STRESSORS IN THE
SECOND HALF OF LIFE
Chair: O.M.Buxton
Co-Chair: S.Lee, Penn State University, University Park,
Pennsylvania
Age and age-related processes degrade sleep. As chronic
insufficient sleep (e.g., <7 hours/night) increases in the adult
population, additional age-related deterioration of sleep
raises concerns about adequate sleep recovery in the sec-
ond half of life. This symposium showcases contemporary
endeavors towards better understanding sleep problems
ing older adults (Age=65yrs+; Health and Retirement Study,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
HRS) test the casual link between insomnia symptoms and
falls. In Paper 2, analyses of a longitudinal sample of workers
from the Midlife in the United States (MIDUS) study exam-
ine changes in perceived work inequality predicting changes
in insomnia symptoms through changes in negative work-to-
family spillover, and age moderation (Mage=50yrs). Paper 3
uses data from the Household, Income and Labour Dynamics
in Australia (HILDA) Survey in adults (Mage=40yrs) to exam-
ine the association between elder care and sleep quality and
how workplace entitlements, such as access to special leave
to care for family members, modify this association. Paper
4 uses data from the National Study of Caregivers (NSOC)
to examine contextual factors and stressors associated with
sleep disturbances among dementia caregivers (Mage=57yrs).
In a natural experiment from the 2011 Japan earthquake
and tsunami, Paper 5 tests the effects of disaster exposure
on sleep disturbances among the elderly (Mage=74yrs). At the
end of these paper presentations, we will discuss their theo-
retical and methodological contributions, and consider chal-
lenges and opportunities for future research examining sleep
in the second half of life.
INSOMNIA SYMPTOMS: ACAUSE OR
CONSEQUENCE OF FALLS AMONG OLDER ADULTS?
T.Chen1, G.Cheng1, S.Lee2,3, O.M.Buxton2,3,4, 1. Duke-
NUS Medical School Singapore, Singapore, Singapore,
2. Pennsylvania State University, University Park,
Pennsylvania, 3. Center for Healthy Aging, Pennsylvania
State University, University Park, Pennsylvania, 4. Division
of Sleep Medicine, Harvard Medical School, Boston,
Massachusetts
We conducted a cross-lagged mediation analysis to
examine the casual link between insomnia symptoms and
falls among older adults using data from three waves of the
Health and Retirement Study (2006[Time1], 2010[Time2],
and 2014[Time3]; n=2755). We hypothesized that, through
the development of poor health (Time2), insomnia symptoms
(Time1) would lead to future falls (Time3). In the reverse
direction, falls (Time1) would cause more insomnia symp-
toms (Time3) via poor health (Time2). The focal variables
were insomnia symptoms (ranging from 04) and single falls
(yes/no). The mediators were overall health (self-rated-health-
status), mental health (Center-for-Epidemiologic-Studies-
Depression-Scale), and physical health (balance-tests and
timed-walk). Results showed that Time1 insomnia symptoms
led to more fall at Time3 via decreased Time2 mental health,
but not vice versa. These findings revealed that older adults
with insomnia symptoms were likely to fall through decreased
mental health, but falls did not seem to cause sleep problems.
PERCEIVED WORK INEQUALITY IMPAIRS EMPLOYEE
SLEEP OVER TIME THROUGH NEGATIVE WORK-TO-
HOME SPILLOVER
S.Lee1,2, J.A.Mogle1,2, O.M.Buxton1,2, 1. Biobehavioral almost every night was reported by 15% of caregivers and
Health, Penn State University, University Park,
Pennsylvania, 2. College of Nursing, Penn State University,
University Park, Pennsylvania
Age impacts insomnia symptoms prevalence. The pro-
cesses by which changes in contextual factors that also vary
with age affect insomnia symptoms are less clear. Using
longitudinal data with three time points over 2 decades
IAGG 2017 World Congress
619
(T1:19951997, T2:20042006, T3:2013) from the Midlife
in the United States (N=1016, Mage=49.7111.29), we tested
whether changes in perceived inequality at work predicted
changes in insomnia symptoms (frequency of having trou-
ble falling/staying asleep) through changes in negative work-
to-family spillover, and how these effects differed by age.
Multilevel modeling revealed that individuals with increased
perceived inequality at work over time significantly increased
in negative work-to-family spillover over time. Increased
negative work-to-family spillover, in turn, significantly pre-
dicted increased insomnia symptoms over time. Age moder-
ated the relationship between perceived inequality at work
and negative work-to-family spillover. Older workers (60yrs)
were more vulnerable than younger workers (30yrs) to expe-
riencing negative work-to-family spillover when they per-
ceived higher inequality at work.
ADULT CAREGIVING, WORKPLACE LEAVE AND
SLEEP QUALITY
J.Lam, University of Queensland, Indooroopilly,
Queensland, Australia
This paper examines whether caring for an elderly or dis-
abled relative may be negatively associated with sleep qual-
ity. Further, it investigates whether workplace entitlements,
such as access to special leave to care for family members
may modify this association. Drawing on data from 8,475
employed respondents (mean age: 40; S.D. 14.3) from wave
13 of the Household, Income and Labour Dynamics in
Australia (HILDA) Survey, where 689 provided some care to
an elderly or disabled relative in a typical week, it finds that
high-intensity carers (those who provide at least 8 hours or
more of care per week) report poorer quality sleep, higher
frequency of having trouble getting to sleep within 30 min-
utes, having taken medicine to help sleep, and having trouble
sleeping because of waking up in the middle of the night.
However, it does not find such associations for respondents
who report access to workplace leave.
WHAT HATH NIGHT TO DO WITH SLEEP?:
DEMENTIA CAREGIVERS EMOTIONAL DISTRESS
AND SLEEP DISTURBANCE
A.Leggett1, D.Maust1,2, H.Kales1,2, 1. Psychiatry, The
University of Michigan, Ann Arbor, Michigan, 2. The
Department of Veterans Affairs, Ann Arbor, Michigan
Care provision for persons with dementia (PWD) can be
rewarding yet may disrupt caregivers health, including sleep
health. Using the National Study of Caregiving (NSOC), we
examine reports of sleep disruption by dementia caregiv-
ers, as well as PWD and caregiver contextual factors, car-
egiver health and psychological well-being as predictors of
sleep disruption. Our sample included 1063 caregivers for
717 PWDs. Waking and having trouble falling back asleep
10% reported that helping the PWD caused their sleep to be
interrupted almost every night. In a hierarchical linear model,
greater sleep disruption was associated with caring for male
PWDs, younger age, higher education, more chronic medical
conditions, pain, emotional difficulty of the care role, and
lower psychological well-being. Caregiver distress was asso-
ciated with trouble sleeping over and above caregiver health
620
and PWD disability. Thus, interventions improving caregiver
distress may improve sleep health.
DISASTER EXPOSURE AND SLEEP DISTURBANCES
AMONG ELDERLY SURVIVORS OF THE JAPAN
EARTHQUAKE AND TSUNAMI
X.Li1, O.M.Buxton2,3,1, H.Hikichi1, I.Kawachi1, 1.
Department of Social and Behavioral Sciences, Harvard
Chan School of Public Health, Boston, Massachusetts, 2.
Department of Biobehavioral health, Pennsylvania State
University, University Park, Massachusetts, 3. Division
of Sleep Medicine, Harvard Medical School, Boston,
Massachusetts
Natural disasters disproportionately affect older adults.
We examined prospectively the associations between disas-
ter exposure and sleep disturbances among elderly survivors
over three years of follow-up. Logistic regression models
were used to analyze data from a natural experiment where
a prospective cohort (aged 65 or older) suffered the 2011
Japan earthquake and tsunami between baseline (2010)
and follow-up (2013) surveys. Of 3,567 panel respondents
(746 years old, 57% female), 13% reported post-disas-
ter sleep insufficiency (not well-rested upon waking), 41%
insomnia symptoms, 11% short sleep duration (< 6 hours/
day), 27% poor sleep quality, and 22% sleep medication use.
Financial hardship was associated with post-disaster sleep
insufficiency, insomnia symptoms, and poor sleep quality, net
of baseline covariates. Property damage predicted sleep med-
ication use while disrupted access to healthcare predicted
poor sleep quality. In contrast, survivors appeared to have
recovered from loss of relatives/friends as it did not predict
any sleep disturbances.
SESSION 2025 (PAPER)
CHRONIC CONDITIONS IN OLDER ADULTS I
THE ROLE OF BODY COMPOSITION AND
STRENGTH ON URINARY INCONTINENCE IN
WOMEN FROM THE HEALTH ABC STUDY
A.Suskind1, P.M.Cawthon2, S.Nakagawa1, L.Subak1,
I.Reinders4, S.Satterfield3, S.R.Cummings2, A.Huang1, 1.
UCSF, San Francisco, California, 2. CPMC, San Francisco,
California, 3. The University of Tennessee, Memphis,
Tennessee, 4. NIH, Bethesda, Maryland
Objectives: To evaluate prospective relationships between
body composition and muscle strength with predominantly
stress- and urgency urinary incontinence (SUI and UUI) in
older women.
Methods: Prospective community-dwelling observational
cohort study of women initially aged 70 to 79years (Health,
Aging, and Body Composition study). Urinary incontinence
was assessed by questionnaires. Body mass index (BMI),
grip strength, quadriceps torque and walking speed were
assessed by physical examination and performance testing.
Appendicular lean body mass (ALM) and whole-body fat
mass were measured using DEXA.
Innovation in Aging, 2017, Vol. 1, No. S1
Results: Of 1475 women, 212 (14%) and 233 (16%)
reported at least monthly predominantly SUI and UUI at
baseline, respectively. At 3 years, there were 1137 women,
164 (14%) with new/persistent SUI and 320 (28%) with new/
persistent UUI. Women had increased odds of new/persistent
SUI if they demonstrated 5% decrease in grip strength,
(adjusted OR [AOR] 1.60, p=0.047). Alternatively, women
had decreased odds of new/persistent SUI if they demon-
strated 5% decrease in BMI (AOR 0.46; p=0.014), 5%
increase in ALM corrected for BMI (AOR 0.17; p=0.004), or
5% decrease in fat mass (AOR 0.53; p=0.010). Only a 5%
increase in walking speed was associated with new/persistent
UUI over 3years (AOR 1.54; p=0.040).
Conclusion: Among women 70years and older, changes
in body composition and grip strength were associated
with changes in SUI frequency over time. In contrast,
changes in these factors did not influence UUI. Findings
suggest that optimization of body composition and muscle
strength is more likely to modify SUI than UUI risk among
older women.
CHANGING FROM APPROPRIATE TO
INAPPROPRIATE URINARY CATHETER USE AMONG
HOSPITALIZED OLDER PATIENTS
F.Hu1, H.Hsu1, H.Shih1, C.Chen2, C.Chang1, 1. National
Cheng Kung University Hospital, Tainan, Taiwan, 2. Chang
Jung Christian University, Tainan, Taiwan
To investigate incidence, rationales and related factors
for changing from appropriate urinary catheter placement to
inappropriate catheter use among hospitalized older patients
in emergency department (ED). A longitudinal study was
adopted at an 1135-bed tertiary-care medical center in south-
ern Taiwan. Patients aged 65 and older with urinary catheter
placed within 24 hours of hospitalization were enrolled.
Demographic factors, present health condition, conditional
factors of catheter placement, rationales for changing from
appropriate urinary catheter placement to inappropriate use
were collected through a review of medical records, inter-
viewing participants or their primary caregivers.
Appropriate urinary catheters were placed within 24
hours of admission at the ED in 117 of the 156 patients
(75%). Of these patients with appropriate urinary catheter
placement, 77 patients (65.8%) experienced changing from
appropriate placement to inappropriate use, with a mean
duration of 2.881.56 days per patient. The common
rationales for changing from appropriate urinary catheter
placement to inappropriate use were post-operation for
hip fracture (36.3%) and no longer need for monitoring
of urine output (27.2%). Hierarchical regression model
shows changing from appropriate urinary catheter place-
ment to inappropriate use was associated with urinary
tract infection diagnosis and no record of indication for
catheter placement.
The study highlights a considerable percentage of chang-
ing from appropriate placement to inappropriate use. Efforts
to improve record of indication for catheter placement and
continue attention to urinary catheter use are necessary to
reduce the incidence of inappropriate urinary catheter use.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
A RETROSPECTIVE COHORT STUDY OF DISCHARGE
HEMOGLOBIN IN OLDER PATIENTS AFTER HIP
FRACTURE SURGERY
K.Khow1,3, C.McNally3, P.Shibu1,3, S.C.Yu1,3, quality and symptoms of insomnia.
M.Chehade3, R.Visvanathan1,3, 1. Aged and Extended
Care, The Queen Elizabeth Hospital, Woodville South,
South Australia, Australia, 3. Adelaide Geriatric Research
and Training with Aged Care (G-TRAC) Centre, University
of Adelaide, Adelaide, South Australia, Australia, 3.
Discipline of Orthopaedics and Trauma, Royal Adelaide
Hospital and University of Adelaide, Adelaide, South
Australia, Australia
Anemia and blood loss is common in patients with hip
fractures. Preoperative and postoperative anemia in older
people with hip fractures have been associated with higher
risk of mortality and reduced ambulation. This study aims to
evaluate discharge hemoglobin and clinical outcomes after
hip fractures in older people. This is a retrospective cohort
study of patients (age 65years) that had hip fracture sur-
gery in a tertiary referral hospital between 1 January 2011
and 31 December 2012. Main outcome measurements were
1-year mortality (data obtained from the local death registry)
and 28-day readmission. Comparisons were made between
patients with discharge hemoglobin <100g/L and those with
100g/L (determined within 3days before discharge). During
the study period, 288 patients were included. Of these, 99
(34%) had hemoglobin <100g/L at discharge. The proportion
of patients with internal fixation was significantly higher in
the group with discharge hemoglobin 100g/L compared to
<100g/L (65% vs. 48%; p=0.009). The group with discharge
hemoglobin 100g/L had higher admission hemoglobin
level (12318g/L vs. 11717g/L; p= 0.005). The transfu- SAHARAN AFRICA
sion rate was similar between the two groups. Hemoglobin
of <100g/L at discharge was not associated with increased
risk of 1-year mortality (30% vs. 22%; p=0.17) and 28-day
readmission rate (11% vs. 10%; p=0.82). These data suggest
that discharge hemoglobin is not a good indicator of mortal-
ity and readmission after hip fracture surgery in older adults.
Further prospective studies are necessary to determine if a
specific target of hemoglobin level at discharge will influence
clinical outcomes.
NONCLINICIAN SLEEP COACHES FOR INSOMNIA:
SECONDARY OUTCOMES FROM ARANDOMIZED
CONTROLLED TRIAL
C.A.Alessi1,2, J.Martin1,2, L.Fiorentino3, C.Fung1,2, (2010) sociocultural stress and coping model to describe
J.Dzierzewski4, J.Rodriguez Tapia2,5, Y.Song1,2, results of a systematic literature review on older adult car-
M.Mitchell1, 1. VA Greater Los Angeles Healthcare
System, Los Angeles, California, 2. University of California,
Los Angeles, Los Angeles, California, 3. University of
California, San Diego, San Diego, California, 4. Virginia
Commonwealth University, Richmond, Virginia, 5.
Pontificia Universidad Catolica de Chile, Santiago, Chile
Background: Cognitive behavioral therapy for insomnia
(CBTI) is recommended for older adults, but availability
of behavioral sleep medicine (BSM) specialists to provide
CBTI is limited. We recently reported improved sleep (e.g.,
Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity
Index [ISI] total scores) in a 4-year randomized controlled
trial testing CBTI provided by nonclinician sleep coaches
among older outpatients with insomnia at one US Veterans
IAGG 2017 World Congress
621
Administration healthcare system. As secondary analyses,
we explored intervention effects on participants beliefs and
attitudes about sleep, specific aspects of self-reported sleep
Methods: Sleep coaches provided 5 sessions over 6 weeks
(including stimulus control, sleep restriction, sleep hygiene
and cognitive therapy) with weekly telephone supervision
by a BSM specialist. Controls received five sessions of gen-
eral sleep education. Analyses were intention to treat, using
mixed effects models testing the Dysfunctional Beliefs and
Attitudes (DBAS16) total score and 4 subscales; PSQI 3-fac-
tor subscales, and ISI individual items; at post-treatment, 6-
and 12-months follow-up.
Results: 159 subjects were randomized (mean age
72.2years, 97% male, 79% non-Hispanic white). Intervention
participants had greater improvement in DBAS16 total score
and sleep expectations subscale; PSQI subscales sleep effi-
ciency and perceived sleep quality; and ISI items satisfaction
with sleep, daily functioning, noticeability to others, and
worry/distress about sleep (all p<.05).
Conclusions: CBT-I provided by nonclinician sleep
coaches with BSM supervision improved sleep-disruptive
beliefs, and multiple aspects of self-reported sleep. The sleep
coach approach may be an important option for the manage-
ment of insomnia in older adults.
SESSION 2030 (SYMPOSIUM)
CONTEXT AND CULTURE: THE IMPACT OF AIDS
ON THE HEALTH OF OLDER PERSONS IN SUB-
Chair: J.Small, Oregon State University, Corvallis, Oregon
Co-Chair: P.Kowal, World Health Organization, Geneva,
Geneva, Switzerland
Discussant: M.Ralston, Mississippi State University, Stark
ville
The confluence of population aging and HIV/AIDS in sub-
Saharan Africa (SSA) has resulted in a wide range of psycho-
social and health impacts that have yet to be fully described.
Our symposium is a unique interdisciplinary reflection on
the differential impacts of demographic shifts and the HIV/
AIDS epidemic on older adults in SSA, highlighting insights
gleaned from cross-national comparisons. Jeon Small (social
scientist) will use a revised version of Knight and Sayeghs
egivers to persons with HIV/AIDS in SSA. Mark Brennan-Ing
(clinical psychology and gerontological research) will present
a comparative study of populations who are aging with HIV
in high-and-low-resource settings of Uganda and the USA.
Gillian Ice (anthropology and social medicine) will present
on the benefits and burdens of caregiving using compara-
tive samples of Kenyan and Rwandan caregivers. Paul Kowal
(global health and aging) will present preliminary findings
from Waves 1 and 2 of the WHO SAGE-WOPS HIV study,
which is a longitudinal study of caregiving and HIV/AIDS in
South Africa and Uganda. Our discussant will integrate the
four papers, highlight the importance of the confluence of
context and culture on older adults directly and indirectly
impacted by HIV and AIDS.
622
CAREGIVING AND HIV+/AIDS IN SUB-SAHARAN
AFRICA: CONTEXT AND CULTURE IN THE STRESS
AND COPING PROCESS
J.Small, Oregon State University, Corvallis, Oregon
JeonSmall,1 CarolynAldwin,1 PaulKowal,2
SomnathChatterji,2 TiesBoerma2, 1.School of Social &
Behavioral Health, Oregon State University 2.World Health
Organization, Geneva, Switzerland
In sub-Saharan Africa (SSA), older adults in unprece-
dented numbers have been recruited into providing care to
persons living with HIV/AIDS (PLWHA) across the lifespan.
The literature on older adult (OA) caregiving in SSA is frag-
mented across several disciplines and lacks a unified theo-
retical framework, we use a revised version of Knight and
Sayeghs (2009) sociocultural stress and coping model exam-
ine the literature on older adult caregivers to PLWHA. An
exhaustive literature review identified 68 articles on OA car-
egiving in SSA. The SSA experience requires understanding
that OAs are often taking care of multiple family members
and are often themselves in need of care. Key findings suggest
that population aging and HIV/AIDS deplete the amount of
social, cultural, and structural capital available to OA car-
egivers. Interventions which focus on collective solutions to
problems such as food insecurity may be needed at both the
extended family and the village level.
GLOBAL AGEING WITH HIV: DIFFERENCES
BETWEEN HIGH- AND LOW-RESOURCE SETTINGS
M.G.Brennan-Ing1,2, C.MacPhail3,4, J.Seeley5,6,
M.Kuteesa6, V.Minichiellp7, F.Venter4, K.E.Porter1,
S.Karpiak1,2, 1. Applied and Translational Research,
ACRIA, New York, New York, 2. New York University
College of Nursing, New York, New York, 3. University
of New England, Armidale, New South Wales, Australia,
4. University of the Witwatersrand, Johannesburg, South
Africa, 5. London School of Hygiene and Tropical
Medicine, London, United Kingdom, 6. MRC/UVRI
Uganda Research Unit on AIDS, Entebbe, Uganda, 7.
LaTrobe University, Melbourne, Victoria, Australia
Globally the HIV epidemic is aging due to the success
of life-prolonging antiretroviral treatment. Historically,
UNAIDS data reporting stopped at age 49. But the UNAIDS
2014 Gap Report identified older adults with HIV (OPH)
as a group left behind. Challenges faced by this population
include multimorbidity management, sexual health, stigma,
and access to social care. Referencing three parallel studies in
Uganda, South Africa and the U.S., this paper will examine
similarities and differences in the complex challenges facing
OPH across resource settings. For example, differences in the
average number of comorbidities are evident (5.3, 1.2, and
3.2, respectively). In Africa, friends and neighbors provide
much greater IADL assistance and emotional support than
is observed in the U.S., but OPH in all settings report need-
ing more support. The challenges in implementing policy and
programmatic responses to the ageing of HIV in the context
of available resources across settings will be discussed.
AGING AND HIV: ASUMMARY OF SAGE-WOPS HIV
WAVES 1 AND 2 IN SOUTH AFRICA AND UGANDA
P.Kowal1,2,3, N.Naidoo1, S.Chatterji1, J.Snodgrass2,
1. SAGE, WHO, Yangon, Myanmar, 2. University of
Innovation in Aging, 2017, Vol. 1, No. S1
Oregon Department of Anthropology, Eugene, Oregon, 3.
University of Newcastle Research Centre for Generational
Health and Ageing, Newcastle, New South Wales, Australia
In highly affected countries of sub-Saharan Africa, not
only do older people play an important role in the care of
HIV-affected adults and children, they themselves are increas-
ingly likely to be infected with HIV. Few studies in the region
have directly investigated the topic of older adults who are
infected or affected by HIV/AIDS, including the effect of car-
egiving, antiretroviral therapy (ART) and co-morbidity with
chronic diseases on the health and well-being of older people.
This presentation describes the main aims of establishing the
cohorts in South Africa and Uganda to describe the: 1)health
status of older people either infected with HIV themselves,
or affected by HIV through having an HIV infected adult
offspring or had recently died of HIV-related causes; and
2)impact of role as caregivers. We will present results from
SAGE-WOPS HIV Waves 1 and 2 on the direct and indirect
effects of HIV on older people in South Africa (W1 n=422;
W2 n=519) and Uganda (W1 n=510; W2 n=478).
THE BENEFITS AND BURDENS OF CAREGIVING:
ACOMPARISON OF KENYA AND RWANDA
G.H.Ice1, A.Sadruddin2, J.Bianco1, 1. Ohio University,
Athens, Ohio, 2. Yale University, New Haven, Connecticut
The HIV/AIDS epidemic has increased care burden in sub-
Saharan Africa but studies on the impact on older persons
are equivocal and benefits of caregiving have also emerged.
This presentation discusses two qualitative studies in west-
ern Kenya and Rwanda. In Kenya, caregiving necessitated an
unexpected disruption and many burdens but the change of
identity/roles with caregiving was both a source of pride and
empowerment for older adults. Caregivers described multiple
burdens yet they felt a moral, familial or spiritual obligation
to provide care. Further, many participants also assistance
from orphans or anticipated reciprocity. In Rwanda, caregiv-
ing was viewed as an opportunity for older persons to make
themselves useful community members. Caregiving, in this
setting, was not considered a burden in the conventional
sense but a moral responsibility and a practice that brought
communities together. These results suggest that caregiving
is multidimensional with a balance of burden and empower-
ment, caregiving and care-receiving.
SESSION 2035 (SYMPOSIUM)
FONDATION IPSEN LONGEVITY PRIZE 2017
AWARDING LECTURE
Chair: Y.Tanguy, Fondation IPSEN
Co-Chair: T.Kirkwood, University of Newcastle and S.N.
Austad, University of Alabama
During this symposium, the Fondation Ipsen Longevity
Prize 2017 will be awarded to Andrzej Bartke.
THE IMPORTANCE OF SINGLE GENE
INTERVENTIONS IN AGING
S.N.Austad, University of Alabama, Birmingham, Alabama
When the history of the basic aging research leading to
medical treatments that extend human health is written,
a significant milestone is likely to be the 1996 paper by
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Brown-Borg, Borg, Meliska, and Bartke describing the first
single gene mutant that extended life in a mammal. Previous
research beginning in the late 1980s had found such genes in
very simple organisms, but many researchers in the field felt
that single genes would never be found to extend life in such
a complex animal as a mammal. Of course, now we know
that there are a number of individual genes several dozen
so far that can extend life in mammals. The significance of
these findings is not that we should begin manipulating the
human genome to allow everyone to live longer. It is that
each such gene represents a potential drug target for slow-
ing aging. Consequently, drugs doing exactly this -- began to
emerge less than 15years after this initial, pivotal discovery.
Dr. Bartke has been a key driver in the field since this original
publication as will be described.
GROWTH AND AGING; THE HIDDEN COSTS OF
STATURE
A.Bartke, SIU, Springfield, Illinois
Elimination of growth hormone (GH) actions by muta-
tions or targeted gene deletion produces a remarkable exten-
sion of longevity in both sexes of laboratory mice. Long-lived
GH-deficient and GH-resistant animals are characterized by
small body size, delayed puberty, reduced fecundity and a
striking delay in multiple symptoms of aging, including the
decline of gonadal function. These findings lead to a some-
what counterintuitive conclusion that the normal actions of
GH incur significant costs in terms of the impact on aging
and longevity. Studies in genetically normal (wild type)
mice, domestic dogs and various human populations indi-
cate that GH signaling is indeed negatively associated with
life expectancy across mammalian species. The evolutionary
history of the genetic variation underpinning the trade-offs
between growth, maturation, reproductive functions, stress
resistance, age-related disease and longevity is difficult to
decipher. However, persistence of a wide range of the cor-
responding phenotypes may benefit survival of populations
under challenging environmental conditions.
Supported by NIA
SESSION 2040 (SYMPOSIUM)
A BINATIONAL COMPARISON OF FAMILY AND
FORMAL SUPPORT IN THE AMERICAS: MEXICO
AND THE U.S.
Co-Chair: J.L.Angel, University of Texas at Austin
K.S.Markides, University of Texas Medical Branch at
Galveston
Discussant: W.Vega, University of Southern California
This symposium examines the relationship between for-
mal eldercare policy and the actual capacities of various
levels of government and other institutions to implement spe-
cific agendas. The symposium will place special emphasis on
the Hispanic population which is rapidly aging in the U.S.,
with the number of adults 65 and older expected to increase
by more than six times by 2050 to 17.5 million. Mexicos
population is also aging and will increase by 227 percent
over the next 25 years. Governments recognize that these
aging trends will cause a strain on both healthcare systems as
well as other community resources.
IAGG 2017 World Congress
623
This symposium will also focus on the consequences
of rapid declines in fertility and rising longevity for the
U.S. and Mexico. Given immigrants interconnectedness,
understanding how aging processes in Latin America influ-
ence health and retirement policy there and how the aging
of older immigrants in the U.S.influence social delivery here
is critically important. As of yet, however, the ways in which
those nations can address the problem of rapid aging remain
unclear.
Presentations will examine issues related to older
U.S.adults, and Mexicans including: 1)the effects of immi-
gration-related factors on financial security, adaptation, and
autonomy, 2)the impact of family and economic resources
on long-term care alternatives, 3) innovative strategies and
concrete solutions to improving health and social welfare,
and 4)identifying methodological challenges and opportuni-
ties for investigations of informal support in Mexico and the
U.S.
CAREGIVING NETWORKS AND BENEFITS OF
CAREGIVING: DIFFERENCES BY RACE AND
ETHNICITY
E.M.Agree1, T.Wakui2,1, 1. Sociology, Johns Hopkins
University, Baltimore, Maryland, 2. Tokyo Metropolitan
Institute of Gerontology, Tokyo, Japan
Research on family caregiving has often focused on the
experience of care burden, but an emerging literature has
shown that caregiving can have benefits for both caregivers
and care recipients, and that these benefits may vary by cul-
tural background, race or ethnicity. This study uses nation-
ally representative data from the U.S. National Study of
Caregiving (NSOC) and National Health and Aging Trends
Study (NHATS) to examine the structure of caregiving net-
works and the experience of benefits by caregivers from dif-
ferent backgrounds. NHATS studies late-life disability and
NSOC collects data on informal caregivers to NHATS par-
ticipants. Preliminary results show that African American
elders have a slightly larger care networks, but are no more
likely to live with their helpers than white elders. Although
previous research has reported higher levels of positive car-
egiving among minority caregivers, we find that health of
the care recipient and relationships are more important than
background.
DEMENTIA AND SOCIAL SUPPORT TRAJECTORIES
IN THE MEXICAN-ORIGIN POPULATION
S.Rote1, J.L.Angel2, T.Hill3, K.S.Markides4, 1. Kent
School of Social Work, University of Louisville, Louisville,
Kentucky, 2. University of Texas at Austin, Austin, Texas,
3. University of Arizona, Tucson, Arizona, 4. University of
Texas Medical Branch, Galveston, Texas
Given the future growth of the elderly Mexican-origin
population, the need for culturally informed dementia care
will inevitably grow in the years ahead. Dementia-related
needs of older adults living in the community are multidi-
mensional and based on severity of dementia; yet, there is
a lack of information on emotional and instrumental sup-
port need as cognitive impairment unfolds for the elderly
population in general and for the Mexican-origin popula-
tion in particular. The current explores different patterns or
trajectories of emotional and instrumental support need for
624
3,050 Mexican Americans aged 65 and older from seven
waves of the Hispanic Established Epidemiologic Studies of
the Elderly (H-EPESE, 1993/942010/11). We identify three
distinct classes of social support trajectories: stable high sup-
port need, increasing support need, and stable low support
need. Mexican American elders with increasing cognitive
impairment report increasing emotional and instrumental
support need throughout the study waves. Predictions of
older Latinos at risk of being left without sound support
and consequently high dependency on public resources are
discussed.
FAMILY AND COMMUNITY-BASED SUPPORT FOR
OLDER ADULTS IN MEXICO
L.Gutierrez-Robledo, M.Lopez Ortega, Instituto Nacional
de Geriatria, Mexico City, Mexico
Mexico is undergoing a rapidly aging process and by the
year 2050 the proportion of adults 60years and older is esti-
mated to increase from the current 10 percent of total popu-
lation to 28 percent in the year 2050. However, this process
is taking place in a context of limited resources, lack of long-
term care policies and specific primary care strategies for
older adults, as well as insufficient regulation of institutional
and community-based care. This study presents a summary
of the current state of social care support systems for older
adults in Mexico, with an emphasis on family and commu-
nity-based care and the challenges they face in meeting an
increasing care demand. It also presents some recommenda-
tions on how to tackle some of these challenges.
AGING IN MEXICO AND THE ROLE OF THE CIVIL
SOCIETY ORGANIZATIONS
V.Montes de Oca Zavala1, P.Rea Angeles1, R.J.Angel2, 1. siders how changes in society shape these views. Fingerman
Universidad Nacional Autnoma de Mxico, Mexico City,
Mexico, 2. University of Texas at Austin, Austin, Texas
The aging population has influenced public policy in
many countries, including Mexico, over the past two dec-
ades. In Mexico, this new focus on the rights of the elderly
influences the positions of civil society organizations. We
analyze official communications from civil society organiza-
tions in Mexico City and employ qualitative techniques to
identify perspectives on active ageing, social participation,
and the social rights of older adults. Our most significant
finding is that organizations have fought for the labor rights
of unions in strategic sectors that have been threatened by
the economic policy of privatization. Their missions are not
framed in terms of aging, but in terms employment. Other
groups focus on concrete needs such as institutionalized care,
strengthening community networks, and defending the rights
of pensioners. Views of old age and that the experience of
aging is heavily determined by ones labor market history
and the more general processes of development.
ISSUES IN SURVEYING FOR FAMILY HEALTH
SUPPORT IN CROSS-NATIONAL STUDIES IN THE
AMERICAS
R.B.Wallace, Epidemiology, The University of Iowa, Iowa
City, Iowa
Comparative research among countries is critical to pro-
moting improved and optimal support for family health
needs among older persons, but conducting household
Innovation in Aging, 2017, Vol. 1, No. S1
surveys has challenges in addition to translation across
languages and native dialects, including: defining representa-
tive samples, gaining permission to approach households;
understanding cultural variation in the use of both formal
and informal care; crafting useful survey items in the face of
substantial differences in general and health literacy; identi-
fying local complementary and alternative health practices;
and selecting the best household respondents. Also, given the
substantial regional variation in actual and potential health
and long-term care services available and accessible to fami-
lies, including from community and public health sources,
many survey formats and items may be inappropriate across
diverse settings. Some potential solutions to these challenges
will be presented, including techniques not yet widely applied
in developed or developing countries.
SESSION 2045 (SYMPOSIUM)
MULTIPLE PERSPECTIVES ON FAMILY LIFE
Chair: K.L.Fingerman, The University of Texas at Austin,
Austin, Texas
Research on families in late life has often focused on indi-
vidual reporters, rather than dyadic or family perspectives.
This symposium considers multiple perspectives on family
relationships as well as the role of changing societies in shap-
ing these perceptions. Suitor and colleagues consider mothers
favoritism in late life, and how grown childrens perspectives
on who is the favorite may differ or coincide with the moth-
ers perspective- with consideration of ethnic differences in
the US. Han examines marital partners discrepant views of
gender roles and marital satisfaction in South Korea and con-
and colleagues look at parents and grown childrens percep-
tions of support exchanges. They find greater discrepancies
in perceptions of support in younger dyads, with parents
reporting receiving less support than offspring report pro-
viding. Finally, migration has increased dramatically world-
wide and family ties are shaped by this experience. Dykstra
and Fokkema examine a large sample of migrants to France,
and consider family patterns in their relationships with their
grown children. Collectively, these studies suggest family
members bring unique perspectives to intergenerational and
marital relationships. Individuals have distinct relationships
with each of their family members, favoring some children
over others and relating to parents differently than to their
children. Importantly, societal changes and cultural values
shape these perceptions and implications of these percep-
tions for family members well-being.
ITS REALLY NOT ME? ADULT CHILDRENS
MISPERCEPTIONS OF MOTHERS FAVORITISM AND
DISFAVORITISM
J.Suitor1, M.Gilligan2, M.Rurka1, S.Peng1, K.A.Pillemer3,
1. Purdue University, West Lafayette, Indiana, 2. Iowa State
University, Ames, Iowa, 3. Cornell University, Ithaca, New
York
Recent studies have revealed that both mothers and adult
children report that maternal favoritism and disfavoritism
are common in later-life families; however, little is known
about whether childrens perceptions of differentiation
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
mirror mothers own reports. In this paper we use data from
310 mothers and 725 offspring from the Within-Family
Differences Study to examine patterns and predictors of con-
gruence regarding reports of favoritism and disfavoritism.
Contrary to the intergenerational stake hypothesis, mothers
and offspring reported similar rates of favoritism and disfa-
voritism; however, children were very inaccurate reporters of
which offspring mothers favored and disfavored. Congruence
was more likely when mothers and offspring were the same
gender, shared values, and frequently exchanged support.
Greater congruence was found in Black than White families.
Given that adult childrens perceptions of such differential
treatment strongly predict depressive symptoms, shedding
light on these processes is important in understanding the
role of intergenerational relations in well-being.
VARIATION IN PARENT-CHILD RELATIONSHIPS
WITHIN MIGRANT FAMILIES
P.A.Dykstra1, T.Fokkema2,1, 1. Erasmus University,
Rotterdam, Netherlands, 2. NIDI-KNAW, University of
Groningen, Rotterdam, Netherlands
Silverstein and Bengtson (1997) were pioneers in exam-
ining multiple dimensions of parentchild relations simul-
taneously. Their typology of American late-life families has
been replicated in different countries. Most of these studies
focused on one parentchild dyad per family and all but one
study2 did not pay attention to the specific case of migrants,
thereby masking within-family variations in intergenera-
tional solidarity and leaving the question about the impact
of migration unanswered. This paper aims to advance our
knowledge in both areas. Data are taken from the French
Route to Retirement of Immigrants survey in which more
than 6000 migrants, aged 4570 and of different origin, were
asked about various dimensions of their relations with each
child: geographical proximity, contact frequency, family obli-
gation norms, and personal, practical and financial support
exchange. Once parentchild are assigned to latent classes,
multilevel multinomial logistic regression will be used to
identify significant predictors.
GENERATIONAL DIFFERENCES IN PERCEPTIONS OF
SUPPORT EXCHANGES
K.L.Fingerman1, M.Huo1, K.Kim3, K.Birditt2, 1. Human compelling evidence for the need to recognize and address
Development, The University of Texas at Austin, Austin,
Texas, 2. University of Michigan, Ann Arbor, Michigan, 3.
University of Massachusetts, Boston, Massachusetts
In Western countries, parents typically provide support to
their children, even after they are grown; grown children may
reciprocate and provide support to parents in late life when
parental health declines. Yet, we do not know whether both
parties perceive these exchanges in the same manner across
adulthood. Participants included two sets of dyads from the
Family Exchange Study: Middle aged parents and young
adult children (n=664 dyads, 1328 participants) and older
parents and middle-aged children (n=221 dyads, 442 par-
ticipants). Participants report frequency of giving and receiv-
ing 6 types of support using the Intergenerational Support
Index (ISI). The older dyads typically agreed in reports of
support provided by parents to offspring and by offspring
to parents. In the younger dyads, the young adult children
reported providing more frequent support of all types than
IAGG 2017 World Congress
625
parents reported receiving. Norms for intergenerational sup-
port may shape perceptions of such support.
KOREAN MIDDLE AGED COUPLES DISCREPANCIES
IN GENDER ROLES, MARITAL AND LIFE
SATISFACTION
G.Han, Y.Bae, Seoul National University, Seoul, Korea (the
Republic of)
Due to gender inequalities, men and women have dif-
ferent subjective experiences of marriage. This discrepancy
between partners might be particularly salient in a rapidly
changing society like Korea. This study asked how discrepan-
cies among Korean middle aged couples beliefs about gender
roles affect marital stability and well being. We used dyadic
data from 1074 middle-aged Korean baby boomer couples
to examine this question. Data were analyzed using actor-
partner interdependence model (APIM). Dependent variables
were marital stability and life satisfaction. Main independent
variables were gender role attitudes, spousal relationship sat-
isfaction and discrepancies in gender role attitude and spousal
relationship satisfaction. Results show that only 42% of the
couple shared an outlook of their marriage where neither
husband nor wife ever considered divorce. In many couples,
more wives considered divorce than husbands. When gender
role attitude discrepancies between partners was larger, mari-
tal stability of the couple tend to be lower.
SESSION 2050 (SYMPOSIUM)
TRAJECTORIES OF CARE FOR LGBT (LESBIAN, GAY,
BISEXUAL AND TRANS) AGEING POPULATIONS
Chair: R.L.Jones, The Open University, UK, Milton
Keynes, United Kingdom
Co-Chair: A.D.King, University of Surrey, Guildford,
Surrey, United Kingdom
This symposium presents research from the UK, US and
Canada which focuses on aspects of care and the care needs
for ageing lesbian, gay, bisexual and trans (LGBT) peo-
ple. The symposium will offer insights which contribute to
broader understandings of the heterogeneity of ageing. It
showcases cutting edge research in the field which provides
the unique care needs of older LGBT individuals - a diverse
new ageing population worthy of more attention within ger-
ontology. In particular, this symposium demonstrates that
despite recent socio-legal shifts, LGBT people are still an
invisible and marginalised population in care settings and
their life-stories and relationships are frequently overlooked
by care providers. The paper by Hafford-Letchfield et al.,
present findings from a pilot scheme designed to find ways
to enhance the inclusion of older LGBT residents in English
care homes. Flatt etal., address the area of long term care in
the US, identifying predisposing, enabling and need factors of
older LGBT people. The papers by both Almack and De Vries
etal., focus on the unique experiences and diversity of sup-
port needs of LGBT older people towards the end of life, in
the UK and Canada respectively. All four papers raise issues
of intersections between ageing, gender identity and sexual
orientation in different geographical contexts and across a
range of care settings.
626
PREPARATIONS FOR END OF LIFE AMONG LGBT
OLDER CANADIANS
B.deVries1,2, G.M.Gutman2, L.Chamberland4, J.Fast3, York, New York, 4. Center on Halsted, Chicago, Illinois, 5.
J.Gahagan5, A.Humble6, S.E.Mock7, 1. Gerontology,
San Francisco State University, San Francisco, California,
2. Simon Fraser University, Vancouver, British Columbia,
Canada, 3. University of Alberta, Edmonton, Alberta,
Canada, 4. University of Quebec at Montreal, Montreal,
Quebec, Canada, 5. Dalhousie University, Halifax, Nova
Scotia, Canada, 6. Mount St. Vincent University, Halifax,
Nova Scotia, Canada, 7. University of Waterloo, Waterloo,
Ontario, Canada
Research over the last decade has documented the unique
historical experiences and demographic characteristics of les-
bian, gay, bisexual and transgender (LGBT) older adults. To
explore the influence of these and other variables on end-of-
life planning, focus groups were held in five Canadian cit-
ies (Vancouver, Edmonton, Montreal, Toronto, and Halifax)
with lesbians and bisexual women (n=29), gay and bisexual
men (n=39) and transgender individuals (n=23) age 55+.
All groups described difficulty identifying potential caregiv-
ers and engaging others in discussion of end-of-life issues.
Lesbians and bisexual women highlighted the need for com-
munity intervention, gay and bisexual men issues of trust
and the legacy of HIV, transgender persons the insensitivity
of health care settings. The findings show both similarities
and differences between LGBT groups and while focused on
the experiences of stigmatized sexual minority groups, have
broad implications for others challenging traditional family
norms. Service provider data (n= 26)compliment the LGBT
data.
IS EVERYONE EQUAL IN OLD AGE? END-OF-LIFE
CARE FOR OLDER LESBIAN, GAY, BISEXUAL AND
TRANS PEOPLE
K.Almack, Health Sciences, University of Nottingham,
Nottingham, United Kingdom
The heterogeneous care needs of older people are often
neglected. This paper examines older LGBT peoples experi-
ences and perceptions of care towards the end of life as a
critical case in addressing diversity within the delivery of
end of life care services in the UK. In doing so, the paper
discusses findings from the qualitative strand (60 in-depth
interviews with LGBT people aged 60+) of The Last Outing
- a large mixed methods UK project. Findings revealed that
despite legislation providing equality and protection for
LGBT people, a significant number of barriers and stressors
still exist in accessing services and support. It is clear that
older LGBT peoples histories and pathways have profound
influences on well-being and access to support towards and
at the end of life. These are issues that need to be addressed
to ensure equitable access to end of life care services for all
in old age.
PREDICTORS OF INFORMAL AND FORMAL LONG-
TERM CARE USE AMONG SEXUAL AND GENDER
MINORITY OLDER ADULTS
J.D.Flatt1, S.Karpiak2,3, E.Seidel2,5, B. Larson4,
M.G.Brennan-Ing2,3, 1. Institute for Health and Aging,
University of California, San Francisco, San Francisco,
California,
Innovation in Aging, 2017, Vol. 1, No. S1
2. ACRIA, Center on HIV and Aging, New York, New
York, 3. New York University College of Nursing, New
Fordham University, New York, New York
Few studies have examined long-term care (LTC) use
among sexual and gender minority (SGM) older adults.
Guided by Andersens Healthcare Utilization Model, we
identified predisposing, enabling, and need factors associated
with informal (caregiving) and formal (homecare, long-term/
continuing care, hospice care) LTC use in a community-
based sample of SGM older adults (n=210), mean age 59.6.
Nearly 20% used informal or formal care in the past year
and 10% used both. Informal LTC use was associated with
identifying as female (OR:8.8; 95%CI:2.235.2), HIV posi-
tive (OR:8.5; 95%CI:2.035.1), having one or more instru-
mental activities of daily living (ADL) impairments (OR:5.2;
95% CI:2.013.2), and having greater service needs (OR:1.4;
95% CI:1.21.7). Formal LTC use was associated with access
to Medicare (OR:4.2; 95% CI:1.710.9) and comorbidities
(OR:1.3; 95%CI:1.11.6). Agreater understanding of LTC
needs of SGM older adults is necessary for developing poli-
cies and services aimed at improving care and quality of life
for this population.
DEVELOPING INCLUSIVE CARE HOME
ENVIRONMENTS FOR OLDER LGBT PEOPLE:
APILOT SCHEME IN ENGLAND
P.Willis1, T.Hafford-Letchfield2, K.Almack3, P.Simpson4, 1.
University of Bristol, Bristol, United Kingdom, 2. Middlesex
University London, London, United Kingdom, 3. University
of Nottngham, Nottingham, United Kingdom, 4. Edge Hill
University, Manchester, United Kingdom
We present findings from an evaluation of a pilot scheme
in England aimed at enhancing the inclusion of older LGBT
residents in care home environments. Implemented in 2016,
six LGBT community members were recruited and trained
to undertake community audits of current care home prac-
tices. The scheme was implemented in one locality across six
homes, which belonged to a national provider of housing for
older people. Based on their findings, Community Advisors
(CAs) advised home managers on ways of developing LGBT-
inclusive environments. As an external team we conducted a
qualitative evaluation, which included pre- and post-inter-
vention interviews (N=39) with CAs (n=8), home managers
(n=6) and other management staff (n=3). Based on the find-
ings, we discuss how the scheme took a co-production turn
and identify ways in which CAs can be a valuable resource
in bridging the gap between hetero-centric cultures of homes
and the lived realities of older LGBT people.
SESSION 2055 (SYMPOSIUM)
EVALUATION OF KNOWLEDGE MOBILIZATION IN
GERONTOLOGY: DIGITAL TOOLS, PAPER TOOLS, OR
BOTH?
Chair: L.McDonald, University of Toronto, Toronto,
Ontario, Canada
Discussant: T.Goergen, Criminological Research Institute
of Lower Saxony
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
The purpose of this research was to evaluate the impact of
pocket tools in digital and paper formats that contained evi-
dence-based information about the core challenges of aging.
The tools, based on current research in aging, were created
by interdisciplinary teams for an established national/inter-
national knowledge mobilization network of older adults,
students, policy makers, academics and practitioners. The
overarching goal of the network was to place the most recent
knowledge on aging in the hands of users in a rapid and
straightforward way. Over 230 tools including care giving,
financial literacy, legal issues, policing, dementia, mental
health, ethnicity, elder mistreatment and technology were
developed and have been utilized by over a million users
nationally and internationally. All researchers, and commu-
nity partners to this project have had strong vested interests
in knowing if the tools were effective, which format worked
best for their stakeholders, and how the information was
used. The investigation included a survey of current users of
the tools (n=800) to evaluate how the tools were used; digital
and paper tool users (seniors, practitioners, caregivers) were
compared on outcomes of effectiveness in 9 random clinical
trials (n=783) and 40 respondents were interviewed in-depth
about their challenges in using the tools. Here we report on
the survey and the first random trial of tools, the outcomes,
challenges and the roles and implications for international
partners. The results suggested that both digital and paper
tools were very helpful in uptake but the digital divide still
existed according to age and education.
THE CONTINUING DIGITAL DIVIDE: RESULTS FROM
THE KNOWLEDGE MOBILIZATION SURVEY
L.McDonald, University of Toronto, Toronto, Ontario,
Canada
Knowledge mobilization (KM) is practical because it is
cost-efficient, makes use of existing research and can hap-
pen at a faster pace then waiting to change the behaviours
of whole generations of seniors, students, practitioners and
policymakers. While KM seems obvious, there is a lack of
research about the effectiveness of KM in the field of geron-
tology. This research traverses new terrain in aging and tech-
nology by evaluating KM through the use of pocket tools,
delivered on paper or digitally. The analyses were based on a
random sample of 3,500 members of a KM network (n=800)
who were surveyed in one hour, standardized telephone
interviews. The results showed digital tools were useful to
the professionals depending on education, occupation and
method of use and caregivers according to age and educa-
tion; for seniors, paper tools were preferred depending on
age and purpose of the tools. Age acted differently across
the groups.
A RANDOM CLINICAL TRIAL OF THE
EFFECTIVENESS OF DIGITAL AND PAPER
CAREGIVING TOOLS
R.M.Mirza1, P.Donahue2, 1. University of Toronto,
Toronto, Ontario, Canada, 2. Kings University College,
Western University, London, Ontario, Canada
This research is part of a multi-method research pro-
gram that evaluated the impact of knowledge mobilization
of evidence-based information for older adults, professionals
and caregivers. This research reports the results from nine
IAGG 2017 World Congress
627
caregiving clinical trials with one group of older adults, one
professional group and one of carers, exposed to three levels
of the intervention in each trial (n=261). The null hypoth-
eses were that caregiving knowledge would not differ across
the three conditions of no tools, paper tools or digital tools.
Respondents were randomly assigned to one of three condi-
tions for each of the three groups. The computed sample size
required 29 respondents assigned to each of the three condi-
tions for each of the three groups Respondents were tested
on knowledge of caregiving pre-post. F tests showed there
were significant differences across each of the three condi-
tions. Professionals achieved higher scores with digital tools
and older adults, the paper tools.
THE PLACE OF INTERNATIONAL PARTNERSHIPS IN
KNOWLEDGE MOBILIZATION
A.Lowenstein, Max Stern Yezreel Academic College, Haifa,
Israel
The purpose here is to examine the role of international
partners in knowledge mobilization (KM) using Israel as a
case example. The International Initiative for the Care of
the Elderly is an international collaboration across four-
teen countries: Australia, Canada, Israel, China, England,
Germany, India, Israel, Japan, Scotland, Brazil South Africa,
Ireland and Switzerland. The international partnership has
enhanced the universality of the content of the pocket tools
as exemplified by Israeli physicians improvement of an elder
abuse tool, or the dementia tool expanded by South Africa.
Second, countries have developed new tools as in Switzerland
for consulting and Brazil on caregiving. Third, partnership
countries have enriched cultural sensitivity especially about
dying as adapted in Brazilian tools. Fourth, translation of the
tools has made them available in Hebrew, English, French,
Portuguese, Hindi, Japanese and Spanish. Lastly, PhD stu-
dents have been participants in many international meetings
to improve their networking.
THE CHALLENGE OF INTERNATIONAL
PARTNERSHIPS FOR ADAPTING KNOWLEDGE
MOBILISATION
A.Phelan, School of Nursing, Midwifery & Health System,
University College Dublin, Dublin, Dublin, Ireland
Knowledge mobilisation has become an important aspect
for both funding agencies and research applications where
findings of studies are required to make a tangible impact
between research or expertise on policy and/or practice.
Within the knowledge mobilisation research focusing on the
use of pocket tools (paper or digital), the National Initiative
for the Care of the Elderly (NICE) convened an international
advisory panel. This paper examines the emerging issues
and challenges inherent in knowledge mobilisation beyond
the national research site. Although such social innovation
seems logical, issues such as cultural context, legislative and
policy boundaries and health and social care structures can
mean that knowledge mobilisation on an international scale
requires careful localisation and adaptation for transferabil-
ity. This paper considers these issues related to the NICE pro-
ject and offers some recommendations for similar projects.
Participants will be introduced to the relevant, experiential
based challenges for international partnerships related to
knowledge mobilisation. In addition, participants will gain
628
knowledge on how to address the emergent issues within
similar projects.
SESSION 2060 (PAPER)
NURSING CARE IMPROVING PATIENT CARE
OUTCOMES
PREPARE OLDER PATIENTS FOR CARDIAC SURGERY:
DEVELOPMENT AND FEASIBILITY OF ANURSING
INTERVENTION
R.Ettema1,2, M.Hoogendoorn3, C.Kalkman2,
M.Schuurmans2,1, 1. University of Applied Sciences
Utrecht, The Netherlands, Utrecht, Utrecht, Netherlands,
2. University Utrecht, The Netherlands, Utrecht, Utrecht,
Netherlands, 3. Isala Hospital, Zwolle, Overijssel,
Netherlands
Background and aim: In older patients undergoing elec-
tive cardiac surgery, timely identification and preparation of
patients at risk for frequent postoperative hospital complica-
tions provides for the opportunity reducing their risk. We
developed an evidence based multi component nursing inter-
vention (PREDOCS-Program) to improve patients physical
and psychosocial condition in order to reduce their risk on
postoperative complications and we tested the PREDOCS-
program on its feasibility and estimated theoretical cost
savings.
Method and material: In a team of researchers, experts,
cardiac surgeons, cardiac surgery nurses and patients, the
first phase of the revised guidelines for developing and
evaluating complex interventions of the Medical Research
Council (MRC) were followed. Subsequently, in a mixed-
methods multicenter study, following the second phase of the
MRC guidelines, we tested the feasibility in three hospitals
and calculated theoretical cost savings.
Results: PREDOCS-program is administered during a
consult by the nurse, two to four weeks before the surgery
procedure. Twenty one females and 49 males out of the 114
eligible patients completed the intervention. Patients were
equally satisfied with the usual care and the PREDOCS-
program (satisfaction rates on a scale from 110 respectively:
7.5 (95%CI: 6.48.7) and 7.6 (6.68.6)). The PREDOCS-
program will be cost-effective when postoperative complica-
tions are prevented in six to sixteen of 1,000 cardiac surgery
patients.
Conclusion: In creating transparency in the assumed
working mechanisms, an extended stepwise multi-method
procedure was used to develop the PREDOCS-program,
which will be already cost-effective when postoperative com-
plications are prevented in six to sixteen of 1000 cardiac sur-
gery patients.
LIVING WITH PAIN: EVALUATING CLINICAL
OUTCOMES WITH THE ROY ADAPTATION MODEL
S.G.Robinson-Lane, Physical Medicine and Rehabilitation,
University of Michigan, Livonia, Michigan
Disparities exist in pain management amongst Black
elders in the US. Although many barriers have been identi-
fied, few studies examine the experience of managing pain
Innovation in Aging, 2017, Vol. 1, No. S1
from the participants perspective. It is hypothesized that the
Roy Adaptation Model provides an appropriate framework
to evaluate clinical pain outcomes in ways that prioritize care
needs and identify culturally relevant interventions.
A 10-month ethnographic study was completed in an
independent living facility housing predominately Black
adults, age 55+ (n=470). Following participant observation
and informal interviews, participants (n=106) completed
questionnaires comprised of a demographic tool, the Brief
Pain Inventory, the PROMIS Global Health tool, and the
Psychological Stress Measure-9 as well structured interviews
(n=20). Structured interview transcripts, fieldwork journal
notes, and questionnaire responses were descriptively and
thematically analyzed. Findings were clarified with partici-
pants and evaluated for model fit.
Severe persistent pain is a primary stressor that causes
discomfort, disability, loss of income, difficulty maintain-
ing social relationships, and impaired emotional wellbe-
ing. Multiple comorbidities, functional status decline, and
poverty exacerbated the pain experience. Fear of depend-
ence motivated engagement in health promotional activities
and self-care, which may have influenced the overall mild
to moderate stress of the group. Identified care priorities
included: improved medication management, patient edu-
cation, integration of non-pharmacological treatments into
care, and encouragement of social engagement. Effective
coping resulted in a positive sense of self, decreased psycho-
logical distress, spiritual well-being, and satisfaction in social
relationships.
The Roy Adaptation Model provides an appropriate
framework for bridging research and clinical practice that
addresses disparities in culturally diverse populations.
CARE INSTABILITY IN NURSING HOMES;
AQUALITATIVE STUDY
M.Rahimi1, R.Fadayevatan2, H.Abedi3, 1. Gerontology
Department, university of Social Welfare and rehabilitation
sciences, Tehran, Tehran, Iran (the Islamic Republic of), 2.
Iranian Research centre of Aging, Grontology Department,
Tehran, Iran (the Islamic Republic of), 3. Nursing-
Midwifary Department, Islamic Azad University, Isfahan,
Iran (the Islamic Republic of)
The use of long-term care services has risen and this trend
is expected to continue as the population reaches old age.
This study was conducted with a qualitative approach
using conventional qualitative content analysis. The study
was conducted on 23 Iranian participants including 14 elders
and 9 caregivers. Data were collected with unstructured
interviews and continued to the point of data saturation.
Analysis of the data was performed continually and concur-
rently with data collection through a comparative method.
As results three themes emerged from 595 open codes
including care as unpleasant task, sustained care and insufficient
resources. Ten subthemes indicated participants experiences
and understanding of caring conditions in a nursing home.
The prevailing given care was the routine one with a
focus on physical aspects although there was some psycho-
logical care given to the older people. The findings of this
research are guidelines for managers and care planners in
nursing homes who should also pay attention to physical and
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Innovation in Aging, 2017, Vol. 1, No. S1
psychological care needs of older people. In addition, it is
important to pay close attention to the needs of the caregiv-
ers and provision of instructions for treatment, supervision,
education of caregivers and medical students and finally bet-
ter care.
ORAL HEALTH MATTERS FOR THE NUTRITIONAL
STATUS OF FRAIL OLDER PERSONS
L.Johansson2, H.Jansson3, C.Lannering1, I.Johansson3,
U.Lindmark3, 1. Institute of Gerontology, Jnkping
University, Jnkping, Sweden, 2. Institute of Gerontology/
Department of Nursing, Jnkping University, Jnkping,
Sweden, 3. Centre for Oral Health, Department of Natural
Sciences and Biomedicine, Jnkping University, Jnkping,
Sweden
Oral conditions such as dry mouth, dental caries and peri-
odontitis increase with age and affect a persons ability to
chew and swallow, which is why eating a healthy diet and
obtaining a satisfactory nutritional status may be a problem.
Oral health is therefore of great importance within elderly
nursing care. The aim of this study was to evaluate oral health
and nutritional status among older persons in a daily care
context. Data from the Swedish quality register, Senior Alert,
including structured assessments of oral and nutritional sta-
tus using the Revised Oral Assessment Guide-Jnkping and
the Mini Nutritional Assessment-Short Form. In total 1190
persons (mean age 82.37.9) had both oral and nutritional
assessments registered by nurses in daily care. Approximately
29% had moderate oral health problems and another 12%
severe problems. Over 60% were considered at risk of mal-
nutrition or malnourished. There was a correlation between
poor nutritional status and poor oral health (r=0.2, p<0.001)
and about half of persons at risk or malnourished simulta-
neously had oral problems. A multivariate logistic regres-
sion revealed that the risk of being at risk or malnourished
increased with voice problems (Exp B CI 1.45.7 p= 0.003),
mucous membranes (Exp B CI 1.05.4 p=0.042) and swal-
lowing (Exp B CI 1.44.1 p= 0.002). Consequently, there was
a relationship between oral problems and nutritional status,
indicating the importance of evaluating oral status for older
persons with nutritional problems. To improve oral health
there is a need for exchanging knowledge between nursing
staff and oral health professionals.
EFFECTIVENESS OF EDUCATIONAL NURSING HOME
VISITS: ARANDOMIZED CONTROLLED TRIAL
A.Buss2, K.Wolf-Ostermann2, S.Strupeit2, 2. Munich
University of Applied Sciences, Munich, Germany, 2.
University of Bremen, Bremen, Germany
Facilitating and maintain functional ability and quality of
life is a major task of nursing. Home visits may have positive
effects on functional ability and quality of life in elderly peo-
ple. The aim of this study was to determine the effectiveness
of educational home visits on the functional status, quality
of life, and care dependency in older adults with mobility
impairments.
A randomized controlled trial was performed in the liv-
ing environments of patients with functional impairments
from Hamburg, Germany. The intervention group received
an additional nursing consultation intervention on mobil-
ity and quality of life. The control group received the usual
IAGG 2017 World Congress
629
care. Data were collected from August 2011 to December
2012 at baseline, 6months and 12months of follow-up. The
main outcomes were functional status (Barthel Index), qual-
ity of life (WHOQOL-BREF), and care dependency (Care
Dependency Scale). Data were analyzed using descriptive
statistics and generalized linear models.
In total, 113 participants were included in the study. The
intervention had no effect on functional status, quality of life,
and care dependency. However, self-efficacy and younger age
were related to better functional status over time. Better self-
efficacy and less depression resulted in a better quality of life
and better self-efficacy resulted in a better functional status
and lower care dependency.
Further studies on the effects of educational nursing
interventions should be performed using different concepts
and rigorous research methods. However nursing education
should be part of nursing practice and may be integrated in
everyday care.
SESSION 2065 (SYMPOSIUM)
MAPPING ACRITICAL ETHICAL LANDSCAPE FOR
DEMENTIA: RESEARCH, POLICY, AND PRACTICE
Chair: P.Kontos, University Health Network
Co-Chair: A.Grigorovich, University of Toronto, Toronto,
Ontario, Canada
In the field of dementia, ethical issues have primarily been
considered from a biomedical perspective, with a focus on
norms for medical treatment and participation in medical
research trials. The primacy of the biomedical approach to
ethics in dementia has eclipsed a broader understanding of
the cultural, political and philosophical assumptions that
underpin current research, policy and practices. This sym-
posium will interrogate current ethical issues in dementia,
raise concerns about the appropriateness of biomedical
approaches to support ethical decision-making, and identify
gaps that require critical ethical intervention. Paper pres-
entations will explore these issues through empirical stud-
ies and critical analyses of case examples including: 1)New
policy and ethical frameworks for guiding future research
and funding efforts in dementia (e.g. Responsible Innovation
and Institutional Corruption); 2)Mild Cognitive Impairment
(MCI) and the ethical fallout of anticipating testing, being
tested, being diagnosed, and living with MCI; 3)Anew ethic
of sexuality that upholds and supports the sexual rights of
older adults living with dementia in long term residential
care settings; and 4) Application of ethical perspectives on
flourishing and solidarity to dementia care in order to shift
societal response from a disability model to an agency pre-
serving model, and from custodial (comfort and control)
goals to ecologically enabling (relational) goals of care.
Conclusions consider how these case studies map a new and
critical ethical landscape for research, policy, and practice for
dementia care.
ETHICS AND DEMENTIA: NEW EVIDENCE-BASED
PERSPECTIVES ON INNOVATION AND PUBLIC
HEALTH
P.J.Whitehouse, Case Western Reserve University,
Cleveland, Ohio
630
Dementia is a huge public health challenge with value
conflicts affecting efforts to treat and care for persons with
cognitive impairment. Standard biomedical ethical frame-
works that focus primarily on the clinical or research arenas
do not provide an adequate moral lens to find the necessary
balance in setting priorities in a world of limited resources,
global climate change, and competing social concerns. What
appears missing in part is a focus on organizational ethics,
including examining the roles of advocacy and professional
organizations, as well as pharmaceutical and diagnostic
device manufacturers. Well-developed and empirically-sup-
ported organizational value and social justice frameworks
such as institutional corruption and responsible innova-
tion will be reviewed. Evidence-based contributions of the
arts and humanities to practice are growing at the interface
between ethics and aesthetics. Increasingly data-driven pre-
vention efforts and community transformation will play a
role in addressing the social challenges of dementia.
NARRATIVE PRACTICES AND ETHICAL FALLOUT IN
THE CASE OF MILD COGNITIVE IMPAIRMENT (MCI)
DIAGNOSIS
S.Katz, Trent University, Peterborough, Ontario, Canada
This paper is informed by emerging critiques of MCI
diagnoses, validity, capitalization, treatment, biomarkers,
and psychometric landscape. Using an interpretive analysis
of data collected with 12 focus groups of older individuals,
families, and care-givers, discussion focuses on the ethical
uses of hybrid vocabularies, metaphors, and narratives to
highlight the
the importance of subjective and lay accounts of aging
and cognitive health. Given that MCI is a category laden
with the threat of Alzheimers disease, the focus group data
reflect a need for meaning-making and caring practices
around diagnoses, as well as creative questioning and con-
testing of the MCI category itself. Conclusions explore how
diagnoses of cognitive impairment are ethical as well as sci-
entific practices, such that experts and practitioners need to
consider how older individuals embed and share diagnoses
in their everyday contexts through narrative practices that
render disruption and apprehension into livable, acceptable,
and coherent stories.
RELATIONAL CITIZENSHIP, SEXUAL RIGHTS, AND
ANEW ETHIC FOR DEMENTIA CARE
P.Kontos1,2, A.Grigorovich1,2, 1. Dalla Lana School of
Public Health, University of Toronto, Toronto, Ontario,
Canada, 2. Toronto Rehabilitation Institute - University
Health Network, Toronto, Ontario, Canada
Despite the important contributions the citizenship move-
ment has made to improving the status and treatment of
persons with dementia, it has not accounted for their sexual
rights. Drawing on a new model of relational citizenship,
we advance an ethic of embodied relational sexuality that
importantly broadens the exclusive goal of biomedical eth-
ics from only the duty to protect individuals from harm,
to also the duty to uphold and support the sexual rights of
persons living with dementia in long-term care settings. The
ethic is grounded in empirical research in long-term residen-
tial care and draws from scholarship on sexual citizenship,
human rights, embodiment, and relationality to articulate a
Innovation in Aging, 2017, Vol. 1, No. S1
multiscalar approach (micro-, meso-, and macro-level). The
adoption of this ethic ensures that persons with dementia
experience freedom from discrimination and have equal
opportunities to pursue intimate sexual activities and rela-
tions to the fullest extent possible.
DEMENTIA AND THE HUMAN GOOD:
RECOGNITION, SOLIDARITY, AND FLOURISHING
B.Jennings, Vanderbilt University Medical Center,
Nashville, Tennessee
Dementia care is often reduced to the custody of the
patients comfort and safety due to an overly limited under-
standing of the achievable quality of life and the relational
capabilities of persons living with dementia. This does not
appropriately recognize the meaningful agency of persons
with dementia, nor does it appreciate the enabling rela-
tionships persons can have in an ecology of caring. I offer
an approach to dementia care informed by an empirically
grounded and theoretical work by philosophers and social
scientists, including M. Nussbaum, T. Kitwood, R. Harr,
S.Sabat, and J.Hughes. This approach focuses on the ena-
bling effects of the overall ecology of dementia care (social
relationality of care providers and the built environment of
facilities) rather than on the neurological deficits of the brain
and its behavioral limitations.
SESSION 2070 (SYMPOSIUM)
NETWORK CHANGES AND HEALTH: WHAT DRIVES
WHAT?
Chair: H.Litwin, Hebrew University of Jerusalem,
Jerusalem, Israel
Discussant: J.Lubben, Boston College, Boston,
Massachusetts
Research has pointed to the relationship between social
network and health in late life. However, it is still unclear
whether greater network resources are responsible for better
health or whether people with better health tend to recruit
and maintain more social ties. This symposium attempts to
disentangle the network/ health nexus by means of uniquely
appropriate longitudinal databases that employ state-of--
the-art social network inventories. We focus, especially, on
data derived from name-generating network mechanisms.
The papers also address a range of populations. The study
by van Tilburg and Broese van Groenou looks at 25years of
data from the Longitudinal Aging Study Amsterdam (LASA)
and finds that social networks are influenced by cognitive
health, but also protect against mortality. Using data from
the German Ageing Survey (DEAS), Deindl and Brandt dis-
covered effects of health on social networks over time and
vice versa. Schwartz and Litwin employed structural equa-
tion modeling to examine data from the Survey of Health,
Ageing and Retirement in Europe (SHARE). The results
show that social networks and mental health have a recipro-
cal relationship, but the effect of mental health is stronger.
Webster, Ajrouch and Antonucci examined two waves of
data (1992; 2015) from the longitudinal Social Relations
Study in Detroit and found that later-life health and rela-
tionship transitions are inter-connected and moderated by
education. Finally, the study by Chi looks at three groups of
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Chinese older adults in immigrant, transnational, and non-
migrant families, and finds that worry about future health
needs are moderated by network factors.
SOCIAL NETWORKS AND PHYSICAL, SENSORIAL
AND COGNITIVE FUNCTIONING IN A25-YEAR
LONGITUDINAL STUDY
T.Van Tilburg, M.I.Broese Van Groenou, Sociology, Vrije
Universiteit Amsterdam, Amsterdam, Netherlands
Social relationships protect against incidence of diseases,
poor physical functioning and early mortality. However,
poor health impoverishes social network size and diversity
by exhausting supporters and limiting investments to main-
tain and renew relationships. We study the causal process
from network functioning to health, and from health to
network functioning, exploiting eight observations of the
Longitudinal Aging Study Amsterdam between 1992 and
2016. Included are 2956 people aged 55102. Networks
have 80 members at a maximum, and individual network
members are followed longitudinally. First analyses show
that having daily network contact, a large and variegated
network, and a stable network composition are threatened in
old age but promoted by good physical, sensorial and in par-
ticular cognitive functioning. Alarge network, in particular
when including non-kin, is protective against early mortal-
ity, also when controlled for physical, sensorial and cognitive
functioning.
RECIPROCAL RELATIONSHIPS BETWEEN SOCIAL
NETWORKS AND MENTAL HEALTH
E.Schwartz1,2, H.Litwin1,2, 1. Paul Baerwald School of
Social Work and Social Welfare, Hebrew University of
Jerusalem, Haifa, Israel, 2. Israel Gerontological Data
Center, Jerusalem, Israel
This study considered the relationship between social net-
work and mental health among older Europeans. The data
came from Waves 4 (2011) and 6 (2015) of the Survey of
Health, Aging and Retirement in Europe (SHARE). The ana-
lytical sample numbered 26,238 respondents. Social network
was measured as the degree of connectednessan index com-
posed of several network characteristics assessed through
a name generator, and by a global measure of satisfaction
with the network. Mental health was a composite construct
based on three mental health indicators: CASP, Euro-D and a
global life satisfaction measure. Across-lagged analysis was
employed, using structural equation modeling. Preliminary
results indicated that social networks and mental health have
a reciprocal relationship across time. These results showed
significant links between both the network indicators and
subsequent mental health changes and between mental
health and subsequent network change. Gender differences
in these associations did not emerge.
LONG-TERM BIDIRECTIONAL LINKS BETWEEN
SOCIAL ISOLATION AND HEALTH: THE
MODERATING ROLE OF EDUCATION
N.J.Webster1, K.J.Ajrouch2, T.C.Antonucci1, 1. University Emotional closeness with adult children was a significant
of Michigan, Ann Arbor, Michigan, 2. Eastern Michigan
University, Ypsilanti, Michigan
This study considers the influence of health changes on
social isolation among older adults and examines how this
IAGG 2017 World Congress
631
association varies by education. The analysis employed two
waves of data (1992; 2015) from the longitudinal Social
Relations Study. Data include a U.S. regionally representa-
tive sample (N=314) of adults age 60+ in 2015 from the
Detroit, MI Metropolitan area. Social isolation, determined
using two measures of network size (total number of net-
work members and number of people respondents couldnt
imagine life without) were assessed using the hierarchical
mapping technique, an ego-centric name generating instru-
ment grounded in the Convoy Model of Social Relations.
Bidirectional cross-lagged effect models were conducted to
test main effects as well as competing theories of cumula-
tive advantage/disadvantage and age as leveler. The findings
identify how later-life health and relationship transitions are
inter-connected. Investigation of the role of education in this
process highlights potentially vulnerable subgroups of older
adults.
CAUSAL LINKS BETWEEN SOCIAL NETWORKS AND
HEALTH
M.Brandt2, C.Deindl3, 2. Technical University Dortmund,
Dortmund, Germany, 3. University of Cologne, Cologne,
Germany
This study considers the complexity of the relationship
between health and social networks. Specifically, the analy-
sis examines network size, composition and social support
exchange in relation to self-rated health. The data are drawn
from The German Ageing Survey (DEAS), which includes
information about health and social networks (using a name
generator) over a period of 18 years (19962014). In the
first step, we estimate fixed-effects models to disentangle the
influences of changes in social networks on health and vice
versa. In the second step, we use a cross-panel design in order
to analyze specific connections between different aspects of
social networks and health over time. First results indicate
significant effects of health on social networks and vice versa
over time. In particular, the variable of social support shows
a causal connection to health, after direct and indirect paths
between health and social network are incorporated into the
analytical model.
SOCIAL NETWORKS AND WORRY AMONG CHINESE
OLDER ADULTS IN IMMIGRANT FAMILIES
I.Chi1, L.Xu2, 1. School of Social Work, University of
Southern California, Los Angeles, California, 2. University
of Texas, Austin, Austin, Texas
This study considered three groups of Chinese older
adults in immigrant, transnational, and nonmigrant families.
It investigated what they worry about and the relationship
of their social networks to their degree of worry (N=786).
Analysis of variance, chi-square tests and stepwise linear
regression were conducted. Results showed that most par-
ticipants worried about having no one to take care of them
when their health needs increase. In general, older Chinese
adults in immigrant families had the highest levels of worry.
correlate of worry for all respondents. The influence of hav-
ing local friends on reducing worry was significantly stronger
among those in immigrant families, as was the influence of
childrens filial piety. Practitioners and policy makers should
632
pay special attention to older adults in immigrant families,
with a particular focus on promoting emotional closeness
with adult children, friend networks, and childrens filial
piety.
SESSION 2075 (SYMPOSIUM)
AIR POLLUTION IN BRAIN AGING AND DEMENTIA
Chair: C.E.Finch, University Southern California, Los
Angeles, California
Co-Chair: J.Chen, University of Southern California, Los
Angeles, California
Discussant: G.M.Martin, University of Washington
Over 75% of older Americans are living in metropolitan
areas, and this urban-dwelling aging population will con-
tinue to grow in the coming decades. Ambient air pollution,
a ubiquitous exposure in urban environments, has emerged
as a new environmental factor in brain aging and demen-
tia. Over the last few years, accumulating epidemiologic
and neurotoxicological data have shown the aging brain
is vulnerable to neurotoxic effects of ambient air pollut-
ants. For instance, elevated levels of fine particulate matter
(PM2.5: PM with aerodynamic diameters<2.5m) are associ-
ated with several years of faster cognitive aging and loss of
white matter volume. Rodent brain models with inhaled PM
exposure suggest the neurodegenerative mechanisms may
involve increased neuroinflammation and soluble amyloid,
and attrition of glutamate receptors. Assembling four pres-
entations with new findings, this symposium aims to better
define the individual risk, heterogeneity, and pathobiologi-
cal mechanisms linking ambient air pollutants with brain
aging and dementia. Epidemiological studies show that both
PM2.5 and O3 exposures may increase the risk for demen-
tia in older women (Chen). Epidemiologic studies also show
that PM2.5 associated adverse effects on aging brain may
be strengthened in populations with APOE4 alleles (Chen)
and in populations of low educational attainment (Ailshire).
Rodent models with PM exposures from traffic emissions
document the role of the lung-brain axis in microglial acti-
vation (Block) and illustrate ApoE4 interaction with expo-
sure contributing to brain amyloid deposition (Cacciottolo).
Together these findings show that environmental factors con-
tribute to accelerated brain aging in synergy with the ApoE4
allele risk factor for Alzheimer disease.
NEUROTOXIC EFFECTS OF AMBIENT AIR
POLLUTION ON BRAIN STRUCTURE AND
DEMENTIA RISK IN OLDER WOMEN
J.Chen1, X.Wang1, R.Casanova2, M.L.Serre3, W.Vizuete3, effects are poorly understood. Recent findings indicate that
H.C.Chui1, S.Resnick4, M.Espeland2, 1. University of
Southern California, Los Angeles, California, 2. Wake
Forest School of Medicine, Winston-Salem, North Carolina,
3. Gillings School of Global Public Health, UNC, Chapel
Hill, North Carolina, 4. National Institute on Aging,
Baltimore, Maryland
Ambient air pollution is a novel determinant of cognitive
aging. Using a Bayesian Maximum Entropy method to esti-
mate outdoor concentrations of PM2.5 (particulate matter <
2.5m; 19992010) and O3 (19962010) for the prospective
cohort (n=7479) from Womens Health Initiative Memory
Study, we examined whether long-term exposures affect the
Innovation in Aging, 2017, Vol. 1, No. S1
aging brain structure and dementia risk, Residing in places
with high PM2.5 (>12 g/m3) increased the relative risk (by
8192%) for global cognitive decline and all-cause dementia,
with greater adverse effects in APOE 4/4. In both region-
of-interest and voxel-based morphometry (VBM) analyses of
brain MRI (n>1300), increased PM2.5 predicted smaller white
matter volumes in multi-modal association regions (frontal;
temporal). In VBM, PM2.5 exposure also predicted smaller
volumes of prefrontal cortex, but not the hippocampal-
amygdalar complex (HAC). Preliminary results suggested
long-term O3 exposure was associated with smaller grey mat-
ter (bilateral HACs/temporal poles; left entorhinal/perirhinal
cortices) and increased the dementia risk in older women.
PM2.5 AIR POLLUTION, EDUCATIONAL
ATTAINMENT, AND COGNITIVE FUNCTION
AMONG OLDER U.S. ADULTS
J.Ailshire1, A.Karraker2, 1. University of Southern
California, Los Angeles, California, 2. University of Iowa,
Aimes, Iowa
This study examines whether the association between
air pollution and cognitive function among older adults dif-
fers by educational attainment. Data on 13,389 adults over
age 50 are from the 2004 Health and Retirement Study and
were linked to 2004 annual average concentrations of ambi-
ent fine particulate matter air pollution (PM2.5). Multilevel
linear regression models were used to examine the associa-
tion of PM2.5 concentrations and individual-level education
on cognitive function. Higher concentrations of PM2.5 were
associated with lower scores on cognitive function, but the
association was stronger among individuals with lower edu-
cational attainment. These findings were robust to the inclu-
sion of a variety of individual demographic, socioeconomic,
and health factors as well as neighborhood-level education
and income. The findings suggest the cognitive harms of pol-
lution exposure may be offset by educational attainment,
and that older adults with low educational attainment may
be particularly vulnerable to air pollution.
AIR POLLUTION, MICROGLIA, AND THE LUNG-
BRAIN AXIS
M.Block, 1. Indiana University School of Medicine,
Indianapolis, Indiana, 2. Stark Neuroscience Research
Institute, Indianapolis, Indiana
Urban air pollution exposure has recently been linked
to increased risk of several central nervous system (CNS)
diseases and conditions, including cognitive decline and
Alzheimers disease (AD). The mechanisms mediating these
the brains innate immune cells, microglia, detect and respond
to inhaled pollutants, where pulmonary damage may signal
to the brain through circulating factors (The Lung-Brain
Axis). Here, we will reveal the role of damage associated
molecular patterns (DAMPs) in the microglial response to
diesel exhaust particles, discuss the effects of these circulat-
ing factors in the 3x-TG murine AD model, and explore how
aging may impact this process. These findings provide insight
into the mechanisms underlying how air pollution may acti-
vate microglia and deleteriously impact central nervous sys-
tem health.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
NEURODEGENERATIVE EFFECT OF NANOSIZED
URBAN AIRBORNE PARTICULATE MATERIAL (NPM)
M.Cacciottolo1, T.Morgan1, A.Saffari2, C.Sioutas2,
J.Chen3, C.E.Finch1, 1. Leonard Davis School of
Gerontology, University of Southern California, Los
Angeles, California, 2. USC Viterbi School of Engineering,
University of Southern California, Los Angeles, California,
3. University of Southern California, Los Angeles,
California
Particulate air pollutants are increasingly recognized for
their neurotoxic impact in human populations and in experi-
mental rodent studies, but the mechanisms involved and
interaction with the APOE 4 risk factor for Alzheimer dis-
ease (AD) remain unknown.
To evaluate the mechanism behind air pollutant neurotoxic-
ity were examined female EFAD transgenic mice (5xFAD+/-/
human APOE 3 or 4+/+) with long-term exposure to nano-
sized urban PM (nPM). nPM exposure increased cerebral
-amyloid, exacerbated by APOE 4. Moreover, nPM exposure
increased A oligomers, caused selective atrophy of hippocam-
pal CA1 neurites and decreased glutamate GluR1 subunit.
nPM-induced CA1 atrophy was confirmed in wildtype female
mice. Pro-amyloidogenic APP processing was also increased in
neuroblastoma cells (N2a-APP/swe) with in vitro exposure to
nPM, and correlates with alteration of lipid raft. We suggest that
airborne PM exposure promotes pathological brain aging, with
potentially greater impact in 4 carriers throughout increased
cerebral A production and glutamatergic remodeling.
SESSION 2080 (PAPER)
GRANDPARENTING RISKS AND RESOURCES
LONG-TERM AND LATER-LIFE STEPGRANDPARENT-
STEPGRANDCHILD RELATIONSHIPS
A.Chapman, Y.Kang, L.H.Ganong, M.Coleman, Human
Development and Family Science, University of Missouri,
Columbia, Missouri
Stepgrandchild-stepgrandparent relationships are increas-
ingly common as a result of relatively high rates of divorce
and remarriage and improved longevity. Positive intergen-
erational step-relationships can strengthen feelings of family
solidarity and promote the social, emotional, and physical
well-being of stepfamily members, yet little is known about
how stepgrandchildren or stepgrandparents define and
develop roles and relationships following remarriage.
Guided by a developmental life course change perspective
and grounded theory methods, we interviewed 41 stepgrand-
children about their relationships with 61 stepgrandparents.
Some stepgrandchildren (N=24) acquired stepgrandparents
when they were adolescents or young adults (i.e., a biological
grandparent remarried in later-life), while other stepgrand-
children (N = 37) acquired stepgrandparents before birth
(i.e., a biological grandparent remarried when a parent of
the stepgrandchild was young). Attention to variations in
the ways in which stepgrandparents were acquired allowed
for systematic examination of relational processes and con-
textual factors that affected stepgrandchild-stepgrandparent
relationships in different family structures. Findings revealed
that stepgrandchildrens closeness to stepgrandparents was
IAGG 2017 World Congress
633
influenced by factors such as timing of life transitions (e.g.,
when in individuals life courses intergenerational relation-
ships began), stepgrandparents roles in the life of the mid-
dle-generation parent and the quality of those relationships,
whether or not the stepfamily defined the stepgrandparent as
kin (e.g., through the use of claiming language), intergenera-
tional contact frequency, stepgrandparents affinity-building
and how stepgrandchildren responded to stepgrandparents
efforts. Findings underscore the importance of attending
to context when examining processes that affect intergen-
erational step-relationship development. Implications for
researchers, practitioners, and educators are discussed.
INTENSITY OF CAREGIVING, WORKING, AND
DEPRESSIVE SYMPTOMS AMONG GRANDPARENTS
IN CHINA
Z.Cheng1, X.Ye1, I.Chi2, 1. Institute of Population
Research, Peking University, Beijing, China, 2. USC
Suzanne Dworak-Peck School of Social Work, Los Angeles,
California
This study investigated the association between intensity
of caregiving and depressive symptoms among grandparents.
And whether working could relieve grandparents depres-
sive symptoms as a moderator. Data came from the Chinese
Health and Retirement Longitudinal Study (CHARLS,
20112012) baseline data, a nationally representative sample
of those 45 and older. The analytic sample contained 5,430
grandparents with grandchildren aged under 16. The CESD-
10 was used to measure depressive symptoms with a score
from 10 to 40. We used Multiple Linear Regression. Most of
grandparents spent high intensity of caregiving (>=48weeks/
year). After controlling demographic and socioeconomic
variables, rural and urban grandparents co-residing with
grandchildren tended to have more depressive symptoms,
when providing care for their grandchildren. However, when
not co-residing with grandchildren, both rural and urban
grandparents had less depressive symptoms with spending
high intensity of caregiving. Working acted as a supportive
moderator on depressive symptoms among rural grandpar-
ents, but tended to be a stressful moderator on depressive
symptoms among urban grandparents, when grandparents
provided care of high intensity. Caregiving to grandchildren
may benefit mental health of grandparents, which may be
because in Chinese culture Pleasure from grandchildren
reduces loneliness. But not all caregiving appears positive;
caregiving could burden grandparents.
CAREGIVER OPTIONS FOR FUTURE CARE
PLANNING BY OLDER CUSTODIAL GRANDPARENTS
RAISING ADOLESCENTS
T.L.Peterson, Social Work, The University of Oklahoma,
Norman, Oklahoma
Grandparents raising grandchildren worry about what will
happen to their grandchildren if they die.Yet, conversations
with custodial grandparents about caregiver options remain
largely understudied. This qualitative study describes issues
related to caregiver options for future care planning with older
grandparents raising adolescent grandchildren. This research
applied a phenomenological approach involving in-depth,
face-to-face interviews with twenty one grandparents ranging
in age from 58 to 88 years. The grandparents identified as a
634
primary caregiver to a grandchild 12 or older and were resi-
dents of Oklahoma, Alabama, or Kentucky. Asemi-structured
interview guide contained a question asking What is your
thinking about caregiving arrangements for your grandchild in
case you are no longer able to provide care? What actual steps,
if any, have you taken to begin these caregiving arrangements
in case you are no longer able to provide care? Recruitment
methods included word of mouth, newspaper advertisements,
and distributing flyers to community agencies. Interviews were
audiotaped and transcribed verbatim to identify themes. Older
grandparents raising adolescent grandchildren described four
issues related to caregiver options and future care planning: (1)
behavioral health of the grandchild, (2) rationale for preferred
caregiver choice, (3) nature/status of conversation with pre-
ferred caregiver, and (4) potential conflicts with grandchildrens
biological parents. These findings suggest older grandparents
raising adolescent grandchildren face complex dynamics when
considering caregiver options for future care planning. These
older caregivers can benefit from research, practice, and policy
to assist with the development of tailored interventions target-
ing future care planning.
DETERMINANTS OF GRANDPARENTS
PSYCHOLOGICAL WELL-BEING: GENERATIVITY
AND ADULT CHILDRENS GRATITUDE
C.Noriega1, J.Lopez1, C.Velasco1, W.Yolpant2, 1. CEU
San Pablo University, Madrid, Madrid, Spain, 2. Case
Western Reserve University, Cleveland, Ohio
Grandparents have become an important source of sup-
port for current families. Two expressions of generativity are
the care provided to grandchild/ren and the values transmit-
ted. Little data have examined how intergenerational rela-
tionships affect to grandparents generativity and well-being.
This study explored the relationship between grandparents
psychological well-being, socializing values and styles, and
adult childrens gratitude. Based on the Generativity Model
of Chen (2009), we hypothesized that the influence on the
grandparents well-being of the values they desire to trans-
mit to their grandchild/ren (generative concerns) would be
mediated by their socializing styles (generative acts), and
adult childrens gratitude (perception of recipients attitude).
Grandparents socializing styles would also influence their
well-being mediated by their adult childrens gratitude. This
study consisted of 300 grandparents from Madrid (Spain),
with grandchild/ren aged 612years old. Participants mean
age was 71.55 (SD=7.32) and 56% were women. Excellent
model fit was found using Path Analysis (2=51.77; p=.26;
CFI=.98; TLI=.98; RMSEA=.02). Personal and relationship
values predicted participants psychological well-being medi-
ated by socializing styles (democratic and liberal styles) and
adult childrens gratitude. A direct influence of the abilities
and knowledge values on psychological well-being, which
had not been hypothesized in the original model, was found.
No significant associations between authoritarian style and
well-being were found, once other variables were considered.
These results highlight that grandparents engagement in
generative acts positively affect their well-being, especially
when adult children express gratitude for the help provided
by grandparents. This suggests the need to promote intergen-
erational shared activities and positive family interactions.
Innovation in Aging, 2017, Vol. 1, No. S1
RESOURCE DEPLETION OR MOBILIZATION?
GRANDPARENTING AND ITS MENTAL HEALTH
IMPLICATIONS IN TAIWAN
C.Peng, Senior Citizen Service Management, Minghsin
University of Science and Technology, Hsin-Chu, Taiwan
As considerable studies have been done to investigate the
effects of grandparenting on grandparents health, most of
these studies were conducted in Western societies and have
found mixed results. To fill these gaps, this study drew on
longitudinal data from the Study of Health and Living Status
of the Elderly in Taiwan to extend the knowledge of grand-
parenting to a cultural context that differs from the United
States, where the majority of the research in this area has
been conducted. Based on the stress and process theory, two
contrasting models were built to test the effect of grandpar-
enting on grandparents mental health. The resource deple-
tion model hypothesized that grandparenting functions as
a stressor that diminishes mental health, while the resource
mobilization model specified that grandparenting mobilizes
psychosocial resources that improve grandparents mental
health. Structural equation modeling was utilized to perform
the analysis. The results supported the resource mobiliza-
tion model, which suggests a positive relationship between
grandparenting and grandparents mental health. It further
revealed that grandparenting provides a protective effect on
grandparents mental health through increased social sup-
port, and multigenerational living arrangement also has posi-
tive effects on grandparents mental health among Taiwanese
elderly. These findings suggest that cultural context and the
expectations of the caregiving role may affect the health
impact experienced by grandparents. This study suggests
caution in assuming that findings in Western countries may
be valid across societies, or that interventions based on these
findings can be applicable in other countries.
SESSION 2085 (SYMPOSIUM)
SUCCESSES IN OLDER ADULT NUTRITION AND
PHYSICAL ACTIVITY STUDIES: AUSDA MULTISTATE
RESEARCH PROJECT
Chair: D.Buys, Mississippi State University, Starkville,
Mississippi
Co-Chair: J.Gilbride, New York University, New York,
New York
Midlife and older adults represent the fastest growing seg-
ment of the US population; they have higher rates of obe-
sity, chronic disease and disability than previous generations
and current younger adults. Often preventable with effective
nutrition and/or physical activity interventions, such efforts
require collaboration between disciplines and institutions
and across the levels of the socio-ecological model. This
symposium highlights a multistate research project (MSRP)
begun in 1989 in the northeastern United States through the
United States Department of Agricultures MSRP mechanism.
Working in partnership with the National Institute for Food
and Agriculture, state agricultural experiment stations con-
duct and coordinate targeted investigations on high priority
topics like nutrition and aging. This MSRP is a long-term col-
laboration among multidisciplinary scientists from private
and state universities, including Land Grant Universities and
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Cooperative Extension. The research, carried out in 5-year
cycles, addresses specific goals for finding novel interventions
and approaches to improve the nutritional health of older
adults. For more than 20 years, multidisciplinary scientists
have built on a legacy of prior research and a culture of col-
laboration by sharing resources and knowledge, jointly col-
lecting qualitative and quantitative data to assess diet and
health, testing tools in rural, suburban and urban settings,
and expanding nutrition education and outreach. Some of
these efforts are presented here, with projects addressing ena-
blers of healthy eating among diverse older adults, measure-
ment of sarcopenia in older women, factors influencing the
nutritional risk and food intake of community-residing older
adults, and telenutrition as an outlet for nutrition interven-
tion among obese men.
RECOMMENDATIONS TO SUPPORT ENABLERS OF
HEALTHY EATING IN OLDER ADULTS IN DIVERSE
COMMUNITIES
N.Cohen1, Q.Jiang1, M.Ventura Marra2, K.Woolf3, of Political Science, Iowa State University, Ames, Iowa, 3.
J.Gilbride3, S.Francis4, 1. Department of Nutrition,
University of Massachusetts Amherst, Amherst,
Massachusetts, 2. West Virginia University, Morgantown,
West Virginia, 3. New York University, New York, New
York, 4. Iowa State University, Ames, Iowa
Communities can provide an age-friendly environment
to support healthy eating in older adults (OA) by addressing
the highest priority approaches that promote key enablers
of good nutrition. Using the Social Ecological Model, nutri-
tion and aging professionals (n=30) from two rural (WV, IA)
and two urban (MA, NY) city/county regions participated
in focus group discussions to identify and prioritize enablers
and behavioral settings essential for OA nutrition. Transcripts
were recorded and analyzed for major themes using content
analysis. The most important enablers were accessibility and
cost, transportation and social support. Recommendations
to improve enablers included nutrition education and out-
reach; modifying or expanding services and advocacy to
improve accessibility and transportation; gearing program
or food content and the built environment specifically to OA
needs; addressing partnerships, policies, discounts and finan-
cial assistance to improve affordability; and fostering social
support and empowerment. Community-based interventions
targeting enablers can support older residents in achieving
optimal nutritional health.
IDENTIFYING SARCOPENIA IN OLDER RHODE
ISLAND WOMEN USING CURRENT DEFINITIONS
S.G.Slezak1, M.Benson1, E.Renna1, K.Mahoney1, 1. West Virginia University, Morgantown, West Virginia, 2.
D.Hatfield1, F.Xu1, I.Lofgren2, M.Delmonico1, 1. Vanderbilt University, Nashville, Tennessee, 3. West Virginia
Kinesiology, University of Rhode Island, Kingston, Rhode
Island, 2. Nutrition and Food Sciences, University of Rhode
Island, Kingston, Rhode Island
Several working groups have established guidelines for
the identification of sarcopenia (i.e. age related loss of lean
mass) among older adults. However, more data need to be
collected to determine sarcopenia prevalence among older
populations using these guidelines. For this purpose a cross-
sectional analysis was performed in a sample of older, com-
munity dwelling, female Rhode Island residents (n=93) aged
68.37.0years with a BMI of 29.66.2kg/m2. Appendicular Registered Dietitian via telephone and videoconferencing.
IAGG 2017 World Congress
635
lean mass was evaluated via DXA and bioelectrical imped-
ance. Participants gait speed and grip strength were assessed.
Using any definition there was sarcopenia prevalence of
17.2%, while criteria specific prevalences varied from 2.2%-
12.9%. Sarcopenia classification variations between differ-
ent guidelines are in line with other populations but indicate
the variation in prevalence depending on guidelines used and
lack of agreement between sarcopenia classification guide-
lines. These results warrant further evaluation with a larger
cohort and among different sub-populations such as race
and/or ethnic groups.
FACTORS INFLUENCING THE NUTRITIONAL RISK
AND FOOD INTAKES OF COMMUNITY-RESIDING
OLDER ADULTS
L.MacNab6, S.L.Francis3, I.Lofgren4, C.Violette1,
M.Shelley2, M.Delmonico5, F.Xu5, 1. Department of
Nutrition, University of New Hampshire, Durham, New
Hampshire, 2. Department of Statistics and Department
Department of Food Science and Human Nutrition, Iowa
State University, Ames, Iowa, 4. Department of Nutrition,
University of Rhode Island, Kingston, Rhode Island, 5.
Department of Kinesiology, University of Rhode Island,
Kingston, Rhode Island, 6. FoodMinds, Chicago, Illinois
Understanding the nutritional status and food intakes
of older adults is essential if this population is to remain
independent. A multistate cross-sectional study evaluated
the nutritional risk (NR) and food practices of 352 older
adults attending various community-based health inter-
ventions. Most participants were white (77.6%) women
(83.5%) between the ages of 60 to 70 years (42.9%). The
majority were classified as at possible NR (53.7%) or at
NR (26.4%). Participants had low lean protein, dairy
and processed meat intake frequencies and moderate
intake frequencies of whole fruit and juice, total and whole
grains, vegetables and added fats, sugars and sweets. Factors
influencing these food intakes include state, age and gender
(p.05). Results indicate that older adults choosing to partic-
ipate in lifestyle interventions are at NR. Future needs-based
nutrition education programs designed to reduce NR should
target protein intakes while addressing the role of state, age,
and gender on food intakes.
IMPROVING WEIGHT STATUS IN OBESE
MIDDLE-AGED AND OLDER MEN THROUGH
TELENUTRITION
M.Ventura Marra1, M.Shotwell2, K.Nelson3, J.Malone3,
University Medicine, United Hospital Center, Bridgeport,
West Virginia
Obesity threatens the health, functionality, and quality of
life of 34.5% of men in the United States with middle-aged
men at highest risk. A randomized controlled trial piloted
the effect of a 12-week telenutrition weight loss program
compared to usual care on body weight in obese men, ages
4070 with hypertension, diabetes or hyperlipidemia. Both
groups (n=60) received educational materials; only the inter-
vention group received individualized weekly support by a
636
In both groups, body weight was significantly reduced from
baseline by 3.0% (95% CI: 1.5%, 4.0%; p-value: <0.001) at
week 6, and by an additional 1.5% (95% CI: 0.8%, 2.2%;
p-value: <0.001) at week 12. Body weight in the interven-
tion group was further reduced by 1.9% (95% CI: 1.4%,
3.6%; p-value: 0.034) at week 12. Telenutrition can be effec-
tive for weight loss among men in health disparate areas like
Appalachia.
SESSION 2090 (SYMPOSIUM)
THE UNSEEN CAREGIVER: SURVIVORSHIP,
CREATIVITY, AND INNOVATION
Chair: K.Cloyes, University of Utah, Salt Lake City, Utah
Co-Chair: J.Eaton, University of Utah, Salt Lake City, Utah
Discussant: L.Ellington, University of Utah, Salt Lake City,
Utah
Older adults will constitute 16% of the worlds popula-
tion by 2050. Meeting the care needs of scores of older adults
with chronic health conditions will depend on the contribu-
tions of informal care provided by family caregivers and
formal care provided by health aides and nursing assistants.
Moreover, the vast majority of these caregivers are women
whose labor represents billions of US dollars, even as they
report struggling with financial and personal burdens.
This symposium examines the experiences and challenges
of three groups of caregivers who, while collectively provid-
ing care and support to many older adults, report feeling
unseen, unacknowledged, and unsupported. Comparative
analysis of their situation reveals both difficulties associ-
ated with their sense of invisibility and opportunities for
enhancing support and empowerment. Jones describes the
lack of social and medical discourse concerning family car-
egivers of cancer survivors, including gaps in understanding
how they transition from chronic illness phase to survivor-
ship and implications for support. Cloyes explores percep-
tions of creative caregiving and connections with long term
care outcomes among nursing assistants, a group seldom
included in research. Finally, Eaton presents findings on the
use of ethnodrama to highlight the experiences of family car-
egivers, including its potential to promote public discussion
of the caregiving experience and caregivers social support.
Ellington, an expert in communication between informal
and professional caregivers, will facilitate discussion of how
a broader and more inclusive view of caregiving, including
innovative methods, will expand the science of caregiving.
ANALYSIS OF SURVIVORSHIP DISCOURSE IN
RELATION TO CANCER CAREGIVERS
A.Kuglin Jones, University of Utah, Salt Lake City, Utah
Cancer is the second most prevalent condition that neces-
sitates the assistance of nearly three million American family
caregivers. Caregivers of adult cancer survivors are invisible
partners in the survivorship journey created by a cancer diag-
nosis. Astructure exists to describe the trajectory of survivor-
ship and support for individuals with cancer but comparative
research is lacking in revealing such a framework for car-
egivers. Iconducted a critical literature review and a model
Innovation in Aging, 2017, Vol. 1, No. S1
inclusive of 6 elements; language, identity, societal reaction,
analogy/metaphor, meaning of health, and support, emerged
allowing for survivorship discourse in relation to the cancer
survivor. Analysis revealed a lack of linguistic or theoreti-
cal resources to describe the survivorship experience through
the lens of the caregiver. No common social language exists
to explain the caregiver experience. Without a common way
to define, describe or explain the experience, identity is con-
flicted, health is ignored and support mechanisms absent.
NURSING ASSISTANTS AS AGENTS OF CREATIVE
CAREGIVING IN LONG-TERM CARE
K.Cloyes, J.Eaton, L.Ellington, College of Nursing,
University of Utah, Salt Lake City, Utah
Nursing assistants (NAs) provide most direct care for
long term care (LTC) residents, greatly impacting resident
wellbeing, yet are often seen as unskilled labor. Our study
explores how arts-based caregiving techniques may improve
resident quality of life and NA empowerment. We present
content analysis of focus group data from NAs in two LTC
facilities (n = 12). Initially, NAs related creativity to being
artistic, not to caregiving. Yet they then described engag-
ing residents in creative activities (singing, dancing, storytell-
ing) to build relationships and reduce challenging behavior.
While most frequently linked with discerning and respond-
ing to resident needs, creativity was also foundational to time
management, teamwork and navigating challenges. Many
reported learning creative approaches by watching experi-
enced NAs and that, while appreciated by family members,
these skills are often unrecognized by professional staff.
Developing NA-centered interventions to promote creative
caregiving may enhance both person-centered LTC and NA
empowerment, improving resident care.
COMMUNITY-BASED ACTION TO MAGNIFY THE
FAMILY CAREGIVER EXPERIENCE THROUGH
ETHNODRAMA
J.Eaton1, N.Madsen2, 1. College of Nursing, University
of Utah, Salt Lake City, Utah, 2. Utah Caregiver Support
Program, Salt Lake City, Utah
The majority of long term care needs are placed upon
family members who often have minimal support. In this
study we collaborate with family caregivers to create an eth-
nodrama about their experience and evaluate the efficacy of
professional performance to increase knowledge and moti-
vate action. Twenty-two participants met over four months
to discuss their life as caregivers. Discussions were analyzed
in a two phase process and themes were developed into a
script performed five times for 253 attendees. Evaluations
(n=153) noted that 70.8% felt the performance represented
their experience and 81% were motivated to take action.
Caregivers expressed feeling valued and relief at the knowl-
edge that they are not alone. While many related to the
content, others assumed that action only applied to those
providing care. Ethnodrama has the potential to humanize
the complex reality of caregiving for family, professionals,
and policy makers.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 2095 (PAPER)
HEALTH AND SOCIAL SERVICE INTERVENTIONS
AND SOCIAL NETWORKS
SOCIAL INNOVATION IN AGEING, THE CHALLENGE
OF SCALABILITY AND REPLICABILITY, NETWELL 10
YEARS ON
L.Carragher2,1, R.Bond2,1, 1. Dundalk Institute of
Technology, Dundalk, Ireland, 2. The Netwell Centre,
Dundalk, Ireland
Background: Evidence suggests that social innovation and
whole system approaches to facilitate greater levels of inde-
pendence for older people are key to future sustainability
of health and social care systems. However, little is known
about how to make social interventions in the ageing field
scalable and replicable. The aim of this program, introduced
in Ireland in 2006 as a longitudinal collaborative experiment
between the Health Service, Local Government and an aca-
demic partner, the Netwell Centre, was to develop, test and
report on a range of service interventions for ageing.
Methods: A community-based participatory research
approach was implemented to partner with older adults,
health care practitioners, not-for-profit providers and
communities.
Results: A total of 1,021 older adults continue to be
supported at home through dedicated service brokerage to
ensure access to the most appropriate services. Where ser-
vice gaps are identified, these are filled through community
and voluntary collaborations. 54 volunteers provide weekly
home visits to the most vulnerable. 48 volunteers provide a
daily telephone information service, making an average of
100 calls per day. 338 older men regularly participate in non-
formal learning activities in Mens Sheds. 124 older women
attend weekly social groups. 20 families receive dementia
support, including one-to-one communication and care-giv-
ing training. 240 older adults from community groups and
nursing homes attend a social event every 6 weeks to grow
and maintain social networks.
Conclusions: Ten years on, our evidence suggests that
while many of the elements of a whole system approach can
be replicated, this is dependent on community vitality and
ensuring the 3rd sector is properly engaged with service deliv-
ery partners.
THE SOCIAL NETWORKS OF OLDER MIGRANTS
IN LUXEMBOURG: STRUCTURE, SUPPORT, AND
CHALLENGES TO OLD AGE
A.Ramos, INSIDE, University of Luxembourg,
Luxembourg City, Luxembourg
Studies on social relations have shown the importance of
categories such as class, gender, and health in the composi-
tion of the social networks of older people. Although ethnic-
ity has been taken into account (Ajrouch, 2007, 2008), we
still know very little about if and how migration influences
the development of older migrants networks, and if and
how it shapes the exchange of emotional and practical sup-
port. The present qualitative study sheds light on this ques-
tion, by analysing the egocentric social support networks
IAGG 2017 World Congress
637
(Kahn & Antonucci, 1980)of 35 individuals aged 65+, who
migrated to Luxembourg in early adulthood, coming from
Italy, Portugal, Germany, Belgium, and France. The results
show that although older migrants have transnational and
spread networks, their interpersonal interactions are mainly
with co-nationals, with whom they share the same language
and cultural background. The exchange of support is chal-
lenged by economic restrictions in interacting at distance, by
the return of close friends after retirement, and by their low
mobility when becoming very old and fragile. The study goes
beyond the discussion on transnational care delivered by
migrant family members (Baldassar & Merla, 2014), giving
visibility to the support provided by non-kin, as neighbours
and friends.
WHOSE CAREGIVER IS AT HIGH RISK? PREDICTING
HELP WITH ACTIVITIES OF DAILY LIVING FROM
CLAIMS DATA
H.B.Degenholtz, R.Schulz, T.Ding, Health Policy
and Management, University of Pittsburgh, Pittsburgh,
Pennsylvania
Unpaid caregivers make substantial contributions toward
the well-being of family members with physical and cognitive
disability. One estimate places the value of these contribu-
tions at $470 billion annually in the US. Many caregivers are
unprepared for the physical and emotional stress, potentially
impacting their own health and psychological well-being.
Caring for someone with higher levels of disability increases
the risk. While there are proven programs and interventions
to support caregivers, the healthcare system faces a problem:
by its very nature, their work is not visible, and is not part
of the medical record, making it nearly impossible to tar-
get them prospectively. We sought to develop a method for
identifying caregivers that could be implemented by a health
system or health insurer as part of an outreach effort. Using
data from the 2011 Medicare Current Beneficiary Survey,
we identified community dwelling people age 65 and older.
We compared the predictive power of three models. Basic
demographic characteristics alone correctly classified 67.2%
of cases as having a helper that provides support with either
basic or instrumental activities of daily living. Adding claims
for durable medical equipment correctly classified 68.7% of
cases and adding diagnostic information correctly classified
70.6%; positive predictive value 72.8%. Asecond series of
models was estimated to predict high risk caregiving (e.g.,
two or more activities of daily living). Using this approach,
outbound telephone calls could be targeted to identify people
who could benefit from supportive programs. Future research
will validate this predictive model as a screening tool.
SOCIAL NETWORKS ASSOCIATED WITH COGNITIVE
FUNCTION AMONG CHINESE ELDERS: AONE-YEAR
FOLLOW-UP STUDY
Y.Cai, D.Cui, Nursing, Wuhan University, Wuhan, Hubei,
China
This study aims to examine social networks of Chinese
elders and explore their influences on cognitive function and
the risk for elders having mild cognitive impairment (MCI).
Alongitudinal database of elderly Chinese from urban China
during 20142015 was analyzed. A sample of 1295 elders
638 Innovation in Aging, 2017, Vol. 1, No. S1

was investigated in 2014 and a total of 614 (47.4%) were SESSION 3000 (SYMPOSIUM)
followed up in 2015. Two types of regression models were
used to explore influences of social networks on cognitive DISRUPTING AGING: CHANGING PARADIGMS OF
function status (a change in the MoCA score) and the risk for REACHING OLDER ADULTS IN UNDERSERVED
having MCI (MoCA score < 26)among these urban elders. COMMUNITIES
The approximate age of this group was 74 years and they Chair: A.Chodos, University of California, San Francisco,
had on average one chronic disease. More than half (57%) San Francisco, California
were at-risk of having MCI. The most important component Co-Chair: E.Tan, AARP, Washington, District of Columbia
of their social networks was family (100%) with the major- Medical, social and mental health services for older adults
ity having face-to-face contact (91.3%). More complex and are often poorly integrated in underserved communities. This
stable social networks were statistically significant in asso- leads to missed opportunities to support and improve the
ciation with better cognitive function status. The findings wellbeing of vulnerable older adults. This symposium will
imply that developing various types of social ties at an ear- first engage the audience in understanding how cultural and
lier age is beneficial to maintaining cognitive function over psychological factors shape the experience of aging, and
time. This study suggests that social interventions and ser- then it will explore how innovative programs incorporate
vices can provide opportunities for Chinese elders to keep or this knowledge to address the needs of the most vulnerable
rebuild connections with old friends, classmates, colleagues, older adults. This session is brought to you by AARP and
relatives, and acquaintances, which may be more helpful in the University of California, San Franciscos Optimize Aging
maintaining cognitive function. Collaborative.
Specifically, this symposium will show how expectations of
aging differ among minority older adults and how the impact
FEE-FOR-SERVICE OR MANAGED CARE?
of negative stereotypes of aging can lead to poor health, and
INVESTIGATING DUAL ELIGIBLE CONSUMER
then focus on programs that disrupt the current paradigm of
PREFERENCES FOR HEALTH CARE
aging. These include an example from Japan where the postal
K.G.Kietzman1, K.McBride1, M.Moon2, A.Bacigalupo2,
service, working with IBM and Apple, delivers iPads to mil-
A.Benjamin1, A.Reynoso1, S.P.Wallace1, A.Bacong1, 1.
lions of older adults who can then connect with services,
UCLA Center for Health Policy Research, Los Angeles,
their community and their families and the One City, One
California, 2. Westside Center for Independent Living, Los
Strategy program in San Francisco that through successful
Angeles, California
collaborations reaches some of the most underserved older
The CHOICE study investigated the preferences and
adults - such as those in minority communities, those living
decision-making behaviors of dual eligible health care con-
alone, and adults with dementia. The intended audience for
sumers (i.e., those eligible for both Medicare and Medi-Cal)
this symposium is broad and includes healthcare providers,
in Los Angeles California. Between April 2014 and March
educators, city planners, and community-based services and
2015, eligible consumers were enrolled into a managed care
agencies.
demonstration program called Cal MediConnect unless they
actively opted out. Cal MediConnect is designed to integrate
ETHNICITY DIFFERENCES IN EXPECTATIONS
the financing and delivery of Medicare and Medi-Cal benefits
REGARDING AGING AMONG MINORITY SENIORS
and provide vulnerable consumers with better coordinated
J.Menkin1, D.Araiza1, C.Reyes1, L.Trejo2, S.Choi1,
care. Yet uptake and retention of Cal MediConnect has fallen
P.Willis3, H.McCreath1, C.A.Sarkisian1, 1. University of
far below expectations. We conducted 48 in-depth interviews
California, Los Angeles, Los Angeles, California, 2. City
with consumers who either opted out or were enrolled in
of Los Angeles, Los Angeles, California, 3. Watts Labor
a Cal MediConnect plan. Using constant comparison anal-
Community Action Committee, Los Angeles, California
ysis, we identified a complex set of factors that influenced
Although there are accumulating, international studies on
consumer decision-making including: relationships with and
expectations regarding aging, few have examined ethnicity
access to providers; anxiety and confusion about health care
differences in expectations within the United States (and have
options; and perceptions of health care quality. While con-
only compared Caucasian, African American, and Latino
sumers acknowledged that extra benefits offered through Cal
older adults). Asian societies are hypothesized to have higher
MediConnect were attractive, many were willing to forgo
esteem for older adults than western societies; however, the
these advantages in order to retain an existing and trusted
empirical literature is mixed. We examined differences in
network of care. Many who opted out also preferred to
expectations regarding aging across 240 African American,
direct their own care and generally disliked the restrictions
Latino, Chinese, and Korean older adults in the Los Angeles
they associated with managed care. Case studies illustrate
area. Contrary to the typical East/West hypotheses, Chinese
how consumers evaluated the options available to them and
and Korean older adults had significantly lower expectations
highlight differences by age, race/ethnicity, and level of dis-
regarding aging than African American and Latino partici-
ability. Understanding how individuals make health care
pants, even after controlling for other sociodemographic
decisions will help inform strategies for effectively commu-
factors. Ethnicity accounted for more variance in expecta-
nicating with and responding to the preferences of a diverse
tions about social and emotional changes than in expecta-
group of dual eligible health consumers and practices that
tions about physical or cognitive function, indicating greater
better support health-related consumer decision making.
cultural differences in older adults social roles than in their

IAGG 2017 World Congress

Innovation in Aging, 2017, Vol. 1, No. S1
expected physical and cognitive changes. Implications for
interventions targeting aging expectations will be discussed.
INTERVENING TO REDUCE THE NEGATIVE IMPACT
OF STEREOTYPE THREAT ON OLDER ADULTS
MEMORY PERFORMANCE
S.Barber, S.Ching Tan, J.Seliger, S.Niblett, San Francisco larly vulnerable older adults- those who live alone, who are
State University, San Francisco, California
Stereotype threat occurs when people know that poor
performance on their part will confirm a negative, self-rele-
vant, stereotype. In response to this people often underper-
form compared to their potential and inadvertently confirm
the stereotype. This in turn has important clinical implica-
tions. In one study, stereotype threat more than doubled the
number of older adults who fell below a clinical threshold
for cognitive impairment on a brief cognitive status exami-
nation. The goal of the current research was to test whether
affirming personal and cultural values would reduce stereo-
type threat in English and Chinese-speaking older adults.
Although value affirmations are effective for younger adults,
there was mixed support with older adults. This adds to
other research showing that factors modulating stereotype
threat effects in younger adults do not always hold when
examining older adults. It also highlights the need to iden-
tify interventions that effectively eliminate stereotype threat
effects specifically in older adults.
PROVIDING INTEGRATED DIGITAL SERVICES TO
ISOLATED OLDER ADULTSINTERNATIONAL
RESEARCH AT IBM
N.Palmarini1, L.Myers 2, 1. IBM, Cambridge,
Massachusetts, 2. IBM, Orlando, Florida
IBM Research, which developed an answering computer
called Watson, is now being applied to Aging-in-Place sup-
port for isolated seniors in Japan and Italy, two countries
that are leading the demographic transition of an aging word.
Cognitive assistants designed to understanding and interact,
along with aging-accessible mobile technologies are exam-
ples that will be presented in a case study from Bolzano, Italy
where IBM is implementing an optimized aging in place solu-
tion to support caregivers to make informed decisions and
enhance both quality of life and safety. In a second case study
from Japan, IBM research will demonstrate how pioneering
text analytics and accessibility technologies (such as natural
language analysis and tracking) have been used to connect
rural older adults to health services through Japan Post. We
will report the results of the expansion of these large-scale
demonstrations of how technology device-based services can
preserve personal dignity and independence.
PARTNERING TO BETTER SERVE VULNERABLE
OLDER ADULTS: THE OPTIMIZE AGING
COLLABORATIVE
A.Chodos, A.Neumann, J.Rivera, J.Myers, R.Frazier, A.E.Scharlach, C.L.Graham, Social Welfare, University of
L.Walter, University of California, San Francisco, San
Francisco, California
All U.S.communities are facing the demographic impera-
tive of serving increasing social and medical needs of older
adults. Despite this, there is poor integration of social and
medical services, and most professionals working with
older adults do not have formal training in key knowledge
IAGG 2017 World Congress
639
areas related to the care of older adults. In San Francisco,
we formed a partnership of public, private and academic
groups engaged in aging services, called the Optimize Aging
Collaborative, with the goal of training all professionals in
the skills needed to be competant in responding to the needs
of all older adults. We included a specific focus on particu-
lesbian, gay, bisexual or transgender, or who have dementia.
We will demonstrate how our collaborative has increased
knowledge and commitment to improve the well being of
older adults and which elements of this partnership contrib-
ute to its success.
SESSION 3005 (SYMPOSIUM)
CREATING CARING COMMUNITIES: SOCIAL
CAPITAL FORMATION AND AGING IN PLACE
Chair: A.E.Scharlach, University of California, Berkeley,
California
Discussant: T.Scharf, Newcastle University, United
Kingdom
Communities throughout the world are seeing the emer-
gence of new types of consumer-driven support structures
to promote aging in place, driven in part by global trans-
formations in traditional family and societal supports. Of
particular interest are grassroots community-based efforts
that not only provide needed assistance, but also promote
social connection, meaningful activity, civic engagement,
and an increased sense of communal trust and solidarity.
This symposium examines existing evidence regarding four
of these initiatives: the Village model (US, Netherlands,
Australia), Supportive Communities (Israel), Active Caring
Communities (Belgium), and civil society voluntary care
networks (Sweden). In the Village model, older community
members create their own elder-led support organizations,
assuming primary responsibility for operations, financing,
and peer support. In Supportive Communities, a retired com-
munity member serves as a convener and key source of social
and instrumental support, with administrative and financial
assistance from the government. Active Caring Communities
involve a neighborhood-organized model of care that sup-
ports frail older people to age in place in deteriorated neigh-
borhoods. Finally, Swedish data examine the growth of
peer and cross-generational informal assistance networks in
the context of declining societal supports for older adults.
Leading scholars will critically examine existing knowledge
regarding each of these approaches, with particular attention
to the ways in which they contribute to individual well-being,
community social capital, and the ability to age in place.
FOSTERING SOCIAL CAPITAL THROUGH THE
VILLAGE MODEL
California, Berkeley, California
The Village model is an innovative approach to aging in
place through social capital development, reflecting Villages
unique combination of community development, consumer
direction, social engagement, civic engagement, and col-
lective bargaining for services. This paper reports findings
from a 3-year longitudinal study of 191 members of seven
640
US Villages regarding social impacts of Village membership.
During their first 36months as Village members, respondents
experienced significant increases (p<.05) in the amount of
interpersonal contact, group participation, ability to get help
with routine tasks, ability to get places when needed, and
feeling of belonging to a community. Earlier qualitative data
revealed that the benefits of Village membership reported
most frequently were the security of knowing that help
was available when needed, social activities, and the sense
of being part of a community. These findings are discussed
regarding their relevance for social capital development in
emerging models of community-based support.
AGING IN PLACE IN ASUPPORTIVE COMMUNITY
S.Y.Hantman1, I.Hemel2, 1. Tel-Hai College, Tel Hai,
Israel, 2. Upper Galilee Municipality, Upper Galilee, Israel
This presentation describes the Supportive Community
Program in a rural community in the north of Israel. The
current demographic, social and economic changes the mod-
ern Kibbutz is undergoing in the last two decades created
a renewed look at the services for the aged. One answer to
these phenomena is the Supportive Community Program that
underscores the role of the older adult as an equal partner
in planning and creating a working community that will be
accessible, suitable and flexible encouraging aging in place.
This program, instigated by JDC - Eshel, is a package of
services provided to older adults living in a designated geo-
graphic community. It reduces the need for the older adults
to move out of their homes into institutional facilities as they
age and their functional abilities decline, and allows them to
remain at home in their communities by delivering the neces-
sary services to them.
CARE CONVOYS WITHIN AN ACTIVE CARING
COMMUNITY
D.Lambotte, L.De Donder, A.Smetcoren, T.Kardol, mates that 20% of older adults worldwide have neurologi-
B.Team, Vrije Universiteit Brussel, Brussels, Belgium
This study aims to provide insights into the dynamic,
diverse and multilayered characteristics of older persons
care networks. Longitudinal data used were gathered during
three interview periods (2014, 2015, 2016)from the Active
Caring Community project. The project is one of the six
Care Living Labs in Belgium. 12 focus groups (N=98) and
11 individual interviews with older people living in Antwerp
and in 2 neighborhoods in Brussels are analyzed. Results
indicate that care networks of older people are very diverse
including a complex interplay between family, neighbors,
social networks, semi-professionals and formal caregiv-
ers. Care networks are multidimensional whereby informal
and formal caregivers differ in positioning according to
the structure, function and adequacy of the provided care.
Furthermore, turnover moments during the life course dem-
onstrate the dynamic aspect of care convoys. Several policy
recommendations to support care convoys within an Active
Caring Community will be discussed.
CIVIC INVOLVEMENT AMONG CITIZENS AGE 75+ IN
SWEDEN: PROFILES AND PATTERNS OF CHANGE
M.Jegermalm1,2, E.Jeppsson-Grassman3, 1. Social Sciences,
Ersta Skondal UC, Huddinge, Huddinge, Sweden, 2.
Dalarna University, Falun, Sweden, 3. Institute for the Study
Innovation in Aging, 2017, Vol. 1, No. S1
of Ageing and Later Life (NISAL) Linkping University,
Department of Social and Welfare studies, Linkoping,
Sweden
The demographic trend with aging populations is a chal-
lenge for the welfare states, and old-old people are viewed as
recipients of care and as a burden. In contrast to this view
this paper discusses volunteering in organizations and infor-
mal caregiving among community-residing persons aged
75+ in Sweden. Acountry characterised as a Public-Nordic
welfare model, where one would expect civic involvement to
be of less importance. The presentation will be based on a
national statistical representative survey repeated five times
in the period 19922014. The results challenge the view of
seeing old-old people as mere recipients of services and care.
Many people 75+ are actors in civil society in fact they
were the single age group where volunteering had increased
the most over time. The findings challenge simplistic inter-
pretations of the role of the welfare state - the public sector
seemed to have an enabling function for civic involvement.
SESSION 3010 (SYMPOSIUM)
AGING AND MENTAL HEALTH: GLOBAL
PERSPECTIVES
Chair: S.Cummings, University of Tennessee
Co-Chair: W.Li, James Cook University, Townsville,
Queensland, Australia
Discussant: N.Kropf, Georgia State University, Atlanta,
Georgia
Globally, the number of elders is growing at an unprec-
edented rate. As the older population continues its inexora-
ble growth, so does the number of older adults with mental
health disorders, such as Alzheimers Disease, depression,
anxiety, schizophrenia and substance abuse. The WHO esti-
cal and psychological disorders (2015). The number of those
with dementia is expected double to over 81 million by 2040.
Late-life depressive disorders are also prevalent and are the
leading cause of disability in older adults worldwide. Mental
disorders lead to increased morbidity and mortality in older
adults, and generate significant social and economic burdens
in terms of increased strain on families and higher medical
costs for societies. Mental health and well-being of older
people across the globe are influenced by varying personal
characteristics, cultural factors, familial constructs, and
national policies and resources. This symposium will pro-
vide an understanding of issues related to ageing and mental
health from a global perspective. Gerontological experts rep-
resenting North American, Oceania, Europe, South Asia and
East Asia will discuss the status of aging and mental health
in their countries including prevalence, culture, caregiv-
ing, polices and services. With the continued global expan-
sion of older populations, developing effective approaches
to address geriatric mental health disorders is essential for
the social and financial well-being of nations. The need for
policies and aged care services to respond to the diversity
in mental health issues for elders in socially, culturally, and
geographically different settings will be discussed.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
AGING AND MENTAL HEALTH: THE U.S.
PERSPECTIVE
S.Cummings, S.Trecartin, University of Tennessee,
Knoxville, Tennessee
By 2040 21% of those living in the U.S.will be 65years
of age and older. U.S.citizens come from different cultures
and bring with them varying views of aging. However, the
U.S.has long been a country with a primary focus on youth.
Even though the U.S.population is rapidly becoming older,
ageism persists. It is estimated that 20% of the older popu-
lation experience mental health problems, including demen-
tias, depression, anxiety and substance misuse. However,
ageism and mental health stigma create barriers to adequate
attention being focused on later-life mental health issues.
National health insurance programs reimburse for mental
health services for older adults, and recent federal policies
have increased insurance compensation for metal health dis-
orders. However, application of the federal policies vary by
state, and service gaps still exit. Cultural and political fac-
tors impacting older adult mental health services will be
considered.
MENTAL HEALTH IN LATER LIFEAN
AUSTRALASIAN EXPERIENCE
H.Park3, W.Li2, 2. James Cook University, Townsville,
Queensland, Australia, 3. Western Sydney University,
Sydney, New South Wales, Australia
Both Australia and New Zealand are ageing societies
where their populations are growing older and more diversi-
fied. As is the case in most developed nations, a significant
proportion of older people experience mental health issues
in their everyday lives in these nations. The prevalence of
mental illness, ranging from depression to dementia, is sig-
nificantly increasing among older adults across genders, cul-
tures and ethnicities. Consequently, there is greater pressure
on the health and social care system to meet the needs of
older adults with mental health conditions, and such chal-
lenges will be constant in coming decades. This presenta-
tion provides an outline of mental health in older adults
in Australian and New Zealand contexts. It also discusses
major issues associated with services and policies, alongside
current programmes and practice models, in mental health
care for older people in both societies. Cultural influences
and caregiving realities are addressed for further discussion.
AGEING AND MENTAL HEALTH IN JAPAN, KOREA,
AND INDIA
H.Kase, School of Human Sciences, Waseda University,
Tokorozawa, Saitama, Japan
One of the most common features of ageing in Japan,
Korea and India is the rapid expansion in the proportion
of older adults. For example, the share of Indias population
aged 60 and older is projected to climb from 8 % in 2010 to
19 % in 2050. This population ageing is likely to be associ-
ated with a further increase in the number of older adults
with mental health problems in these countries. The preva-
lence of dementia is 8~10% of aged population in Japan,
8.1%~8.9% in Korea, and has been shown to vary from
0.84% to 6.7% in Indian studies. This presentation will dis-
cuss current issues and practices related to mental health in
older adults in these three nations. The presentation will also
IAGG 2017 World Congress
641
address the importance of community-based mental health
service delivery systems to meet growing needs on long-term
care and mental health services, and to reduce a financial
burden on medical care.
SWITZERLAND: TOWARD AN INCREASING
AWARENESS OF OLD PEOPLES MENTAL HEALTH
E.Galleguillos, Ie, University of Lausanne, Lausanne,
Switzerland
In Switzerland, there is strong evidence of the signifi-
cant human, social, and economical consequences of mental
health problems. Although the country has one of the highest
life expectancies in the world, with over 17% of the Swiss
population being over 65, interest in mental health in later
life is lacking. Moreover, despite a performing and expen-
sive healthcare system, the federal structure and subsidiarity
characterizing the Swiss political system tend to impede the
implementation of coherent mental health policies. This pres-
entation provides data regarding the prevalence of mental
disorders affecting the elderly and current key policy debates.
BEYOND TRADITIONAL VALUES: MENTAL HEALTH
IN LATER LIFE IN CHINA AND HONG KONG
A.Au1, W.Li2, 1. Hong Kong Polytechnic University,
Hong Kong, China, Hong Kong, 2. James Cook University,
Townsville, Queensland, Australia
According to the World Bank, China has the fastest aging
population in human history. Strongly influenced by filial
piety, there has been a culture of honoring an older person as
a treasure at home However due to various factors includ-
ing rapid urbanization and associated policies, empty nest
households are becoming more prevalent in Mainland China.
In Hong Kong, traditional values are eroding, reinforced by
a decline in the social status of older adults as a result of
relatively low levels of education and lack of gainful employ-
ment. Moreover, social stigma and face saving are prevalent
in Chinese cultures. Mental illness is considered shameful.
Negative stereotypes affect intervention models. This presen-
tation examines the development of mental health services in
China as well as the unique challenges faced by the different
regions, including the paucity of community services in the
Mainland and the sustainability of health/ community care
in Hong Kong.
SESSION 3015 (SYMPOSIUM)
USING MOBILE APP AND INTERGENERATIONAL
SUPPORT TO HELP OLDER ADULTS LEARN
DIABETES SELF-MANAGEMENT
Chair: S.Wu, University of Southern California, Los
Angeles, California
Discussant: H.Ya-Hui, Taipei Tzu Chi Hospital, New
Taipei City, Taiwan
Diabetes is a prevalent chronic disease and a major
medical disability worldwide. It affects 1 in 5 older people
in Taiwan. Better self-management and greater social inte-
gration are effective means to contribute to active aging.
Internet and mobile technology offer great potentials to
improve diabetes self-management and social integration.
642
Older adults, however, are less likely to use such technology.
This symposium will introduce the Intergenerational Mobile
Technology Opportunities Program (IMTOP) designed to
motivate and train older adults to use mobile technology for
diabetes self-management. The IMTOP curriculum is based
on the evidence-based Chronic Disease Self-Management
Program (CDSMP) combined with tablet and Internet skill
training, and delivered in 8 weekly sessions of 2-hour long
small group classes. Two innovative components of IMTOP
are: 1)using a graphic-based aging-friendly touchscreen dia-
betes self-management app to activate self-monitoring and
behavior change; and 2) deploying college students as vol-
unteer teaching assistants to provide intergenerational and
technological support. To understand the program effects, a
wait-list control trial with 350 people age 55 and older with
diabetes was conducted in Taiwan in 2 hospital outpatient
settings. College students were recruited from local universi-
ties to serve either as volunteers or as pure control (140 in
each group). Five presentations in the symposium will dis-
cuss the IMTOP research design, the app development and
usage, the obstacles and motivations of using the diabetes
app, and the preliminary outcomes between the intervention
and wait-list control groups, and qualitative analysis of the
young volunteers experiences in the program.
RESEARCH DESIGN OF THE INTERGENERATIONAL
MOBILE TECHNOLOGY OPPORTUNITIES PROGRAM
(IMTOP) IN TAIWAN
S.Wu, H.Hsiao, I.Chi, School of Social Work, University
of Southern California, Los Angeles, California
The IMTOP study creatively integrates group-learning
activities, the CDSMP, and skill training for using mobile
tablet and a home-grown diabetes app for older adults,
along with intergenerational support by college students.
The 16-hour training curriculum teaches older adults to use
a tablet device and an app to learn about the CDSMP and to
help activate their monitoring and behavior change for dia-
betes self-management. The program was delivered through
a small group class setting with 10 older adults and 4 col-
lege students serving as volunteer assistants to teach tech-
nology use. The quasi-experimental trial recruited 350 older
diabetes patients from two outpatient clinics and 280 col-
lege students in Taiwan. The older adults were assigned to
immediate intervention or 4-month wait-list control group
and were followed up every 4months for 3 times. The col-
lege students were assigned to intervention or control group
and were assessed using mixed-methods evaluation up to
4months.
DEVELOPMENT OF ADIABETES SELF-
MANAGEMENT APP AND ANALYSIS OF USAGE
PATTERNS AMONG OLDER PATIENTS
S.Wu, H.Hsiao, I.Chi, P.Lee, School of Social Work,
University of Southern California, Los Angeles, California
This presentation will describe how an interdisciplinary
team developed a diabetes self-management App specifically
taking into account older adults engagement with technol-
ogy. The IMTOP Diabetes App used a graphic-based inter-
face to help the older adults to record their biomarkers and
health behaviors for self-management of type 2 diabetes. The
data, presented in the forms of daily, weekly and long-term
Innovation in Aging, 2017, Vol. 1, No. S1
charts, facilitates patient self-service visual analytics and
their communication with healthcare providers. The evalua-
tion framework for mobile health applications developed by
Singh etal. was applied to evaluate the app development in
terms of patient engagement, quality, and safety. Using quan-
titative data from app usage and follow up questionnaires,
the research team plots the usage pattern and compares the
perception of app usefulness between high and low intensity
users. Preliminary data shows regular app users significantly
reduced diabetes symptoms.
ANALYSIS OF OBSTACLES AND MOTIVATIONS
FOUND UTILIZING ADIABETES HEALTH APP FOR
OLDER PATIENTS
M.Li2, A.Hagedorn1, T.Yi Chuan1, L.Pan2, S.Wu1,
H.Hsiao1, I.Chi1, 1. School of Social Work, University of
Southern California, Los Angeles, California, 2. Shih Chien
University, Taipei, Taiwan
Daily health behaviors for older adults managing dia-
betes can be improved using mobile applications (APPs).
The Intergenerational Mobile Technology Opportunities
Program (IMTOP) taught 350 older adults diabetes self-
management principles and tested a new application. We
conducted 4 qualitative focus groups with 52 participants
ages 5575 who were either heavily or weakly engaged par-
ticipants reporting their health behaviors via the APP. We use
the Task-Technology Fit model to study APP adoption issues
during an 8-week diabetes management course. The main
findings of obstacles include: poor disease health manage-
ment behavior before participation, lack of social network
with other diabetic patients, lack of friendly environment or
user-friendly device available, concern the app is too com-
plicated, and lack of technical support. The most motivated
App users reported: positive attitude about disease manage-
ment, strong utilization of the APP, expectation the scientific
evidence would benefit them, and willingness to engage in
diet control and exercise behavior.
THE EFFECTS ON HEALTH AND WELL-BEING OF
OLDER DIABETES PATIENTS USING IMTOP MOBILE
APP IN TAIWAN
I.Chi, S.Wu, H.Hsiao, P.Lee, School of Social Work,
University of Southern California, Los Angeles, California
This presentation aims to understand the effects of the
IMTOP participation on the disease self-management, health
outcomes and quality of life among older adults with type 2
diabetes. Atotal of 350 older adults (aged 55 and above) with
Type 2 diabetes were recruited from 2 hospitals in Taiwan
and assigned to the immediate intervention group (n=165)
or 4-month waitlist control group (n=185). Patients were
assessed at baseline and every 4months for up to 12months
post intervention. Health status, diabetes symptoms and
self-care, social engagements, patient empowerment, use of
technology, depression, and quality of life were measured
repeatedly. After participating in the intervention, the pre-
post changes for the intervention group were significantly
better than the waitlist group at 4-month in terms of physi-
cal health status, diabetes self-care, use of mobile technology,
and overall quality of life. In addition, the intervention group
was less depressed compared to its counterpart.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
HOW YOUNG ADULTS CHANGED ATTITUDES
TOWARD AGING AND HEALTH THROUGH IMTOP
VOLUNTEERING EXPERIENCE
H.Hsiao, S.Wu, I.Chi, School of Social Work, University participation, health status, and cognitive skills among adults
of Southern California, Los Angeles, California
Providing young adults opportunities to teach older adults
mobile technology may have positive impact on their atti-
tudes towards aging and health awareness. In this presenta-
tion, the experience of 140 IMTOP college student in Taiwan
who served as IMTOP volunteers for 8 weeks was analyzed
qualitatively using thematic coding by 2 researchers. The
volunteers received preparatory training to learn about the
concepts of aging and motivational interviewing. They then
provided 16-hour services to teach older adults mobile tech-
nology skills related to learning about the CDSMP and the
IMTOP app. From their self-reflections, young volunteers
reported that the most important things they learned from
this experiences were effective communication skills with
older adults and health knowledge. The intergenerational
interaction broke down their stereotypes about older adults
and developed their empathy and patience with better under-
standing of difficulties and challenges older adults encounter
when using technology products. Their health awareness was
also enhanced.
SESSION 3020 (SYMPOSIUM)
WHAT PIAAC TELLS US ABOUT EDUCATION AND
TRAINING, COMPETENCIES AMONG OLDER
ADULTS, AND LABOR MARKET
Chair: J.Soroui, American Institutes for Research,
Washington, District of Columbia
Co-Chair: P.Cummins, Miami University, Oxford, Ohio
Discussant: R.Harootyan, Senior Service America Inc,
Silver Spring, Maryland
In March 2016, the National Center for Education
Statistics of the U.S. Department of Education, released
results from the Program for the International Assessment of
Adult Competencies (PIAAC). The 2016 report is based on
data collected in 20112012 and in 2013- 2014. Together,
the two rounds of PIAAC household data collection provide
a nationally representative sample of 8,670 noninstitutional-
ized adults ages 1674 in the U.S.
In addition to assessing key information-processing skills
-- literacy, numeracy, and digital problem solving, partici-
pants also responded to an extensive background question-
naire on their educational attainment, employment, skill use
at work and at home, as well as demographic questions, and
questions related to health status and preventive health.
The PIAAC results indicate a strong relationship between
age and performance in all three cognitive domains. In both
literacy and numeracy domains, a smaller percentage of
adults ages 4574 performed at top proficiency levels than
adults ages 2534 and 3544, and a larger percentage of
adults ages 4574 performed at the lowest proficiency levels
compared to younger adults.
The first presentation will give an overview of PIAAC and
key results for older adults. The second will use PIAAC data
to examine relationships between skills and variables such
as participation in formal and non-formal education and
IAGG 2017 World Congress
643
training programs and employment, as well as labor force
participation and income, for adults aged 45 to 65. The third
presentation will examine associations between labor force
aged 66 to 74.
SKILLS OF U.S. OLDER ADULTS: PROGRAM FOR
THE INTERNATIONAL ASSESSMENT OF ADULT
COMPETENCIES (PIAAC)
J.Soroui, American Institutes for Research, Washington,
District of Columbia
This presentation is based on the results of the Program
for the International Assessment of Adult Competencies
(PIAAC) conducted in 2012 and 2014 in the U.S. and 33
countries. In the U.S. the study administered in 2012 and
2014 to a nationally representative sample of 8,670 adults
ages 1674. As a large-scale study, PIAAC is focused on
measuring adults key cognitive skills, including literacy,
numeracy and digital problem solving, and the relationships
between these skills and individuals background and demo-
graphic characteristics. This session provides an overview
of the study plus a comparison of results in the U.S. and
other countries by demographic characteristics including age
groups, with a focus on skills gaps between the younger and
older populations in the U.S.and internationally. The PIAAC
results indicate that the skills gap between the older and
younger generation in the U.S.is smaller than other countries
which may have significant policy implications.
ASSOCIATIONS BETWEEN EMPLOYMENT STATUS
AND COMPETENCIES AMONG OLDER WORKERS IN
THE UNITED STATES
T.Yamashita3, P.Cummins2,1, A.Arbogast1, 1. Scripps
Gerontology Center, Miami University, Oxford, Ohio, 2.
Scripps Gerontology Center, Oxford, Ohio, 3. University of
Nevada Las Vegas, Las Vegas, Nevada
Over the past two decades, there have been substantial
increases in labor force participation rates for ages 65 to 74:
approximately 21% of males were in the labor force in 1994
and participation is expected to increase to 34% by 2024.
Increases for older women over the same period were even
greater (14% to 26%). It is critical to seek systematic strate-
gies to promote employment security or to avoid unemploy-
ment among aging workers. This study analyzed the U.S.data
from the Program for the International Assessment of Adult
Competencies (PIAAC) to examine the association between
labor force participation, health status and a series of com-
petency indicators (i.e., literacy, numeracy skills) among
adults aged 66 to 74years old. Results showed that greater
competencies were associated with higher chance of being
employed. Additionally, older adults with better self-rated
health had more proficient literacy and numeracy skills.
EDUCATIONAL PROGRAMS FOR OLDER
ADULTS: OUTCOME ANALYSIS AND COUNTRY
COMPARISONS USING PIAAC DATA
P.Cummins2,1, S.R.Kunkel2,1, 1. Scripps Gerontology
Center, Miami University, Oxford, Ohio, 2. Scripps
Gerontology Center, Oxford, Ohio
Continuous learning over the life course is necessary to
effectively compete in a knowledge-based global economy.
644
Shifts in the age structure of the U.S.labor force combined with
increased labor force participation among older adults add
to the importance of gaining a better understanding of how
adult education and training (AET) influences labor market
outcomes for middle-aged and older workers. This study used
U.S.data from the Program for the International Assessment
of Adult Competencies (PIAAC) to examine the relationship
between participation in AET programs and employment,
labor force participation, and income for adults aged 45 to 65.
Participation in an AET program significantly improved the log
odds of both employment and labor force participation and
significantly improved the log odds of moving up one income
quintile. We also compared outcomes of AET participation in
the U.S.with those in Germany, Japan, Sweden, and the U.K.
SESSION 3025 (SYMPOSIUM)
GSA DONALD P.KENT AWARD LECTURE AND
ROBERT W.KLEEMEIER AWARD LECTURE
Chair: V.Mor, Brown University, Providence, Rhode Island
S.Olshansky, University of Illinois at Chicago, Chicago,
Illinois
The Donald P.Kent Award Lecture will feature an address
by the 2016 Kent Award recipient, S.Jay Olshansky, PhD of
University of Illinois at Chicago. The Kent Award is given
annually to a member of The Gerontological Society of
America who best exemplifies the highest standards of pro-
fessional leadership in gerontology through teaching, service,
and interpretation of gerontology to the larger society.
The Robert W.Kleemeier Award Lecture will feature an
address by the 2016 Kleemeier Award recipient, Vincent
Mor, PhD of Brown University. The Kleemeier Award is
given annually to a member of The Gerontological Society of
America in recognition for outstanding research in the field
of gerontology.
AGING SCIENCE HAS COME OF AGE
S.Olshansky, University of Illinois at Chicago, Chicago,
Illinois
The seeds of aging science were planted thousands of years
ago but visible today is a fully blossomed tree that should bear
fruit in our lifetime. The tree of aging science took root in the
late 19th century; sprouted in the early 20th century; become full
grown during the last 50years; and now appears ready to yield
benefits that could rival the most important discoveries in pub-
lic health. Here Iwill tell the story of one branch of aging sci-
ence that has led to the modern realization that our longer lives
are a wonderful gift -- but it came with a Faustian trade. The
longer we live, the more important biological aging becomes
as a risk factor for fatal and disabling diseases. Continued
life extension using the current medical model could yield an
extended period of frailty and disability Anew paradigm of
public health is now warranted.
FROM CLINICAL ASSESSMENTS TO POPULATION
DATA: FROM VISION TO REALITY
V.Mor, 1. Health Services, Policy & Practice, Brown
University, Providence, Rhode Island, 2. Providence
Veterans Administration Medical Center, Providence, Rhode
Island
Innovation in Aging, 2017, Vol. 1, No. S1
Sidney Katz believed that structuring clinical assessments
determines the quality of information and this was reflected
in the 1987 Nursing Home Reform Act, which mandated all
residents be comprehensively assessed using a standardized
instrument. Over the last 30 years these assessments, now
computerized and linked to Medicare and Medicaid claims,
have transformed our knowledge of long term care popula-
tions, services and policies. Enlightened facilities stratify risk,
target treatment and conduct quality improvement inter-
ventions. Researchers link assessment and utilization data,
longitudinally tracking patients and create facility, county,
state and year aggregates for public use. These data facilitate
policy evaluation, pharmaco-epidemiology and comparative
effectiveness studies. Most recently, pragmatic cluster rand-
omized trials of quality innovations are undertaken, rivaling
research being done by hospital systems. This lecture docu-
ments a career shaping this transformation of knowledge
and practice, revealing the great opportunities that remain.
SESSION 3030 (SYMPOSIUM)
EXAMINING AGING AND SOCIAL INCLUSION
THROUGH DIFFERENT LENSES
Chair: P.Marier, Concordia University, Montreal, Quebec,
Canada
Co-organised by the Centre for Research and Expertise in
Social Gerontology (CREGES) and the research team dedi-
cated to the study of aging and social exclusion (VIES), this
interdisciplinary symposium studies diverse groups of older
adults (immigrants, lesbians, users of health and social ser-
vices, and older women) and how they experience various
forms of social inclusion and exclusion in their daily lives, be
it by public authorities and the community in general. The
contributions also analyse how social exclusion and inclu-
sion affect older adults.
Dr. Marier provides an analysis of the concept of auton-
omy, how it is used in the health and social service sector, and
how its use in evaluation tools can result in diverse forms
of social exclusion with marginalized groups experiencing
less access to services. Ms. Beauchamp presents results of a
series of interviews with lesbian older adults on their expe-
rience with agism and heterosexism. Her findings reveal a
lack of social recognition and visibility, but also a willing-
ness on their part to play a more predominant societal role.
Dr. Brotman studies the lived experiences of immigrant older
adults and uncover the common structural stressors that
affect their well-being. She will highlight the roles of the
community and of government to support older immigrants
and to ensure their social inclusion. Dr. Wallach discusses the
effects of Western societys beauty norms on older women
and how an aging female body can lead older women to
experience social exclusion, not only by others but largely by
self-social exclusion.
CHALLENGING AUTONOMY: ACOMPARATIVE
ANALYSIS AND AVIEW FROM CANADIAN OLDER
ADULTS
P.Marier1,2, A.Dub3, D.Dickson1,2, 1. Concordia
University, Montreal, Quebec, Canada, 2. Center for
Research and Expertise in Social Gerontology, Montreal,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Quebec, Canada, 3. Universit de Montral, Montreal,
Quebec, Canada
This paper presents an in-depth analysis of the concep-
tualization of autonomy, as it pertains to older adults. The
concept of autonomy plays a prominent role among health
and social service professionals as it is used to measure physi-
cal and cognitive decline. However, the social gerontology
literature has strongly criticized the lack of social considera-
tions and the omnipresence of biomedical tools to address
the needs of seniors. This reliance on biomedical tools can
result in diverse forms of social exclusion with marginalized
groups experiencing less access to services. Focus groups
with older adults were conducted in their local retiree asso-
ciations and in representative organizations. Preliminary
findings reveal the extent to which older adults presented
a different and more nuanced understanding of autonomy.
Interviewees emphasized the lack of governmental support
and, as a result, stress the importance of family, friends and
even neighbors to ensure that aging in place is possible.
THE PERCEPTIONS OF AGING AMONG GAY AND
LESBIAN OLDER ADULTS: SOCIAL EXCLUSION OR
INCLUSION?
J.Beauchamp1,2, L.Chamberland1, H.Carbonneau3, 1.
Universit du Qubec Montral (UQAM), Montreal,
Quebec, Canada, 2. Center for Research and Expertise
in Social Gerontology, Montreal, Quebec, Canada, 3.
Universit du Qubec Trois-Rivires (UQTR), Trois-
Rivires, Quebec, Canada
Ageism and heterosexism as social exclusion processes
can contribute to the social invisibility of gay and lesbian
older adults. This contribution wishes to shed a light on the
perceptions of aging and on the place of older gay and les-
bian people in society, as perceived by gay and lesbian older
adults. It is based on the results of semi-structured individual
interviews conducted with 22 gay and lesbian older adults
aged 60 and over. The participants discourses reveal, among
others, two elements: a lack of social recognition and vis-
ibility of gay and lesbian older adults in society as well as the
willingness to assert themselves and take their place. The dis-
cussion will propose a reflection of the intersection between
sexual orientation, age and generation to examine the dual
process of social exclusion, due to ageism and heterosexism,
and of social inclusion.
THE AGING FEMALE BODY, AGEIST BEAUTY
NORMS, AND SOCIAL EXCLUSION: FROM
INTERNALIZATION TO RESISTANCE
I.Wallach1,2, L.Chamberland1, J.Lavigne1, J.Beauchamp1,2,
J.Duford1, G.Miller1, 1. Universit du Qubec Montral at improving the transition from hospital to home for acute
(UQAM), Montreal, Quebec, Canada, 2. Center for
Research and Expertise in Social Gerontology, Montreal,
Quebec, Canada
The preservation of youth is a main issue in Western soci-
eties resulting in the predominance of ageist beauty norms.
Our research aims to determine whether these standards have
negative effects on older women and lead them to experi-
ence social exclusion. Favouring a qualitative approach, this
research is based on individual interviews with 20 women
aged 64 to 83, lasting an average of 1h45, and analyzed using
a thematic approach. The participants discourses reveal the
IAGG 2017 World Congress
645
internalization of beauty norms focussed on youth and the
perceived pressure to attain these. Even though some women
feel socially excluded by others due to an aging body, these
ageist beauty norms mostly lead to experiences of self-social
exclusion (choice of clothing, social activities that required
a bare body, engagement in new intimate relationships).
However, the results reveal that many are critical of these
beauty standards, highlighting their agency against the exclu-
sion of older female bodies.
EXPERIENCES OF IMMIGRANT OLDER ADULTS:
STORIES OF DIVERSITY AND EXCLUSION
S.Brotman1,2, I.Ferrer1,2, S.D.Koehn3, M.Badger3,
K.Sohng1, A.Lang1, K.N.Li3, S.Bukhari3, 1. McGill
University, Montreal, Quebec, Canada, 2. Center for
Research and Expertise in Social Gerontology, Montreal,
Quebec, Canada, 3. Simon Fraser University, Burnaby,
British Columbia, Canada
This paper presents the results of a narrative-photovoice
project on the life stories of 18 older immigrants living in
two Canadian provinces. The objective was to deepen our
understanding of the diverse lived experiences of immigrant
older adults (those who immigrated in later life and those
who immigrated earlier and aged in Canada). Findings reveal
factors impacting the immigrant aging experience, including
language barriers, income (in)security, family and transna-
tional relationships/obligations, work, retirement, health,
social isolation, community engagement, and quality of life.
Photographs provided visual documentation of significant
places, objects, and people that embody the struggles and
rewards of aging. Our study uncovers significant heterogene-
ity among immigrant older adults and common structural
stressors that deserve attention from policy-makers and ser-
vice providers. Results highlight the community sector as an
outlet for engagement, information and social connection,
and the role of government in funding services and programs
to support older immigrant adults.
SESSION 3035 (SYMPOSIUM)
HEALTHCARE TRANSITIONS: CHALLENGES
OF IMPLEMENTATION IN PATIENT-CENTERED
RESEARCH
Chair: A.K.Hughes, Michigan State University, East
Lansing, Michigan
Researchers from the MISTT (Michigan Stroke
Transitions Trial) study will discuss the development and
implementation of this patient-centered practical trial aimed
stroke survivors and their caregivers. Interventions in stroke
rarely focus on the post-acute hospital phase and few have
been patient-centered. This intervention is innovative in that
it focusses on patient and caregiver psychosocial needs as
well the typical physical ones. The three presentations in
this symposium will provide an overview of patient-centered
healthcare transition research which situates the MISTT pro-
ject in the context of these two frameworks. In addition, an
overview of the MISTT study development and implementa-
tion will be provided. Lastly, the challenges associated with
implementation of patient-centered transition projects will
646
be discussed, as well as the specific challenges that this pro-
ject is facing in the field. As is typical of much intervention
research this team faced challenges with recruitment. The
evaluation of and problem solving around those challenges
will be described, as will the outcomes of changes to the
recruitment process. This team also faced challenges associ-
ated with the incorporation of technology in the interven-
tion. Lessons learned and suggestions for future research will
be presented.
SETTING THE STAGE: HEALTH CARE TRANSITIONS
AND PATIENT CENTERED RESEARCH
A.T.Woodward, Michigan State University, East Lansing,
Michigan
The transition from hospital to home is a challenging
period for older patients with comorbid illnesses and com-
plex physical, psychological, and social needs. Many patients
are slow to recover because of poor access to follow up care,
education, and information. Caregivers report high levels
of burden and stress. Rehospitalization rates for complex
patients are high. While many existing transition-based inter-
vention studies have been effective, most are not patient-cen-
tered. For example, they tend to be hospital-based despite
patient and caregiver reports that they cannot fully absorb
information in the hospital and do not yet know what help
they will need. A patient-centered approach that engages
patients and caregivers early in the process would suggest
that a home-based transition intervention would be prefer-
able. This presentation will provide an overview of patient-
centered research, particularly within the context of health
care transitions.
THE MISTT STUDY
A.K.Hughes, M.Reeves, M.Fritz, School of Social Work, health among older adults in the U.S.and Canada. Wu and
Michigan State University, East Lansing, Michigan
Michigan Stroke Transitions Trial (MISTT) is a practi-
cal clinical trial that aims to improve patient and caregiver
experiences of healthcare transitions after an acute stroke.
Potential participants are recruited in the inpatient setting
and randomized to one of three conditions- usual care,
social work case management, or social work case manage-
ment plus access to a curated website of stroke information
and resources. The social work case management interven-
tion was developed with input from patients and caregivers
who mirrored our study population. Their input informed
the four aspects of the intervention that we think character-
ize a good transition: support (emotional and practical);
preparedness; addressing unmet needs; and stroke preven-
tion. The MISTT trial is funded by PCORI (Patient Centered
Outcomes Research Institute) and we expect to enroll 480
participants from four sites over the course of the trial. Our
primary outcome measures are changes in levels of patient
activation, caregiver strain, quality of life, and depression.
MISTT: IMPLEMENTATION CHALLENGES
P.Freddolino, Michigan State University, East Lansing,
Michigan
Many randomized control trials (RCTs) encounter imple-
mentation challenges and MISTT has been no exception. The
most salient challenges have come in two areas.
Recruitment issues have included lower census of stroke
patients than expected in the providing hospitals; and some
Innovation in Aging, 2017, Vol. 1, No. S1
differences in perspective by hospital staff on the nature of
research and the purpose of this particular project by staff on
whom the project depends to initiate recruitment.
Developing the technology tool essentially a web portal
has been more complex than anticipated. While the con-
tent was based on what survivors and caregivers in our pilot
phase indicated would be important, a usability evaluation
indicated the need for major revisions in the organization
and presentation of content. Also, there was less interest in
using the web site than expected based on pilot participant
interviews.
The presentation will report on how the team became
aware of these challenges, the steps developed to address
them, and the results of changes made.
SESSION 3040 (SYMPOSIUM)
ORAL HEALTH IN LATER LIFE: RESEARCH
CHALLENGES, OPPORTUNITIES, AND INNOVATIONS
Chair: D.Carr, Rutgers University, New Brunswick, New
Jersey
Discussant: G.S.ONeill, The Gerontological Society of
America
One of the most serious yet under-researched concerns
among older adults is oral health. Mounting population-
based research demonstrates stark socioeconomic, ethnic,
and regional disparities in service utilization, edentulism,
and untreated decay. Practitioners have identified poor qual-
ity oral health among long-term care residents, due in part to
lack of training among staff and family caregivers. This panel
brings together population health researchers and practition-
ers to identify the challenges in studying and treating oral
Luo describe oral health disparities in the United States. Using
National Health Interview Survey data, they also reveal vast
heterogeneity in the dental health of Asian Americans, and
delineate the role of language and cultural factors in explain-
ing these disparities. Zwetchkenbaum and Carr provide an
overview of large longitudinal data sets in the United States
that are well-suited to studying oral health and its psycho-
social correlates over the life course, and recommend future
data collection initiatives. Yoon and Hoben describes gaps
in research and assessment of the oral health concerns of
long-term care residents, and present newly developed, valid
assessment tools. They present plans for the development of
an oral health think tank that will address research priorities
identified by key stakeholders. Agha & Lyford describes the
philosophies and practices of a holistic dental clinic in the
United States, and documents the efficacy of this innovative
care coordination model for enhancing late-life oral health.
Panelists will propose new research and practice partner-
ships to further address late-life oral health concerns.
DISPARITIES IN ORAL HEALTH AND DENTAL CARE
AMONG OLDER ADULTS IN THE U.S. AND ABROAD
B.Wu2, H.Luo3, 2. New York University, Rory Meyers
College of Nursing and NYU Aging Incubator, New York,
New York, 3. East Carolina University, Greenville, North
Carolina
Oral health disparity reflects some of the greatest chal-
lenges in the U.S. This presentation provides an overview
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
of oral health disparity in older adults across regions,
race/ethnicity, socioeconomic status, and nations. Dental
care and oral health are strongly correlated. This pres-
entation also presents findings on dental care utilization
among several Asian immigrant populations in the U.S.
Using data from the 2013 and 2014 National Health
Interview Surveys, this study examined acculturation and
dental service use among 2,948 Asian immigrants in the
U.S. Acculturation was measured by length of stay in the
U.S., English language proficiency, and U.S. citizenship.
This study found that dental service use varied across
Asian immigrant groups. Controlling for socioeconomic
status and health behaviors, longer length of stay was sig-
nificantly associated with having a dental visit (p<0.05).
Compared with other adult population, older adults (age
65+) were more likely to seek dental visit.
PSYCHOSOCIAL INFLUENCES ON ORAL HEALTH
AMONG OLDER ADULTS IN THE U.S.: DATA
RESOURCES AND CHALLENGES
S.Zwetchkenbaum2, D.Carr1, 1. Rutgers University,
New Brunswick, New Jersey, 2. Rutgers School of Dental
Medicine, Newark, New Jersey
Disparities in oral health are well documented. Most stud-
ies use large cross-sectional health surveys, and document
differentials in outcomes such as frequency of dentist visits,
edentulism, and untreated tooth decay. However, important
questions remain under-explored such as the impact of psy-
chosocial factors shaping oral health treatment, prevention,
and quality of life as individuals age. We provide an over-
view of large longitudinal data sets in the United States that
are not widely used for studying oral health, yet have rich
information on the family, psychological, and economic fac-
tors that enhance or impede oral health. We provide exam-
ples of the rich data available in studies like the Wisconsin
Longitudinal Study (WLS) and Midlife in the United States
(MIDUS), and recommend new data collection and analy-
sis projects informed by the complementary knowledge and
skills that social scientists and oral health practitioners bring
to the study of later-life oral health.
A PROGRAM OF RESEARCH: IMPROVING ORAL
HEALTH OF OLDER ADULTS LIVING IN LONG-
TERM CARE
M.N.Yoon1, M.Hoben2, 1. School of Dentistry, University
of Alberta, Edmonton, Alberta, Canada, 2. Faculty of
Nursing, University of Alberta, Edmonton, Alberta, Canada
Oral health (OH) and OH care are neglected and sub-
standard in long-term care. Poor OH not only compro-
mises general health but also impacts overall quality of life.
Despite existing OH care best practices, there are gaps in our
ability to translate such evidence into care for frail people.
This presentation will outline a program of research aimed
at improving OH for older adults living in long-term care.
Focus will be given to a) systematic reviews highlighting
gaps in research; b) validation work on existing oral health
instruments and the development of new psychometrically
robust instruments; and c) an oral health think that identified
targeted research interventions to address research priorities
identified by key stakeholders.
IAGG 2017 World Congress
647
AN INNOVATIVE MODEL OF INTEGRATED ORAL,
HEALTH, AND WELLNESS CARE TO ADVANCE
SUCCESSFUL AGING
Z.Agha1, S.Lyford2,1, 1. Gary and Mary West Health
Institute, La Jolla, California, 2. The Gary and Mary West
Foundation, Solana Beach, California
Poor oral health is a pervasive health issue for seniors and
is associated with increased use of medical services, increased
risk for chronic conditions and reduced quality of life. There
is growing momentum for innovative holistic and integrated
care delivery models to ensure comprehensive, human-cen-
tered, and sustainable healthcare that best addresses the
needs of seniors. The Gary and Mary West Senior Dental
Center, a unique community dental clinic in San Diego,
opened in 2016 to provide high-quality oral healthcare coor-
dinated with overall health and wellness services. This clinic
integrates over 30 community nonprofits at the Gary and
Mary West Senior Wellness Center to provide dental, health,
housing services, nutritious meals and critical social and
support services, together under one roof. Participants will
discuss the development and implementation of the clinic,
and will share initial research findings focused on improving
health outcomes.
SESSION 3045 (SYMPOSIUM)
AN INTERNATIONAL PERSPECTIVE ON THE
ENGAGEMENT OF OLDER ADULTS IN PHYSICAL
AND DAILY ACTIVITIES
Chair: J.de Man-van Ginkel, University Medical Center
Utrecht, Utrecht, Netherlands
Co-Chair: S.Metzelthin, Maastricht University, Maastricht,
Netherlands
Discussant: G.Meyer, Universitat Witten/Herdecke
Impaired mobility and functional decline are often the
consequence of body changes due to normal ageing or disa-
bling conditions such as a stroke. Aneed for acute or long-
term care is often the consequence. However, professionals
tend to focus on completion of care tasks rather than engag-
ing older adults in daily and physical activities. Poor reha-
bilitation, further deconditioning and functional decline are
common consequences of this inactivity. By contrast, profes-
sionals should encourage older adults to actively engage in
physical and daily activities. These activities need to match
with the capabilities and preferences of older adults as well
as the care situation, setting and culture. This symposium
addresses different studies, which are related to this topic. In
the first presentation, an overview will be given of the most
promising interventions for maintaining and restoring opti-
mal physical functioning of patients who are in need for care.
The second presentation provides insight into the phe-
nomenon physical activity in German hospitals according to
nurses and patients. The third presenter from the US talks
about the role of Function Focused Care regarding the pre-
vention and management of sarcopenia. The fourth presenter
from Denmark reports about the preliminary results of a
randomized controlled trial evaluating a reablement service
model. The last presentation will be about the Stay Active
Home program, which is recently developed and pilot-tested
in the Netherlands.
648
ENHANCEMENT OF PHYSICAL FUNCTIONING IN
THE DAILY NURSING CARE: ASYSTEMATIC REVIEW
OF INTERVENTIONS
C.Verstraten1, J.de Man-van Ginkel1, S.Metzelthin2,
M.Schuurmans1, 1. Julius Center for Health Sciences
and Primary Care, University Medical Center Utrecht,
Utrecht, Netherlands, 2. Maastricht University, Maastricht,
Netherlands
Impaired physical functioning in daily activities are often
the consequence of body changes due to normal ageing or
disabling conditions. Therefore, nursing care should focus
on maintaining and restoring physical functioning of their
patients. Although nurses consider initiating and monitoring
interventions to be parts of their role, little is known about
the interventions they can use in their daily care.
A systematic review was conducted using the Cochrane
method and the PRISMA-P guideline, focusing on interven-
tions suitable for daily nursing care. The first search resulted
in 2348 hits. Of the finally selected studies, the methodologi-
cal quality of the studies, the level of evidence of the findings
of these studies, and the effectiveness of the interventions
will be presented. This will result in an overview of the most
promising interventions for maintaining and restoring opti-
mal physical functioning of patients who are in need for
nursing care.
PHYSICAL ACTIVITY IN OLDER PATIENTS IN
GERMAN HOSPITALSA QUALITATIVE STUDY
I.T.Schneider, G.Ayerle, G.Meyer, Martin Luther
University Halle-Wittenberg, Halle/Saale, Germany
Physical activation of older patients is mandatory to avoid
loss of independence. Aliterature review suggests insufficient
options for patients mobility but potential for promotion
of physical activity. In 2015/16 a qualitative study in two
German hospitals was conducted aimed to describe mobility
patterns during typical nursing situations. Aphenomenolog-
ical-hermeneutic approach was used to gain insight into the
promotion of mobility in nursing and the meaning of mobil-
ity perceived by patients and nurses. Informed consent was
obtained by nurses and patients. N= 37 interactions (bathing/
dressing, transfer, eating) were observed using non-partici-
pating observations followed by focused interviews (nurses
n=9, patients n=6). Data were analyzed in order to arrive at
a thick description. Results indicate inflexible organizational
structures and working processes, time constraints, nurse/
patient attitudes, substitution of mobility by related activi-
ties carried out by nurses. The study is a first step towards
a mobility enhancing nursing climate in hospitals for older
patients.
PREVENTING SARCOPENIA: OPTIMIZING
FUNCTION AND PHYSICAL ACTIVITY USING
FUNCTION-FOCUSED CARE
B.Resnick, E.Galik, University of Maryland School of
Nursing, Ellicott City, Maryland
Sarcopenia is the age-associated loss of skeletal muscle
mass and function. The loss of skeletal muscle mass associ-
ated with sarcopenia results in a loss of strength, rate of force
development and muscle power. Sarcopenia contributes to
functional deficits in mobility and overall functional capac-
ity. To overcome sarcopenia, behavior change that focuses
on optimizing protein intake and increasing time spent in
Innovation in Aging, 2017, Vol. 1, No. S1
function and physical activity are needed. We developed the
Function Focused Care approach to help prevent and man-
age sarcopenia among older adults. Function Focused Care
(FFC), involves teaching and motivating nurses, patients,
and other members of the health care team to focus on and
optimizing dietary intake and function and physical activ-
ity during all care interactions with patients. In this session,
we provide the theoretical support for FFC and the success-
ful ways in which to implement Function Focused Care in a
variety of clinical settings to prevent and manage sarcopenia.
REABLEMENT IN DENMARKBETTER HELP,
BETTER QUALITY OF LIFE?
T.Rostgaard, L.Graff, KORA - Danish Institute for
Local and Regional Government Research, Copenhagen,
Denmark
Reablement in long-term care for older people is intro-
duced by law in Denmark. Reablement provides a short-
term, goal-oriented and multi-disciplinary intervention with
the aim of strengthening functional ability in IADL and ADL
in community-dwelling older adults. All municipalities must
since January 2015 assess the potential for reablement and
provide the necessary services. Only if the older person is
believed not to have the potential for reablement, is tradi-
tional compensatory home help services given. Services are
provided by multi-disciplinary teams of social care work-
ers and physio- and occupational therapists, working close
together with dieticians, nurses etc. This study presents
preliminary results from the first RCT trial of reablement,
reporting on changes in quality of life (ASCOT), health
related quality of life (EQ-5D), loneliness (UCLA) and physi-
cal ability (Barthel) for 540 persons 65+. The study applies a
control group design comparing results with persons of the
same age receiving traditional compensatory home help.
DOING WITH RATHER THAN DOING FOR
OLDER ADULTS: THE STAY ACTIVE AT HOME
PROGRAM
S.Metzelthin1, G.Zijlstra1, J.de Man-van Ginkel2, E.van
Rossum3,1, G.Kempen1, 1. Department of Health Services
Research, CAPHRI Care and Public Health Research
Institute, Maastricht University, Maastricht, Netherlands,
2. Nursing Science Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht,
Netherlands, 3. Research Centre for Community Care,
Faculty of Health, Zuyd University of Applied Sciences,
Heerlen, Netherlands
In the Netherlands, 95% of older adults (65years) are
community-dwelling with 20% of them receiving homecare
services. The Stay Active at Home program focuses on
doing self-care and domestic tasks with older adults rather
than for them. The training program for professionals was
pilot-tested using a mixed-methods design. Out of 33 pro-
fessionals, who were invited to participate in the pilot, 20
attended the kick-off meeting of whom 18 agreed to partici-
pate in the study; 94% were female with an average age of
43.7years. Face-to-face interviews showed that professionals
particularly valued the practical examples to stimulate active
engagement in daily and physical activities and the possibility
to exchange experiences with their colleagues. Furthermore,
the weekly newsletter with tips & tricks is perceived as useful
to remain aware of the needed behavioral change. Overall, a
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
trend towards better scores for knowledge, self-efficacy and
outcome expectation were found.
SESSION 3050 (PAPER)
POPULATION-BASED EPIDEMIOLOGICAL STUDIES
RACIAL DIFFERENCES IN MORTALITY RISK IN
THE HEALTH, AGING, AND BODY COMPOSITION
(HEALTH ABC) STUDY
M.M.Marron1, D.G.Ives1, D.C.Bauer2, R.Boudreau1, spirometry in 1010 men, age 6980years in the Gothenburg
T.Harris3, S.Satterfield4, R.I.Shorr5, A.Newman1, 1. part of the Swedish MrOS-study. Both forced expiratory
Epidemiology, University of Pittsburgh, Pittsburgh,
Pennsylvania, 2. Division of General Internal Medicine,
University of California, San Francisco, California, 3.
Laboratory of Epidemiology and Population Sciences,
Intramural Research Program, National Institute on Aging,
Bethesda, Maryland, 4. Department of Preventive Medicine,
University of Tennessee Health Science Center, Memphis,
Tennessee, 5. Veterans Affairs Medical Center, Gainesville,
Florida
U.S.blacks have a higher risk of death than whites. This
varies by cause of death; stroke, kidney disease and some
cancers are higher in blacks. We evaluated cause-specific
mortality risk factors in Health ABC to determine whether
specific risk factors are more important for these causes of
death in blacks than whites. Potential risk factors included:
demographics, smoking, body mass index, chronic disease,
physical function, and cognition. Among N=3075 partici-
pants ages 7079 (41.7% black), average follow-up was
11.9 years. Underlying cause of death was adjudicated by
committee and categorized as: cardiovascular disease, stroke,
cancer, dementia, pulmonary, infection, kidney, and other
cause. Median survival (95% confidence interval) among
black men, white men, black women, and white women was
10.6 (10.0, 11.5), 12.8 (12.4, 13.4), 13.4 (12.6, 14.6), and
15.3 (14.8, 16.2) years, respectively. Adjusting for age and
sex, blacks had higher risks of dying from: any cause (haz-
ard ratio=1.32 (1.21, 1.44)), kidney disease (HR=2.10 (1.17,
3.78)), cancer (HR=1.35 (1.13, 1.62)), and stroke (HR=1.32
(0.97, 1.75)). Higher all-cause mortality risk among blacks
was attenuated by further adjustment for gait speed (black
race adjusted HR=1.06 (0.95, 1.17)) or digit symbol sub-
stitution test (black race adjusted HR=1.01 (0.91, 1.12)),
but minimally by prevalent diseases (black race adjusted
HR=1.25 (1.13, 1.38)). Gait speed also attenuated higher risk
of kidney and stroke deaths among blacks, but not cancer
deaths. Factors contributing to poorer physical and cognitive
function in similarly aged community-dwelling ambulatory
black men and women could be targets to reduce disparity
and excess mortality.
LOW LUNG FUNCTION IS APREDICTOR OF
MORTALITY ALSO ADJUSTED FOR SARCOPENIA.
D.Mellstrm1, E.Waern1, .Tivesten2, C.Lewerin1, ses were assumed to be due to nosocomial infection.
C.Hongslo Vala1, T.Cederholm3, M.Lorentzon1,
C.Ohlsson1, 1. Center for Bone and Arthritis Research
(CBAR), Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden, 2. Wallenberg Laboratory for
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649
Cardiovascular and Metabolic Research, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden,
3. Department of Public Health and Caring Sciences/
Clinical Nutrition and Metabolism, Uppsala University,
Uppsala, Sweden
Low lung function has been related to functional aging,
chronic bronchitis and cardiovascular disease. However, low
lung function has also been associated to muscle function
and body size. The purpose of this study was to examine
if low lung function is an independent predictor of 10year
mortality (379 died). We examined lung function with
volume 1.0(FEV1.0) and vital capacity (VC) decreased with
age, and the age corrected HR for 10year mortality per SD
decrease in FEV1.0 was 1.39 (CI 1.251.54) and for VC 1.38
(CI 1.241.53). Bone mineral density (BMD) and body com-
position (including appendicular lean mass) was measured
with Hologic 4500 A.Hand grip strength was measured with
a Jamar dynamometer. FEV1.0 associated with hand grip
strength (r= 0.36, p<0001). Sarcopenia was defined accord-
ing to EuroWorkGroup in grip strength, gait speed and
appendicular lean mass. Amultivariate Cox model with mor-
tality as dependent variable and age, sarcopenia-hand grip
strength, gait speed, appendicular lean mass and lowest quin-
tile of FEV1.0 revealed that only low FEV1.0 was a signifi-
cant predictor HR 2.0 (CI 1.562.57). In a Cox model with
10 year mortality as dependent variable and with FEV1.0,
hand grip strength, gait speed, hip BMD, height, BMI, dia-
betes, hypertension, cancer, stroke, COPD and myocardial
infarction at baseline as covariates, HR per SD decrease in
FEV1.0 was 1.24 (CI 1.081.42). We conclude that lung
function is an independent predictor of all cause mortality
in elderly men.
NOROVIRUS GASTROENTERITIS IS AN IMPORTANT
CAUSE OF NOSOCOMIAL INFECTIONS IN
GERMANY
F.Kowalzik1, D.Zller1, H.Binder1, R.Clemens2,
T.Verstraeten3, F.Zepp1, 1. University Medical Center
of the Johannes Gutenberg University, Mainz, Germany,
2. GRID Europe Consult, Mainz, Germany, 3. P95
Pharmacovigilance and Epidemiology Services, Leuven,
Belgium
Noroviruses are the most important global cause of acute
gastroenteritis (AGE). Testing for norovirus in patients hos-
pitalized with AGE is incentivized in Germany because a
positive diagnosis impacts reimbursement. We estimated the
number of nosocomial infections overall and by age-group
for norovirus gastroenteritis (NGE) using federal German
databases. All hospitalizations in Germany are registered
with the German Federal Statistics Office (DESTATIS). We
extracted aggregate data for patients hospitalized with NGE
(ICD-10 codes A08.1) as primary or non-primary diagnosis
for the period 20072012. Cases with a non-primary diagno-
During the six-year study period and based on our
assumption, there were a total of 241,667 nosocomial NGE
cases among hospitalized patients in Germany; an average of
40,278 cases per year studied (range 32,25957,561). In any
650
study year the number of nosocomial NGE cases was 1.3 to
1.7-fold higher than the number of community acquired NGE
hospitalizations. The average duration of hospitalization was
3.4 to 4.5-fold longer (1718 days versus 45 days) when
NGE was nosocmial compared to community-acquired.
Adults of 85years of age and older suffered the highest rate
of nosocomial NGE (range 33.6 to 59.1/10,000 population).
We conclude that Noroviruses are an important cause
of nosocomial infections among hospitalized patients in
Germany. Assuming all non-primary coded NGE episodes to
be nosocomial in nature may have lead to an overestimation.
DERIVATION AND VALIDATION OF ASCREENING
TOOL FOR CHIKUNGUNYA VIRUS INFECTION IN
THE ELDERLY
M.Drame1,2, F.Najioullah3, R.Cesaire3, J.Fanon3,
L.Godaert3, 1. Faculty of Medicine, EA 3797, University
of Reims Champagne-Adenne, Reims, France, 2. University
Hospitals of Reims, Reims, France, 3. Geriatry, University
Hospital of Martinique, Fort-de-France cedex, Martinique
The aim of the study was to derive a score for Chikungunya
virus infection (CVI) screening in the elderly. Patients were
65+, and admitted to acute care units of Martinique University
Hospitals for suspected Chikungunya virus infection (CVI).
Reverse Transcription Polymerase Chain Reaction (RT-PCR)
was used as gold standard testing. Apoint value was assigned
to each independent factor according to the adjusted odds
ratio of the final logistic regression model. Point values were
rounded to the nearest integer and summed. The ROC curve
was used to determine the best cut-off of the score that better
identify confirmed positive CVI patients. Bootstrap analy-
sis was used to evaluate the internal validity of the model
and to estimate the C-statistic 95% confidence interval. In
all, 687 patients were included. Mean age was 808, 51%
were women, and 68% had positive RT-PCR. By multivari-
able logistic regression model, four variables were found to
be independently associated with positive RT-PCR (fever:
3 points; arthralgia of the ankle: 2 points; lymphopenia:
6 points; absence of neutrophil leucocytosis: 10 points).
Bootstrap methods showed good internal validity of the
final model. The score ranged from 0 to 21, with an aver-
age of 146. The C-statistics was 0.86 (95% CI: 0.830.89).
Ascore greater or equal 12 was considered as the best cut-off
to identify positive RT-PCR patients (Sensitivity: 87%; 95%
CI: 83%-90%; Specificity: 70%; 95% CI: 63%-76%). This
score has good performances and good internal validation.
It could be a helpful tool to screen elderly people with CVI.
PREDICTORS OF CRASHES AND MOVING
VIOLATIONS IN ADIVERSE SAMPLE OF OLDER
WOMEN: THE WHIMS STUDIES
R.A.Marottoli1,2, E.Dugan3, S.Gaussoin4, M.Naughton4,
S.R.Rapp4, B.M.Snively4, L.Vaughan4, 1. Yale University,
New Haven, Connecticut, 2. VA Connecticut Healthcare
System, West Haven, Connecticut, 3. University of
Massachusetts, Boston, Massachusetts, 4. Wake Forest
School of Medicine, Winston-Salem, North Carolina
The US population is aging and licensure rates are increas-
ing among older drivers. The factors associated with crashes
and moving violations among older women are not well char-
acterized. Our aim was to determine the predictors of crashes
Innovation in Aging, 2017, Vol. 1, No. S1
and moving violations among participants in the Womens
Health Initiative (WHI) Memory Study-Epidemiology of
Cognitive Health Outcomes (WHIMS-ECHO) and the
WHI Memory Study of Young Women (WHIMS-Y), com-
prised of geographically diverse cohorts of older US women.
Participants were enrolled in the WHI hormone therapy
trial at ages 5054 (WHIMS-Y) and 6579 (WHIMS-
ECHO). Atelephone questionnaire assessing driving status,
self-reported crashes, and moving violations in the previ-
ous year was administered to surviving WHIMS-ECHO
and WHIMS-Y participants from September 2013 to June
2015. Given the age differences between participants in the
two groups, we evaluated the cohorts separately: N=1029
respondents in WHIMS-Y (mean age 70.6SD 1.7) and
N=1716 in WHIMS-ECHO (86.0 3.4 years). Results
showed that self-reported crashes were more common in
the older WHIMS-ECHO cohort (105.32 v.80/1000 person-
years), but moving violations more common in WHIMS-Y
(35.56 v 9.2/1000 person years). Predictors of a combined
measure of all adverse driving outcomes were: older age
(p=0.03 WHIMS-Y, p<0.001 WHIMS-ECHO) and less
social support in both cohorts (p=0.02, p=0.009), while
lower cognitive scores predicted more events in WHIMS-
ECHO (p= 0.004). Future analyses will further explore the
predictors of adverse driving events and aim to identify
interventions.
SESSION 3055 (SYMPOSIUM)
WHAT WORKS, WHAT DOESNT, AND WHY:
LEARNINGS FROM THE WORLDS LARGEST
HOSPITAL FALLS PREVENTION TRIAL
Chair: A.L.Barker, Monash University, Melbourne, Victoria,
Australia
Co-Chair:. J. van der Velde, Academic Medical Center,
Amsterdam, Netherlands
Discussant: J.Treml, Queen Elizabeth Hospital,
Birmingham, United Kingdom
Patient falls remain a common cause of harm in hospi-
tals worldwide. Recent studies suggest harm is increasing
despite investment in practice guidelines and implementation
of prevention programs. This symposium presents key learn-
ings from the 6-PACK project which will be compared to the
learnings of prior studies. 6-PACK is a nurse-led falls pre-
vention program reflective of Australian hospital accredita-
tion standards and best practice guideline recommendations.
The 6-PACK project incorporated a study of falls prevention
beliefs, practice, safety climate and outcomes; a cluster RCT
testing effectiveness of the 6-PACK, including economic and
program evaluations; and an assessment of sustainability of
practice and outcomes. It collected information from 540
staff and 50,150 patients from 24 wards across six Australian
hospitals. This symposium includes four presentations. In the
first, the 6-PACK RCT results will be presented including
impacts on practice, falls and fall injuries; and implemen-
tation fidelity of the 6-PACK during the trial. The second
reviews known barriers and enablers to the implementation
of falls prevention programs and compares these to those
experienced in the 6-PACK. The third presents findings of
a cost of falls study conducted alongside the RCT. The final
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
presentation summarizes evidence relating to patient safety
climate and falls, including measurement tools and climate
in the wards participating in 6-PACK. The symposium will
conclude by discussing novel solutions to hospital falls by the
discussant, who will review the presented findings in terms
of impact and clinical implications; and also compare to
UK and European activities including NICE guidelines and
FallSafe.
THE 6-PACK PROGRAM TO DECREASE FALL
INJURIES IN HOSPITALS: THE WORLDS LARGEST
FALLS PREVENTION TRIAL
A.L.Barker1, R.T.Morello1, R.Wolfe1, R.Lindley2, Australia, 4. Curtin University, Bentley, Western Australia,
J.Kamar3, The 6-PACK Investigator Team1, 1. Department
of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia, 2. University
of Sydney, Sydney, New South Wales, Australia, 3. The
Northern Hospital, Melbourne, Victoria, Australia
The nurse-led 6-PACK falls prevention program includes
a fall-risk tool and individualised use of falls alert signs;
supervising patients in the bathroom; ensuring walking aids
are within reach; a toileting regime; low-low beds; and bed/
chair alarms. This RCT evaluated the effect of the 6-PACK on
falls and fall injuries in 24 acute wards from six Australian
hospitals compared to usual care over 12-months. Positive
changes in falls prevention practice occurred following the
introduction of the 6-PACK. During the RCT, there were
46,245 patient admissions, 1831 falls and 613 fall injuries.
The rate of falls (IRR=1.04, 95% CI, 0.78 to 1.37) and fall
injuries (IRR=0.96, 95% CI, 0.72 to 1.27) were similar in
intervention and control wards. The findings are in accord-
ance with previous studies, which together provide increas-
ing evidence of no effect for falls prevention interventions in
acute wards. Novel solutions to the issue of in-hospital falls
are required.
BARRIERS AND ENABLERS TO EFFECTIVE FALLS
PREVENTION IN ACUTE HOSPITALS
D.R.Ayton1, A.L.Barker1, J.Talevski1, R.T.Morello1, Melbourne EpiCentre, The University of Melbourne,
C.A.Brand1, K.D.Hill2, The 6-PACK Investigator Team1,
1. Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Victoria, Australia, 2.
Curtin University, Bentley, Western Australia, Australia
Knowledge from hospital staff may assist us with imple-
menting effective falls prevention programs. This study
aimed to assess nurse and senior management perceptions
of barriers and enablers of effective falls prevention in acute
public hospitals to inform implementation of the 6 PACK
program. Data was obtained via focus groups with nurses
(n=12 with 96 nurses); interviews with senior hospital staff
(n=24); and nurse surveys (n=420). Analysis was thematic
and guided by the Theoretical Domains Framework and
COM-B framework developed by Michie and colleagues.
Barriers included a lack of time, skills, effective strategies
and resources. Patient complexity, environmental factors and
belief that falls were inevitable were also identified as barri-
ers. Enablers included face-to-face education; leadership; and
use of audit, reminders, feedback and benchmarking. These
results inform that future implementation of falls prevention
IAGG 2017 World Congress
651
programs should include promotion of executive and ward
leadership; on-ward face-to-face education; and improved
access to falls prevention resources.
FALLS NOT FALL INJURIES: THE REAL DRIVERS OF
HOSPITAL COST-ANALYSES OF IN-HOSPITAL FALLS
R.T.Morello1, A.L.Barker1, J.Stoelwinder1, T.P.Haines1,
M.Bohensky2, J.Watts3, K.D.Hill4, The 6-PACK
Investigator Team1, 1. Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne,
Victoria, Australia, 2. University of Melbourne, Melbourne,
Victoria, Australia, 3. Deakin University, Burwood, Victoria,
Australia
In-hospital falls are clearly associated with increased hos-
pital costs. Given the lack of comprehensive and contempo-
rary data on the cost of falls, this prospective cohort study
conducted alongside the 6-PACK trial aimed to quan-
tify the additional length of stay (LOS) and costs associated
with falls in acute hospitals in Australia. We identified 1,330
falls and 418 fall injuries from 27,026 hospital admissions.
Patients with an in-hospital fall had a mean increase in LOS
of 8days (P<0.001) compared with non-fallers, and incurred
mean additional hospital costs of $6669 (P<0.001). Patients
with a fall-related injury had a mean increase in LOS of
4days (P=0.001) compared with fallers without injury, and
incurred mean additional hospital costs of $4727 (P=0.080).
Findings from this study provide contemporary costs associ-
ated with an in-hospital fall and associated injury. Programs
need to target the prevention of all falls, not just the reduc-
tion of harm.
MEASURING SAFETY CLIMATE IN AUSTRALIAN
HOSPITALS: POTENTIAL TO MAKE CHANGES AND
IMPROVE SAFETY
S.Soh1,3, A.L.Barker1, R.T.Morello1, C.A.Brand1,2, 1.
Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Victoria, Australia, 2.
Melbourne, Victoria, Australia, 3. Department of
Physiotherapy, Monash University, Melbourne, Victoria,
Australia
There is a growing body of evidence linking adverse
events such as falls with poor patient safety climate. This
study explored nurse perceptions of safety climate to guide
the implementation of the 6-PACK falls prevention pro-
gram. The Safety Attitudes Questionnaire (SAQ) was used
to quantify safety climate. 420 nurses from 24 acute wards
across 6 Australian hospitals responded to the questionnaire
(response rate 59.8%). On average, 53.5% of nurses held
positive attitudes towards job satisfaction followed by team-
work climate (50.5%). There was variability in SAQ domain
scores across hospitals as well as across wards within a hospi-
tal. Findings from this study provide an insight into possible
targets for strategies to improve safety climate. Implications
of the association between safety climate and falls will also
help to tailor patient safety programs keeping in mind that
wards may have their own safety sub-culture distinct to the
overall hospital culture.
652
SESSION 3060 (SYMPOSIUM)
GETTING PATIENTS UP: DESIGNING AND
IMPLEMENTING GLOBAL INTERVENTIONS TO
PROMOTE PATIENT AMBULATION
Chair: B.King, University of Wisconsin Madison, Madison,
Wisconsin
Co-Chair: C.Brown, The University of Alabama at
Birmingham
Discussant: C.Brown, The University of Alabama at
Birmingham
Loss of independent ambulation in older adults during
hospitalization is a worldwide phenomenon. Investigators
from multiple countries have identified limited ambulation of
older adults in the hospital setting to be independently asso-
ciated with functional decline and loss of mobility at hospi-
tal discharge. Hospital settings are complex, thus engaging
patients in ambulation is riddled with barriers that prevent
hospital staff from walking patients. Therefore, designing
and testing interventions to improve patient ambulation in
the hospital setting will require innovative approaches. The
aim of this symposium will be to highlight studies to improve
patient ambulation conducted in four countries. Presenters
will describe novel design approaches, study results and dis-
semination of a model of ambulation care.
The first presentation will discuss the impact of knowl-
edge, attitudes and behaviors of multiple healthcare provid-
ers on whether or not patients are ambulated. The second
presentation will describe the use of a human factors engi-
neering model to design a multilevel intervention (MOVIN)
and strategies to engage stakeholders in launching a complex
design. The third presentation will describe the use of a simple
strength-training program (STAND-Cph), initiated during the
hospital stay and continued post discharge for 6-months. The
fourth presentation will describe dissemination of a multi-
level intervention study, MOVE ON, identifying components
that impact sustainability. Loss of independent ambulation
in hospitalized older adults is a global health concern. Due
to the complexity of hospital systems and unique care needs
of older adults, pioneering approaches to overcome barriers
and create sustainable models of ambulation care are needed.
BARRIERS AND FACILITATORS TOWARD
IN-HOSPITAL PATIENTS MOBILITY: THE WALK-FOR
STUDY
A.Zisberg1, M.Agmon1, E.Gil2,3, D.Rand4, E.Azaiza5, Institute, St. Michaels Hospital, Toronto, Ontario, Canada
M.Azriel5, 1. The Cheryl Spencer Department of Nursing
Faculty of Social Welfare and Health Science,University
of Haifa, Israel, Haifa, Israel, 2. Internal Medicine and
Geriatric Unit, Bnei- Zion Medical Center, Haifa, Israel,
Haifa, Israel, Israel, 3. Faculty of Medicine, Technion,
Israel, Haifa, Israel, Israel, 4. Department of Occupational
Therapy, Sackler Faculty of Medicine, Tel-Aviv University,
Israel, Tel-Aviv, Israel, 5. HaEmek Medical Center, Clalit
Health Services, Afula, Israel, Afula, Israel
Although mobility during hospitalization prevents func-
tional decline, medical teams knowledge, attitudes and
behaviors may pose barriers toward its promotion. To
describe these barriers and facilitators toward in-hospital
mobility among physicians, nurses, physical-therapists (PT),
and nurse assistants (NA) we conducted 10 in-depth inter-
views, and administered surveys among 90 medical team
Innovation in Aging, 2017, Vol. 1, No. S1
members of two internal medical units in Israel. Mixed
methods analyses reveal a complex, multi-faceted and para-
doxical picture of organizational and personal factors: fear
of falls overshadowed every positive attitude toward mobil-
ity. Nonetheless, PTs and NAs express the most positive atti-
tudes toward mobility compared with physicians and nurses.
Moreover, while family members were not considered as
potential collaborators in mobility assistance, NAs demon-
strated desire to learn and take more responsibilities toward
patients mobility. To conclude, identifying barriers and facil-
itators toward mobility may help in designing and adopting
effective interventions to promote patients mobility.
DESIGNING AND IMPLEMENTING MOBILIZING
OLDER ADULT PATIENTS VIA ANURSE-DRIVEN
INTERVENTION (MOVIN)
B.King, L.Steege, School of Nursing, University of
Wisconsin Madison, Madison, Wisconsin
Up to 65% of older adults (aged 65 or older) experience
functional decline or loss of independent ambulation dur-
ing hospitalization. Limited ambulation during the hospital
stay is an independent predictor of these adverse outcomes.
Registered nurses (RNs) are responsible for promoting patient
ambulation. But multiple system barriers prevent nurse-ini-
tiated patient ambulation. Systems Engineering Initiative for
Patient Safety (SEIPS), a human factors engineering model,
offers a critical understanding of how system components
(people, tools and technology; physical environment; and
organizational culture) impact nurse-initiated patient ambu-
lation. This presentation will describe using human factors
engineering for work system redesign, mapping our prior
findings on barriers to patient ambulation onto SEIPS to
create Mobilizing Older adult patients Via a Nurse-driven
intervention (MOVIN), and strategies to engage stakeholders
in a multilevel intervention. Patient ambulation in hospitals
is a complex process. Asystems based approach to overcome
barriers is necessary to improve patient ambulation.
SUSTAINABILITY AND SPREAD OF MOVE ON:
AMOBILIZATION INITIATIVE TWO YEARS AFTER
IMPLEMENTATION
B.A.Liu1,2, J.E.Moore3, S.Khan3, W.Chan3, C.Harris3,
S.E.Straus1,3, 1. University of Toronto, Toronto, Ontario,
Canada, 2. Regional Geriatric Program of Toronto,
Toronto, Ontario, Canada, 3. Li Ka Shing Knowledge
Mobilization of older patients in hospitals is a clinical
care priority that can reduce functional decline, delirium
and length of stay. The Mobilization of Vulnerable Elders in
Ontario (MOVE ON) initiative promoted 3 core messages:
Mobilization should occur at least 3 times daily, mobilization
should be progressive and scaled, assessment should take
place within 24 hours of admission. Coordinated centrally,
MOVE ON included 14,540 patients in 14 hospitals, mean
age 79.9 years. In interrupted time series analysis, 10.56%
more patients mobilized compared to pre-intervention.
Using mixed methods, including 212 staff surveys, we iden-
tified success factors for spread and sustainability. Success
factors for sustainability included contextualized education,
cultural shift, implementation of formal procedures (poli-
cies, role revision, and documentation), visible corporate
support, collaborative resource sharing and alignment with
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
system priorities. The spread of MOVE ON continues, being
adapted in over 40 hospitals in Ontario, and to other prov-
inces and countries.
MOBILITY DURING AND AFTER HOSPITALIZATION
IN OLDER MEDICAL PATIENTS: THE STAND-CPH
TRIAL
M.M.Pedersen1,8, J.Petersen1,2, N.A.Beyer3,4, L.Damkjr5, bidity and confounding. We also aimed to quantify trajecto-
H.G.Juul-Larsen1, A.C.Bodilsen1,8, O.Andersen1,
T.Q.Bandholm1,6,7, 1. Optimed, Clinical Research Centre,
Copenhagen University Hospital, Hvidovre, Hvidovre,
Denmark, 2. Section of Biostatistics, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark,
3. Musculoskeletal Rehabilitation Research Unit, Bispebjerg
and Frederiksberg Hospitals, University of Copenhagen,
Copenhagen, Denmark, 4. Department of Clinical Medicine,
Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark, 5. Department
of Rehabilitation, Copenhagen Municipality Health
Administration, Copenhagen, Denmark, 6. Department
of Orthopaedic Surgery, Copenhagen University Hospital,
Hvidovre, Hvidovre, Denmark, 7. Physical Medicine
Research-Copenhagen (PMR-C), Clinical Research Centre,
Copenhagen University Hospital, Hvidovre, Hvidovre,
Denmark, 8. Physical Medicine Research-Copenhagen (PMR-
C), Department of Physiotherapy, Copenhagen University
Hospital, Hvidovre, Hvidovre, Denmark
During hospitalization, older adults spend most of their
time being physically inactive or bedridden with a risk of los-
ing independence. In addition, it seems that in older adults,
episodes of bed rest are associated with a subsequent decline
in physical activity creating a possible vicious circle of inac-
tivity. Therefore, in a randomized-controlled trial in 80 older
medical patients (+65years) we evaluated whether a simple,
minimally time-consuming supervised strength training pro-
gram, consisting of two lower extremity exercises, initiated
during hospitalization and continued at home after discharge,
was superior to usual care on mobility during and after hos-
pitalization. The intervention consisted of training daily dur-
ing hospitalization and 3 times weekly at home for 4 weeks
after discharge. We assessed 24-h mobility (time spent sitting/
lying, standing and walking) throughout hospitalization and
for three one week periods after discharge (immediately after
discharge, after 4 weeks and after 6months).
SESSION 3065 (PAPER)
EPIDEMIOLOGICAL STUDIES: OBESITY, GRIP
STRENGTH AND BODY COMPOSITION IN OLDER
ADULTS
MODERATE OBESITY IN LATER LIFE: IS IT REALLY
PROTECTIVE FOR HEALTHY AGING?
D.Melzer1,2, K.Bowman1, 1. IBCS, University of Exeter,
Exeter, Devon, United Kingdom, 2. University of
Connecticut Center on Aging, Farmington, Connecticut
There is very contradictory evidence on whether being
overweight or moderately obese (BMI 30 to 35)is protective
IAGG 2017 World Congress
653
or risky in later life for both survival and ageing well. With
the increasing prevalence of obesity world-wide, there is a
need to clarify this so-called obesity paradox of later life,
including addressing suggested confounders and measure-
ment errors. We aimed to extend the current evidence using
very large-scale electronic medical record data and volunteer
cohort data, plus improved measures of adiposity, co-mor-
ries of BMI change in the years before death, to clarify the
effect of reverse causation.
We used Clinical Practice Research Datalink (England)
linked primary care, hospital and death certificate elec-
tronic medical record data on nearly 1 million patients aged
60 years in England from 1 January 2000 onwards. Cox
survival models for each age-subgroup were adjusted for
age, gender, alcohol use, smoking, calendar year, and socio-
economic status. We also used data from the UK Biobank, a
volunteer study of 500,000 people aged 40 to 69, followed
for up to 8years.
Our program of work has shown that 1) In the 14 years
before death there are progressive declines in BMI over the
entire period, which accelerate in the last 2years of life. 2)After
accounting for the decline in BMI before death, smoking and
major disease, most of the BMI risk paradoxes with mortality
and cardiovascular disease (CVD) incidence in the 60s disap-
pear or reverse. 3.Misclassification of central adiposity in later
life by the conventional BMI measures explains more of the risk
paradox. Measures combining BMI and Waist Hip ratio are
associated with major excess risks for mortality and CVD inci-
dence from both being overweight or moderately obese in oth-
erwise healthy 60 to 69year olds. 4.Accounting for the above
issues, levels of exercise and muscle strength remain important
independent predictors but do not interact with risks due to
adiposity. In conclusion, when adiposity is measured appropri-
ately, being overweight or obese is predictive of substantially
worse outcomes in older people who do not have confounding
conditions. Calls for changing policies on obesity prevention
because of the claimed risk paradoxes are misplaced.
MYOSTATIN IN OLDER ADULTS: THE HEALTH,
AGING, AND BODY COMPOSITION (HEALTH ABC)
STUDY
P.M.Cawthon1, N.Parimi1, B.Goodpaster2, A.Newman3,
T.Harris4, S.R.Cummings1, 1. Research Institute, California
Pacific Medical Center, Alameda, California, 2. Translational
Research Institute, Orlando, Florida, 3. University of
Pittsburgh, Pittsburgh, Pennsylvania, 4. National Institute
on Aging, Bethesda, Maryland
Myostatin (also known as GDF8) is a negative regula-
tor of muscle development and size. We tested the hypothesis
that higher myostatin levels are associated with reduced lean
mass, deceased muscle density, lower strength and slower
walking speed in older adults.
We used data from 399 randomly selected men and
women (meanSD age: 78.32.8years) participating in the
Year 6 visit of Health ABC Study. Myostatin was detected in
previously frozen serum using a validated sandwich ELISA
with proprietary antibodies specific to myostatin (Eli Lilly).
Muscle and function variables included appendicular lean
mass assessed by whole body DXA; thigh cross-sectional
654
area and muscle density by QCT; walking speed by usual
pace over 6 meters; and grip strength by Jamar dynamom-
eters. Ordinary least squares regression models (adjusted for
age, BMI, race, sex and self-rated health) were used to cal-
culate adjusted mean levels of the muscle and function vari-
ables across quartiles of myostatin. We tested for interactions
between myostatin and sex, and myostatin and race using
linear regression.
In adjusted models, mean muscle density values increased
as myostatin quartile increased (p for trend <0.001, ~3% dif-
ference between Q1 vs Q4). No other associations between
moystatin and the muscle and function variables were sta-
tistically significant. (p for trend>0.10 for all). There was no
evidence for any interaction tested (p for interaction >0.10
for all).
In conclusion, myostatin levels were unrelated to meas-
ures of muscle size and physical function; the association
between myostatin levels and muscle density was modest and
opposite of the hypothesized direction.
GRIP STRENGTH AND LOW BODY MASS INDEX
PREDICT MORTALITY: FINDINGS FROM THE
LONGITUDINAL SABE STUDY
J.Ferreira Santos1, T.Alexandre2, Y.Duarte3, M.Lebrao4, up. The odds of experiencing an onset of physical disability
1. Social Medicine, University of Sao Paulo, Ribeirao Preto,
Sao Paulo, Brazil, 2. Federal University of Sao Carlos, Sao
Carlos, Sao Paulo, Brazil, 3. Escola de Enfermagem - USP,
Sao Paulo, Sao Paulo, Brazil, 4. Faculdade de Sade Pblica
- USP, Sao Paulo, Sao Paulo, Brazil
Background: Some studies showed that grip strength pre-
dicts mortality. Both muscle mass and muscle strength decline
with age, but it is not clear yet how body composition acts in
the process. This article investigates the relationship between
grip strength, body composition and mortality of inhabitants
of So Paulo, Brazil, aged 60 and plus in 2006. Methods:
1423 participants were interviewed during the second wave
(2006) of the SABE study. Handgrip strength was collected
at baseline along with data on body mass index, (BMI) num-
ber of comorbidities, income and schooling. At the end of
follow-up a Poisson regression was used to evaluate mor-
tality rate ratios (IRR), adjusted for age and sex. Results:
After 5.9years there were 1080 survivors, 268 deaths and 65
(4.6%) lost to follow up. Death rate was 30.3 per 1000 per-
son-years; death rates by Hand Grip Strength in men were
23.0 (normal strength) and 78.6 (reduced strength) - a rate
ratio of 3.4. In women: 15.3 (normal) and 56.7 (reduced)
a ratio of 3.7. Poisson regression showed that schooling,
income and number of comorbidities had no significant
IRRs. Low BMI proved different from Normal (IRR=2.1),
women differed from men (0.7); ages 75+ differed from ages
6075 (IRR=2.4). Reduced Hand Grip strength showed a
mortality rate 2.3 greater than normal strength. Conclusions:
This study showed that Hand Grip Strength is an important
tool for prognostic of survival along with low category of
BMI, independent of age, sex, income, education and number
of comorbidities.
DISABILITY RISK IN OLDER ADULTS WITH MUSCLE
WEAKNESS: RESULTS FROM THE HEALTH AND
RETIREMENT STUDY
K.Duchowny1, M.D.Peterson3, P.J.Clarke1,2, 1. University
of Michigan, Department of Epidemiology, Ann Arbor,
Innovation in Aging, 2017, Vol. 1, No. S1
Michigan, 2. University of Michigan, Institute for Social
Research, Ann Arbor, Michigan, 3. University of Michigan,
Department of Physical Medicine and Rehabilitation, Ann
Arbor, Michigan
Background: Muscle weakness, as determined by hand-
grip dynamometry, is a robust indicator of disability, chronic
disease and mortality. While we recently proposed sex/race-
specific cutpoints for clinical muscle weakness in a diverse,
nationally representative sample of older Americans, the
extent to which these cutpoints predict subsequent physical
disability remains unknown.
Objective: To examine whether sub-group specific mus-
cle weakness cutpoints predict physical disability status in a
nationally representative of Americans aged 65+.
Methods: We used data from the 20082012 Health and
Retirement Study. Fully-adjusted, weighted multinomial
logistic regression models were used to quantify the odds
of experiencing an onset or progression in ones activities of
daily living (ADL) status among weak versus non-weak indi-
viduals over a 4-year period.
Results: In this nationally representative sample, 44% of
individuals were classified as weak at baseline. Twenty-six
percent of individuals had difficulty with 1+ ADL at follow-
were 36% higher among weak individuals at baseline com-
pared to non-weak individuals (OR= 1.37, 95% CI= 1.36,
1.37). Additionally, the odds of experiencing a progression
in physical disability were substantially higher among those
who were weak at baseline compared to non-weak individu-
als (OR= 2.23, 95% CI= 2.22, 2.24).
Conclusions: Using cut-points derived from a nationally
representative sample of older Americans, we have shown for
the first time that weakness is associated with greater risk of
experiencing physical disability in later life. Results under-
score the importance of using population-specific cutpoints
to identify individuals at greatest risk for adverse health
outcomes.
ASSOCIATION OF SARCOPENIC OBESITY WITH
MORTALITY: DATA FROM NHANES 19992004
J.A.Batsis, T.A.Mackenzie, S.Bartels, Medicine, Geisel
School of Medicine at Dartmouth, Lebanon, New
Hampshire
Background: The Foundation for the NIH Sarcopenia
Project validated cutpoints for appendicular lean mass
(ALM). Individuals with sarcopenia (SP) and obesity are
thought to be at higher risk of adverse events. We ascertained
the relationship between SP obesity and mortality and identi-
fied predictors in this subgroup.
Methods: 4,984 subjects 60 years old were identified
from the cross-sectional National Health and Nutrition
Examination Survey 19992004. Mortality data from the
National Death Index was linked to this dataset. SP was
defined using two definitions: a) reduced ALM (men<19.75;
females<15.02kg); b) ALM divided by body mass index
(BMI) (ALM/BMI: <0.789; <0.512, respectively). Obesity
was defined using dual-energy X-ray absorptiometry body
fat (males25%; females35%). SP obesity was defined
using criteria for both SP and obesity. Proportional hazard
models determined the risk of death (referent=no SP obesity).
Results: Mean age was 71.10.19years (56.5% female).
Median follow-up was 102 months (IQR: 78,124) with
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1 655

1,901 deaths (35.0%). Using ALM, prevalence of sarco- PROGNOSIS COMMUNICATION IN LATE-LIFE
penic obesity was 33.5% in females, and 12.6% in males. DISABILITY
Risk of overall death was HR 1.31 [95%CI:1.111.55] and T.Wong1,4, R.Romo4, A.Au-Yeung4, S.Lee4, P.Moran2,
1.59 [1.172.15] in males and females, respectively for those J.H.Karlawish3, A.K.Smith4, 1. UCSD, La Jolla, California,
with SP obesity. Using ALM/BMI, prevalence was 27.3% 2. UCSF, San Francisco, California, 3. University of
and 19.1%, and risk of death was 1.14 [0.99,1.32] and 1.17 Pennsylvania, Philadelphia, Pennsylvania, 4. UCSF/VA, San
[0.98,1.39], respectively. Diabetes, cancer, kidney disease, Francisco, California
and presence of physical limitations were associated with For older adults with late-life disability, learning their
greater risk of death using both SP definitions. long-term prognosis, or life expectancy, can inform clinical
Conclusions: Risk of death in Sarcopenic obesity is def- and personal decisions, but many clinicians worry that tell-
inition-dependent becoming non-significant when using the ing patients their prognosis may harm them. We therefore
ALM/BMI definition. Having diabetes, cancer and renal dis- conducted a study to explore the safety and reactions to
ease predict a worse prognosis in both classifications. prognosis communication in late-life disability. We recruited
community-dwelling older adults age 70+ with at least one
SESSION 3070 (PAPER) disability in activities of daily living from the San Francisco
Bay Area. We conducted qualitative in-person interviews in
English, Spanish, or Mandarin. Participants were asked to
CARE PREFERENCES AT END OF LIFE
estimate their own life expectancy and then were presented
their calculated life expectancy using the Lee index from
IMPACT OF ADVANCE CARE PLANNING SELF-
ePrognosis.org. Psychological and behavioral outcomes were
EFFICACY AND BELIEFS ON PROFESSIONAL
assessed using metric measures. Outcomes were re-assessed
JUDGMENTS
by telephone 24 weeks later. The sample included 35 older
K.Baughman1, R.Ludwick3,4, D.Jarjoura2, D.Kropp1, 1.
adults with a mean age of 79 (56% female, 74% white, 3%
Family & Community Medicine, Northeast Ohio Medical
black, 14% Latino, 6% Chinese). 85% responded Not at
University, Rootstown, Ohio, 2. Ohio State Univeristy,
all or A little bit to statements about feeling anxious or
Columbus, Ohio, 3. Kent State University, Kent, Ohio, 4.
depressed after knowing their calculated life expectancy. An
University Hospitals Portage Medical Center, Ravenna,
overarching theme of fitting life expectancy into ones narra-
Ohio
tive emerged from the data. Participants interpreted the cal-
We examined the impact of advance care planning
culated prognosis based on how they understood their health
(ACP) self-efficacy and beliefs in predicting skilled nurs-
conditions, life history, and factors that influence health. For
ing facility (SNF) provider judgments about initiating
example, if participants saw themselves as healthy or had
ACP conversations. This multi-site study of 353 nurses
long-lived family members, they often dismissed a shorter
and social workers within 29 SNFs used a factorial sur-
prognostic estimate. In conclusion, communicating long-
vey approach in which providers judged vignettes with
term life expectancy does not appear harmful in this sample.
assigned features of a typical SNF resident. Mixed models
However, many may not accept the estimated life expectancy
were used to test hypotheses about vignette responses. At
if it does not align with their life narrative.
the vignette level, residents at high risk for hospitalization,
with rapidly declining health, a diagnosis of cancer vs. dia-
PREFERENCE OF DISCLOSING TERMINAL ILLNESS
betes, and those needing more assistance with activities of
AMONG KOREAN OLDER ADULTS
daily living were rated in more need of ACP (p<.001 for
H.K.Park1, C.Koh2, 1. Duke university, Durham, North
each variable). In addition, these disease trajectory varia-
Carolina, 2. Seoul National University, Seoul, Korea (the
bles also were significantly associated with providers feel-
Republic of)
ing responsible for ensuring ACP conversations took place
The disclosure of a terminal illness is a significant issue in
(p<.001 for each variable). At the provider level, providers
terms of protecting the patients autonomy and right to know
who had more negative beliefs about ACP were less likely
at the end of life. However, in Korea, families are informed of
to judge residents in need of ACP by -0.68 points (based on
the patients condition instead of the patients, and they make
a 19 scale, with standard deviation=2.21, and CI -1.05,
medical decisions for the patients as their proxies. Therefore,
-0.32, p<.001) and to feel responsible (-0.79 same scale
it is vital to know patients preferences regarding the disclo-
with standard deviation=2.34, CI -1.24, -0.34, p=.001).
sure of terminal illness.
Self-efficacy did not have a significant impact on judg-
Method: Disclosure preferences regarding terminal ill-
ments of need (estimate=0.28, CI -0.08, 0.65, p=.13), but
nesses and factors related to disclosure preferences among
did significantly impact judgments of responsibility (esti-
the older adults were investigated utilizing survey. The par-
mate=0.80, CI 0.38, 1.23, p<.001). In conclusion, both
ticipants were 183 community-dwelling older adults in Seoul,
negative beliefs about ACP and confidence in ones ability
South Korea. Disclosure preference regarding terminal illness
to conduct ACP discussions were associated with profes-
was measured by a questionnaire specifically developed for
sional judgments regarding ACP. The findings illustrate
this study. The questionnaires also incorporated the Family
the importance of addressing negative beliefs and increas-
APGAR score and the Information Seeking Preference Index.
ing provider ACP self-efficacy through education and
Finding: One hundred one participants (58.4%) would
policies.
want to be told of their terminal illness, whereas 72 partici-
pants (42.6%) would not want to be told. Older age and
higher education were significantly associated with the

IAGG 2017 World Congress

656
disclosure of terminal illness. Higher Family APGAR score
and a higher Information Seeking Preference Index score
were also significantly related to the disclosure. A logistic
regression analysis revealed that the Information Seeking
Preference Index score was a significant predictor after con-
trolling for age, education, and the Family APGAR score
(R^2 =.352, p < .001).
Conclusion: Health care providers should assess their
patients preferences to be told medical information and
should provide appropriate information based on each
patients individual preference.
SPEAKING FROM THE HEART: THE CHANGING
GOALS OF HEART FAILURE PATIENTS IN THE LAST
YEARS OF LIFE
S.Schellinger, E.W.Anderson, M.Frazer, S.Curran,
K.Fernstrom, Allina Health, Minneapolis, Minnesota
Heart failure is the most common admission diagnosis for
older adults, with a one-month mortality rate of 11% and a
30% readmission rate. It is a condition that afflicts the whole
person and burdens families over years. Knowing the goals
and wishes of persons with serious illness is essential for indi-
vidualizing care. This study aims to understand the evolution
of medical and nonmedical serious illness goals by asking
advanced heart failure patients to describe what is most
important to them. As part of LifeCourse, patients received
monthly in-person visits by a lay health care worker, called
a care guide. Care guides promoted whole-person, family-
oriented care using assessment tools, whole-person and goals
of care questions, and advance care planning discussions.
Patients self-defined goals were documented in the medical
record. We examined the medical records of 30 heart failure
patients who received supportive care up to 920days before
death. A qualitative analysis of the medical record data
affirmed goals evolved over the illness experience. Goals that
originally focused on physical (66%) acquired psycho-social,
emotional, and spiritual facets as patients came closer to end
of life. Non-medical goals (27%) occurred in the middle of
the illness experience. An emotional or psychological element
was often (80%) attached to goals. Family/caregiver goals
(26%) and aspirational goal statements (13%) appeared con-
sistently throughout the study period. The dynamic nature of
serious illness requires ongoing goals of care discussions to
promote collaborative decision making that allows for indi-
vidualized care and a whole person experience.
THE RELATIONSHIP BETWEEN DISEASE
BURDEN, CARE SETTING, AND LIFE-SUSTAINING
TREATMENT CHOICES
E.Chen1, C.T.Pu2, J.Ragland2, J.Schwartz2, M.Fairbanks2,
J.E.Mutchler1, 1. University of Massachusetts, Boston,
Massachusetts, 2. Partners HealthCare, Boston,
Massachusetts
Over 70% of the U.S.population is expected to die from
advanced chronic illness. We hypothesized that high illness
burden, measured by the number and severity of comorbidi-
ties and patient age (Charlson Score), leads to low odds for
choosing aggressive life-sustaining treatments.
Life-sustaining treatment preferences were collected
from 593 Physician (or Medical) Orders for Life-Sustaining
Innovation in Aging, 2017, Vol. 1, No. S1
Treatment forms (MOLST) at three hospitals. Logistic regres-
sion models were used to estimate the odds for choosing All
Treatment (aggressive) vs. Limitations to Life-sustaining
Treatments for patients with Charlson>5 (vs. 5), control-
ling for decision-maker (patient/proxy), care setting (with/
without a palliative care practice; MD/PA/NP), and patient
demographics.
Over one-third (36%) chose All Treatment. Mean
Charlson Score was 8 (SD=3). Proxy decision-makers signed
43% of the forms. Mean patient age was 71 (SD=15); 49%
were male; and 83% were non-Hispanic White. Palliative
care clinicians administered 50%, and both non-palliative
and palliative MDs administered 52% of the MOLSTs.
Patients with Charlson>5 were 70% (OR=0.31;
p0.001) less likely to choose All Treatment than those with
Charlson5, when controlling for only patient characteristics
(pseudo R2=0.148; p0.001). Adding care-setting variables
showed that Charlson>5 still reduced the odds for choos-
ing All Treatment. However, the participation of palliative
care clinicians attenuated the magnitude of the relationship
between illness burden and life-sustaining treatment prefer-
ences (OR=0.54; p0.10) (pseudo R2=0.431; p0.001).
These results support our hypothesis that high illness
burden is negatively associated with preferences for All Life-
sustaining Treatments, but results also point to the strong
influence of palliative care clinicians in these decisions.
SESSION 3075 (SYMPOSIUM)
UNREGULATED CARE PROVIDERS (CARE AIDES) IN
NURSING HOMESA RESOURCE FOR QUALITY OF
CARE
Chair: M.Hoben, University of Alberta
Co-Chair: J.Holroyd-Leduc, University of Calgary
Translating Research in Elder Care (TREC) is a longitu-
dinal program (20072022) of applied research, involving
>40 investigators and decision makers from across Canada.
TRECs aims are to find practical solutions that contribute
to sustainable improvements in quality of care and life of
frail older nursing home residents, and quality of worklife of
their payed care providers. Unregulated care providers with
little formal training (are aides) provide up to 80% of direct
care in nursing homes, and are therefore a critical resource
for quality of care. However, little research has focused on
this provider group, and our understanding of their situa-
tion and how to best use this largely untapped resource to
make improvements is limited. Therefore, care aides are an
important research focus in TREC. In this symposium we
will first give an overview of the TREC research program.
We will specifically present findings on care aides quality of
worklife and best practice use, and the association of care
aides work environment (i.e., care unit work context) with
these outcomes. We will then present specific findings on care
aides physical and mental health. The third presentation will
focus on pain in nursing home residents. Furthermore, we
will present two ongoing cluster randomized intervention
studies, in which care aides and their leaders are systemati-
cally targeted in order to improve quality of care, life and
worklife on nursing home care units.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
THE TRANSLATING RESEARCH IN ELDER CARE
(TREC) PROGRAM: AN INTRODUCTION
P.G.Norton2, M.Doupe3, M.Hoben1, J.Holroyd-
Leduc2, J.A.Knopp-Sihota4, A.Wagg1, C.A.Estabrooks1,
1. University of Alberta, Edmonton, Alberta, Canada,
2. University of Calgary, Calgary, Alberta, Canada, 3.
University of Manitoba, Winnipeg, Manitoba, Canada, 4.
Athabaska University, Athabasca, Alberta, Canada
The core of the TREC research program is the TREC
Measurement System (TMS): a longitudinal, representative
study in urban nursing homes in Western Canada, using
staff surveys and resident data (RAI-MDS 2.0) to moni-
tor, examine and modify factors influencing organizational
context, staff health/well-being, and care quality. TMS data
provides outcome data for TREC implementation studies:
two randomized trials (both of which will be presented in
this symposium), a Social Network Analysis (SNA) to iden-
tify advice seeking networks among nursing homes in the
eight Western and Atlantic provinces and the three Northern
Territories, System Projects addressing stakeholder needs at
various levels related to care of residents, and trainee pro-
jects. Important findings of TREC are that 1)work context
influences provider and resident outcomes, 2)the care unit is
a critical level at which to monitor data over time and tar-
get interventions, and 3)care aides are key to performance
improvement.
PHYSICAL AND MENTAL HEALTH STATUS OF
CANADIAN NURSING HOME CARE AIDES
J.A.Knopp-Sihota1,2, M.Hoben2, J.E.Squires3,
G.Cummings2, P.G.Norton4, C.A.Estabrooks2, 1. Faculty
of Health Disciplines, Athabasca University, Edmonton,
Alberta, Canada, 2. University of Alberta, Edmonton,
Alberta, Canada, 3. University of Ottawa, Ottawa, Ontario,
Canada, 4. University of Calgary, Calgary, Alberta, Canada
Care aides work long hours providing care to an increas-
ingly complex nursing home population. Because of related
stresses, workers are at greater risk for health problems (e.g.,
burnout). The SF-8, an abbreviated version of the original
SF-36, is a psychometrically sound self-report survey used
to evaluate physical and mental health status.
This observational study utilized data collected in
2009/2010 in the TREC Measurement System (TMS) sur-
vey to describe the health status of 1,367 care aides within
a representative sample of 30 urban nursing homes. The
majority of care aides were middle aged and female. When
compared to the general US and Canadian population, care
aides reported on average similar mental and physical health
status. This is the first study reporting normative SF-8 data
for Canadian health care providers. Normative data are fun-
damental when comparing group or individual scores and
can be used in other studies.
END-OF-LIFE PAIN FOR NURSING HOME
RESIDENTS: THE ROLE OF HEALTHCARE AIDES AND
CONTEXTUAL FACTORS
M.Doupe1, G.Thompson1, C.Reid2, J.Baumbusch2,
J.A.Knopp-Sihota3, 1. University of Manitoba, Winnipeg,
Manitoba, Canada, 2. University of British Columbia,
Kelowna, British Columbia, Canada, 3. Athabaska
University, Edmonton, Alberta, Canada
IAGG 2017 World Congress
657
Pain management is a hallmark of quality end-of-life
care. This presentation will define pain trajectories in nursing
home (NH) residents last six months of life, and show how
these trajectories are influenced by health care aides (HCAs)
and their working environment.
This observational study utilizes the RAI-Minimum Data
Set (MDS) linked to the TREC Measurement System (TMS)
survey. MDS provides resident-level longitudinal data on
pain plus various clinical measures. TMS captures point-in-
time metrics on HCA supply, their characteristics (e.g., time
rushed, feelings of empowerment) and their working envi-
ronment (e.g., team leadership, care culture). Data are availa-
ble on a representative sample of NHs from Western Canada.
Data were analyzed on 982 residents in their last six
months of life. Pain levels were negligible for 60.6% of
residents during this time, and increased substantially or
remained high for 34.4%. The effect of HCAs and contex-
tual factors on these pain trajectories is discussed.
SAFER CARE FOR OLDER PERSONS IN RESIDENTIAL
ENVIRONMENTS (SCOPE)
A.Wagg1, J.A.Knopp-Sihota1, P.G.Norton1, M.Doupe2,
C.A.Estabrooks1, 1. University of Alberta, Edmonton,
Alberta, Canada, 2. University of Manitoba, Winnipeg,
Manitoba, Canada
The majority of direct care in Canadian nursing homes is
provided by care aides. This body of unregulated, variably
trained staff is rarely encouraged to lead in quality improve-
ment initiatives. SCOPE is a controlled, cluster randomised
study which examines the effect of engaging and empower-
ing care aide led teams to effect system change at the clinical
unit level. This report presents the barriers and facilitators
to successful operation of the intervention in the first seven
intervention sites in a fully powered study. Pitfalls in fidelity
monitoring will be discussed with regard to unit, leader, qual-
ity improvement team and researcher experiences.
IMPROVING NURSING HOME CARE THROUGH
FEEDBACK ON PERFORMANCE DATA (INFORM)
M.Hoben1, L.R.Ginsburg2, P.G.Norton3, A.Wagg1,
C.A.Estabrooks1, 1. University of Alberta, Edmonton,
Alberta, Canada, 2. York University, Toronto, Ontario,
Canada, 3. University of Calgary, Calgary, Alberta, Canada
INFORM is a 3.5-year pragmatic, cluster-randomized trial
to systematically evaluate the effectiveness of three feedback
strategies (standard feedback, and two assisted, goal-directed
strategies) for improving performance within nursing home
care units. Methods and results of international audit/feed-
back studies are heterogeneous. They have been criticized for
a lack of systematic use of theory, and a lack of head-to-
head comparisons of different feedback strategies. INFORM
is based on theory (audit/feedback, goal setting, complex
adaptive systems). Interventions target care unit managerial
teams. We randomized 67 Western Canadian nursing homes
with 203 care units to the three study arms: Primary out-
come is the increased number of Formal Interactions (e.g.,
resident rounds or family conferences) involving care aides.
We will present methods of INFORM and results of the ini-
tial Goal Setting Workshops. Participants were able to set
performance goals and tailor improvement strategies to
658
identified barriers/facilitators, and participants found attend-
ing the workshops beneficial.
SESSION 3080 (SYMPOSIUM)
INTERNATIONAL, PRAGMATIC, AND MULTISITE
TRIALS: DESIGN, IMPLEMENTATION AND ETHICAL
CONSIDERATIONS
Chair: T.Travison, Beth Israel Deaconess Medical Center,
Boston, Massachusetts
Co-Chair: H.Allore, Yale University, New Haven,
Connecticut
Discussant: M.Tai-Seale, Palo Alto Medical Foundation
Research Institute, Palo Alto, California
Recent work drawing a clearer distinction between
explanatory clinical trials (concerned with the estimation
of causal effects) and pragmatic trials (focused on selection
between therapeutic strategies) illuminates the interplay
between internal validity and the generalizability of quan-
titative results. In gerontology and geriatrics, these tensions
present a particular challenge, as there is often a dramatic
contrast between those individuals eligible to enroll in inter-
vention trials and the more diverse older patient populations
to which conclusions would ideally apply.
In practice, large multisite trials are often designed with
both explanatory and pragmatic considerations in mind.
Therefore, flexible methodologies are required to insure valid
design while bolstering the generalizability of results. In this
symposium, we provide a series of international perspectives
on modern approaches to participant recruitment and reten-
tion, randomization, statistical analysis, and research ethics
in the context of complex sampling populations and flex-
ible research designs. We focus in particular on scenarios
in which clustered sampling of older participants is neces-
sary, either because of the nature of the intervention (e.g. a
change in clinical practices) or the population under study
(e.g. where patient subgroups are nested within geographic
regions). We then consider the ethical implications of enroll-
ment of older subjects in complex trials with pragmatic foci,
for which foundational principles may differ from those of
conventional explanatory trials. Finally, we discuss a frame-
work guiding the interplay between trial design, best sta-
tistical practices, and the ethical conduct of interventional
research, and consider the application of these designs to
research within differing healthcare systems.
RECRUITING OLDER PEOPLE AT NUTRITIONAL
RISK FOR CLINICAL TRIALS: WHAT HAVE WE
LEARNED?
V.Naganathan3, C.Piantadosi1, I.Chapman1, P.Hunter2,
I.Cameron3, R.Visvanathan1, 1. University of Adelaide,
Adelaide, South Australia, Australia, 2. Alfred Health,
Caulfield, Victoria, Australia, 3. University of Sydney,
Sydney, New South Wales, Australia
There is limited information about effective ways to screen
and recruit older people into trials, and the reasons for their
reluctance to enroll. This presentation examines recruitment
efforts for a community-based randomized clinical trial that
targeted undernourished men and women, aged 65years in
three Australian cities. Participants were allocated to either
Innovation in Aging, 2017, Vol. 1, No. S1
oral testosterone and high calorie oral nutritional supple-
ment or placebo medication and low calorie oral nutritional
supplementation. 4023 potential participants were identified
and 767 were screened by a variety of methods: hospital note
screening, referrals from geriatric health services, advertis-
ing and media segments/appearances. 53 participants (7%
of total screened) were recruited. The majority of potentially
eligible participants declined participation in the trial after
reading the information sheet. Media was the more success-
ful method of recruiting, whereas contacting people identi-
fied by screening a large number of hospital records was not
successful in recruiting any participants.
PARTICIPANT RANDOMIZATION IN COMPLEX
TRIAL DESIGNS
T.Travison1, D.Esserman3, E.Greene3, H.Allore2, 1. Beth
Israel Deaconess Medical Center, Boston, Massachusetts, 2.
Yale School of Medicine, New Haven, Connecticut, 3. Yale
School of Public Health, New Haven, Connecticut
Clinical trial design entails specific challenges when the
intervention is applied to groups of individuals, requiring
them to be randomized together (as a cluster). Although the
number of participants may be high, there may be few clus-
ters, and thus simple randomization may lead to imbalances
between the randomized groups. To insure statistical power
and validity, one must consider the potential for these imbal-
ances, as well as the between-cluster variation in number of
eligible participants and the intra-cluster correlation in out-
comes. Some of these cannot be known at design time. Where
additional complexities are inherent to the sampling frame
(e.g. multi-level correlation in nested samples) or the experi-
mental design (e.g. crossover in the stepped wedge), rand-
omization entails additional corresponding challenges. This
presentation will detail implications for participant alloca-
tion of trials of cluster-level interventions for older adults,
review existing and novel computational and software tools
that facilitate design of complex multisite trials.
ANALYSIS OF TRIALS WITH MULTI-LEVEL
CLUSTERING, RECURRENT EVENTS AND
COMPETING RISKS
H.Allore1, T.Jung2, D.Esserman2, P.N.Peduzzi2, 1. Yale
School of Medicine, New Haven, Connecticut, 2. Yale
School of Public Health, New Haven, Connecticut
Oftentimes participants in randomized trials are clustered at
multiple levels. For instance, they may be grouped in practices,
which in turn are grouped within hospitals within healthcare
systems. The complex hierarchical relationships introduced
within resulting data structures must be acknowledged in data
analyses to insure valid estimation of treatment effects.
When such trials are conducted among older individuals,
additional complexities may present themselves, as in the
case when death or other competing risks preclude observa-
tion of clinical endpoints. When the outcome of interest is
a potentially recurrent event, such as fall or hospitalization,
there may be interest in understanding the rates of both inci-
dence and recurrence, but existing methods are inadequate to
estimate them in this setting. In this presentation, we propose
a novel analytic approach for estimation of treatment effects
for time-to-event endpoints in the presence of multilevel clus-
tering and competing risks.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
PRAGMATIC COMPARATIVE EFFECTIVENESS
TRIALS: INTERPLAY BETWEEN DESIGN AND ETHICS
M.Taljaard, University of Ottawa, Ottawa, Ontario,
Canada
Pragmatic RCTs comparing effectiveness of treatments
integrated in usual care can reduce variations in care, improve
uptake of evidence-based practice, reduce costs and improve
patient outcomes. Novel designs such as cluster crossover and
stepped wedge cluster RCTs can detect small but important
differences at population-level. However, these trials raise
important methodological and ethical issues. Existing ethical
frameworks were developed primarily for trials focusing on
efficacy of experimental treatments for marketing approval.
Common elements include tightly controlled conditions
with individual patient recruitment, randomization and fol-
low-up. This talk will address the importance of pragmatic
comparative effectiveness trials as a tool to support decision-
making by patients, clinicians and policymakers. Using a case
study of a cluster RCT allocating nursing homes to high dose
versus standard dose influenza vaccine, it will address the
interplay between ethics and statistical design by reviewing
alternative design choices and their implications for trial fea-
sibility, generalizability, and validity.
ETHICAL CHALLENGES IN PRAGMATIC
COMPARATIVE EFFECTIVENESS TRIALS
C.Weijer, University of Western Ontario, London, Ontario,
Canada
Pragmatic RCTs raise ethical issues that have not yet been
adequately addressed. Consider a trial allocating nursing
homes to high dose versus standard dose influenza vaccine:
if designed as an individual patient RCT, informed consent
would need to be sought for randomization, intervention
and outcome assessment; but if treatments are implemented
institution-wide as a policy intervention, is it acceptable to
proceed without patient consent? Do patients need to be
informed about the trial and if so, how? Some reject the
research-practice distinction by advocating that low or no-
risk pragmatic RCTs do not require more stringent oversight
than clinical practice. Modifications to traditional consent
models have been proposed, but it is unclear if they ade-
quately protect patients rights. The lack of adequate ethi-
cal guidance for pragmatic RCTs presents a practical threat
to the conduct of socially valuable research. If important
research is to proceed, novel guidance is required.
SESSION 3085 (PAPER)
FACTORS AFFECTING DEMENTIA RISK AND
BEHAVIORAL SYMPTOMS
MALNUTRITION ARISK FACTOR OF MORTALITY
IN HOSPITALIZED ADULTS WITH DEMENTIA IN
THE UNITED STATES
E.W.Gonzalez1, J.Slaughter1, R.Di Maria-Ghalili1,
P.Abeysekara1, H.Resnick2, P.Guenter3, 1. Drexel
University, Philadelphia, Pennsylvania, 2. NIA/NIH,
Washington, District of Columbia, 3. American Society of
Parenteral & Enteral Nutrition, Springfield, Maryland
IAGG 2017 World Congress
659
Background: As people live longer, the prevalence of
chronic illness including dementia has become a public
health concern. Although studies have found persons with
dementia (PWD) are at risk for malnutrition little is known
about the mortality risk among hospitalized PWD. This
study examined the relationship between malnutrition and
mortality among PWD.
Methods: Data are from the 2010 Nationwide Inpatient
Sample (NIS), a nationally representative sample of dis-
charges from community hospitals in the United States. The
sample was restricted to inpatients 65years with a primary
or secondary diagnosis of dementia. Logistic regression was
used to calculate d unadjusted and adjusted odds ratios (OR)
and 95% confidence intervals (CI).
Results: Among PWD, the mean age was 83.2 (SE=0.06)
years, 62.8% female, and 76% white. The majority of PWD
were admitted from their homes. The prevalence of malnutri-
tion was 12.2% (95% CI: 11.712.7) and in-hospital mortality
was 4.8% (95% CI: 4.65.0). When stratified by malnutrition,
mortality was 7.8% (95% CI: 7.48.2) for patients malnu-
trition versus 4.4% (95% CI: 4.24.5) for patient without
malnutrition. Unadjusted results showed malnutrition to be
significantly associated with in-hospital mortality (OR=1.86,
95%CI:1.771.96). After adjusting for demographics, point
of origin, chronic conditions and comorbidities, and receipt
of parenteral or enteral nutrition, the likelihood of mortality
for PWD was 39% greater for those with a malnutrition com-
pared to those without malnutrition.
Conclusions: The findings highlight the need to recognize
nutritional risk for PWD living at home. PWD diagnosed
with malnutrition are at risk of mortality.
SLEEP EARLIER IN LIFE AND LATE-LIFE DEMENTIA:
MULTI-CENTER POPULATION DATA FROM SWEDEN
AND FINLAND
S.Sindi1,2, L.M.Johansson3, J.Skoog3, L.Sjberg1,2,
H.Wang1,2, I.Skoog3, M.Kivipelto1,2,4, I.Kreholt1,5, 1.
Aging Research Center, Karolinska Institutet and Stockholm
University, Stockholm, Sweden, 2. Karolinska Institutet
Center for Alzheimer Research, Stockholm, Sweden, 3.
Institute of Neuroscience and Physiology, Center for Health
and Ageing AGECAP, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden, 4. Institute of Clinical
Medicine, University of Eastern Finland, Kuopio, Sweden,
5. Institute of Gerontology, School of Health and Welfare,
Jnkping University, Jnkping, Sweden
Sleep disturbances commonly follow the onset of demen-
tia. However, few longitudinal studies have assessed how
sleep disturbances can increase dementia risk. The current
study examines the association between sleep disturbances
and dementia using population-based data.
In three population-based studies (two Swedish, one
Finnish), general questions were administered about sleep
quality, reduced sleep hours and terminal insomnia. The
short-term follow-up analyses (910 years follow-up time)
used all three studies (N=1446). Mean baseline ages in the
three datasets were 70, 70, and 84 years. The long follow-
up analyses used the Finnish dataset with 22 and 32 years
follow-up (N=759) and mean age was 50years.
660
We performed binary logistic and hazard regressions for
the associations between sleep and dementia. The following
potential baseline confounders were adjusted for: Data mate-
rial, follow-up time, baseline age, sex, years of education
(linear), alcohol consumption (linear), presently smoking,
physically active, cohabitation, cardiovascular conditions,
hypnotics (yes/no), APOE4 allele (for short follow-up data)
and hopelessness.
Short follow-up results showed significant associations
in all models between terminal insomnia and a higher like-
lihood of dementia (fully adjusted model using all covari-
ates, (odds ratio (OR)=1.94, p=0.027). No associations were
found between reduced sleep and dementia (OR=0.99). Long
follow-up results (Finnish data) showed that insomnia was
associated with a higher risk for dementia (fully adjusted
hazard ratio=1.24 p=0.030).
In conclusion, more severe insomnia earlier in life is asso-
ciated with a higher risk of late-life dementia. Individuals
with sleep disturbances may benefit from interventions to
improve sleep.
PAIN INTERFERENCE AND DEPRESSIVE SYMPTOMS
IN ALZHEIMERS DISEASE: APILOT STUDY
J.Wang1, M.S.Dietrich1,2, S.F.Simmons3, R.L.Cowan2,4,
T.Monroe1,2,4, 1. Vanderbilt University School of Nursing,
Nashville, Tennessee, 2. Vanderbilt University School of
Medicine, Nashville, Tennessee, 3. Center for Quality Aging,
Vanderbilt University Medical Center, Nashville, Tennessee,
4. Department of Psychiatry and Behavioral Sciences,
Vanderbilt University School of Medicine, Nashville,
Tennessee
There were five million older adults in the U.S.with AD
in 2015; 4386% of those with AD report regular pain.
Yet, little is known about the degree to which pain inter-
feres with everyday activities in this population. We con-
ducted a cross-sectional, secondary analysis of data from
52 older (65) communicative adults with AD who were
free from chronic pain. Instruments included the Mini
Mental State Exam (MMSE, cognitive function), Brief Pain
Inventory Short Form (BPISF, pain interference score) and
the Geriatric Depressive Scale (GDS-15, depressive symp-
tomology). Median BPI score was 0.0 with a range from
0 to 8. Reports of pain interference with specific activi-
ties included general activity (13.5%), mood (13.5%),
walking ability (13.5%), normal work (11.5%), enjoy-
ment of life (11.5%), relations with other people (9.6%),
and sleep (9.6%). Average MMSE was 18.5 (SD=5.1),
indicating moderate cognitive impairment. Median GDS
score was 2.0 (IQR=16). There were statistically signifi-
cant associations of pain interference with both cognitive
function (rs=0.46, p=0.001) and depressive symptomol-
ogy (rs=0.45, p=0.001), indicating that greater perceived
pain interference was related to better cognitive function
and more depressive symptoms. Our findings showed that
the association of pain interference with cognitive impair-
ment and depression may place older adults at risk for
under-management and unnecessary suffering. Due to the
disabling impact of pain interference on everyday activi-
ties, assessment of pain interference should be incorpo-
rated into routine clinical practice to better manage pain.
Innovation in Aging, 2017, Vol. 1, No. S1
Accurate assessment of pain interference can also help
identify older adults at high-risk for depression.
SESSION 3090 (SYMPOSIUM)
A BIOBEHAVIORAL APPROACH TO HEALTH IN
MIDLIFE AND OLDER AGES
Chair: H.R.Collins-Farmer, Pennsylvania State University
Co-Chair: A.Thierry, The Pennsylvania State University
Discussant: L.A.Wray, Pennsylvania State University
This symposium is intended to incorporate a biobehav-
ioral approach to understanding the biological mechanisms
that may underlie patterns of health in midlife and older
ages. Psychosocial and behavioral factors are related to
health status, but less is known about the biological mani-
festations of these factors and how they are linked to the
development of health problems. Current research suggests
that they may lead to physiological dysregulation, a precur-
sor to morbidity and mortality. The research presented in this
symposium will focus on the associations among biological
mechanisms, health status, social status, and psychosocial
experience using data from the nationally representative
Health and Retirement Study. First, Amy Thierry will discuss
the links between the development of different measures of
physical disability and telomere length, a biomarker associ-
ated with biological aging. The next two talks will examine
the link between social status, health and C-reactive protein
(CRP), which is an indicator of systemic inflammation. CRP
has been linked to cardiometabolic problems and mortality.
Heather Collins-Farmer will illustrate the complex relation-
ships of race and all-cause mortality, by focusing on the ways
that education, everyday discrimination, and CRP explain
racial disparities in mortality. Finally, Marina Armendariz
will explore the Hispanic paradox and test whether Mexican-
Americans and those who were foreign-born have lower
circulating CRP levels compared to their U.S.-born counter-
parts. After attending this session, participants will have a
greater understanding of the roles that social status, behav-
ior, and health status can influence physiological function-
ing, and thus, morbidity and mortality, in midlife and older
ages.
IS TELOMERE LENGTH ASSOCIATED WITH
PHYSICAL DISABILITY IN U.S. MIDLIFE AND OLDER
ADULTS?
A.Thierry, I.Shalev, L.A.Wray, The Pennsylvania State
University, University Park, Pennsylvania
Telomere length, a biomarker of accumulated cellular
damage and physiological dysregulation, is negatively associ-
ated with risk of developing disabling conditions in older age.
However, little is known about the telomere length-physical
disability relationship. Using Health and Retirement Study
data collected in 20082014, linear regression models tested
the association between baseline telomere length and change
in number of functional limitations, activities of daily living
(ADLs), and instrumental activities of daily living (IADLs)
in a diverse, nationally representative sample of US adults
>50 years of age (n=4,085). In participants 65 (n=2,602),
those with shorter telomeres accumulated more disabilities
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
over time, even after including demographic, socioeconomic,
and health status variables (b=-1.314, SE=0.50, p<0.05). This
relationship was driven by accumulation of functional limi-
tations, and not ADLs or IADLs, in this age group. Because
telomere length was associated with disability development,
future research should further examine biobehavioral mech-
anisms implicated in this complex process.
AN EXAMINATION OF THE BIOPSYCHOSOCIAL
MECHANISMS LINKING RACE TO ALL-CAUSE
MORTALITY
H.R.Collins-Farmer, L.A.Wray, Pennsylvania State
University, University Park, Pennsylvania
The protective and negative experiences of education and
discrimination may contribute to Blacks elevated mortal-
ity rates. C-reactive protein (CRP), linked to chronic stress
and mortality, may explain this disparity. Core, biomarker,
and leave-behind data from 2006 and 2008 were pooled
from the Health and Retirement Study, a nationally repre-
sentative sample of middle-aged and older adults, and Cox
proportional hazard models were used to examine the rela-
tionship between race, education, everyday discrimination,
CRP, and mortality in 2014. In the sample of 9,168 respond-
ents, 11.30% died at follow-up. Race was associated with
increased mortality (HR=1.45, p .001), and was reduced
to non-significance after controlling for education, everyday
discrimination, and CRP. Everyday discrimination explained
8% of the association between race and mortality, CRP
explained 5%, and education reduced the association to non-
significance. The relationship between race and mortality is
complex: inequalities in social status and stress exposure
may drive mortality.
EXAMINING THE HISPANIC PARADOX IN
C-REACTIVE PROTEIN (CRP) IN MIDDLE-AGED AND
OLDER AMERICANS
M.Armendariz, H.R.Collins-Farmer, A.Thierry, L.A.Wray, OF DEMENTIA CLIENTS: AFEASIBILITY AND
Biobehavioral Health, Pennsylvania State University,
University Park, Pennsylvania
Although the Hispanic Paradox indicates that Hispanics
health is comparable to non-Hispanic Whites, empirical data
suggest this paradox may not exist in biological health pro-
files. This study examines the Hispanic Paradox in C-reactive
protein (CRP), a biological indicator of inflammation. Data
were pooled from the 2006 and 2008 core and biomarker
waves of the Health and Retirement Study, a nationally
representative study of middle-aged and older Americans.
Multiple regression analyses tested the relationship between
adults of Mexican origin (n=727) and CRP, net of the effects
of immigrant status and survey language preference. Mexican
Americans had higher CRP levels than Whites, controlling
for age and sex (=.06, p<.01); however, when both immi-
gration status and language preference were controlled, the
association between being Mexican American and CRP was
reduced to non-significance (=.04, p>.05). Future research
should fully investigate how biological, social and behavioral
factors link Mexican origin to higher CRP.
IAGG 2017 World Congress
661
SESSION 3095 (PAPER)
PHYSICAL ACTIVITY AND HEALTH
ACUTE EFFECT OF DIFFERENT TYPES OF EXERCISE
ON BLOOD PRESSURE OF HYPERTENSIVE OLDER
WOMEN
G.O.Campos, R.F.Bertani, J.C.Moriguti, E.Ferriolli,
N.K.Lima, Ribeiro Preto Medical School - University of
So Paulo, Ribeirao Preto, Sao Paulo, Brazil
Heart disease is the leading cause of deaths worldwide.
Systemic arterial hypertension contributes to raising the risk
of cardiovascular events. In older women the incidence of
hypertension is higher compared to men. The role of exer-
cise in the prevention and treatment of hypertension is
undeniable, however, the best mode has not been set. The
present study investigated the hemodynamic responses
of systolic blood pressure (BP) of 30 elderly hypertensive
women under drug therapy, subjected to continuous aero-
bic exercise (CAE), interval aerobic exercise (IAE), resistance
exercise (RE) and control (C) with a minimum interval of
7 days, in random order, with the same intensity. Systolic
BP measurements were obtained before and immediately
after the sessions by the oscillometric method, and 24-hour
ambulatory blood pressure monitoring (24-h ABPM) was
performed in 4 groups. The data were analyzed by mixed-
effects model. It was observed a decrease in systolic BP in the
CAE (12317mmHg to 11619mmHg, p <0.001), in the
IAE (12216 to 11216mmHg, p <0.001), with no imme-
diate change in ER. In the 24-h ABPM was observed lower
systolic BP in IAE than in CAE (<0.001). The hypotensive
effect of IAE session is larger and longer than CAE session,
suggesting that the change in intensity over time of exercise
can influence the magnitude of the systolic BP fall in hyper-
tensive older women.
EFFECT OF KINECT TAI CHI ON OVERALL HEALTH
USABILITY STUDY
N.Neubauer, V.Fernandez, L.Liu, E.Stroulia, University of
Alberta, Edmonton, Alberta, Canada
The prevalence of dementia is increasing worldwide.
Dementia clients experience an increased risk for depression
and physical inactivity. Tai Chi can enhance the physical and
mental health of healthy older adults, including persons with
dementia. However, programs tailored for dementia clients
are scarce and barriers, such as transportation and accessibil-
ity, further limit participation in Tai Chi. The purpose of this
pilot study was to evaluate the usability of a home Kinect-
based Tai Chi system (K-TaiChi), and to determine its effect
on perceived physical and mental health of dementia clients
in preparation for a large-scale study. Using a serious-games
methodology, K-TaiChi was developed to guide dementia cli-
ents through postures and movements, recognize features of
their movement, and provide visual feedback and rewards
when movements are performed well. Ten community
dwelling individuals with mild to moderate dementia used
K-TaiChi in their homes three times per week, for six weeks.
662
Focus groups with dementia clients and their caregivers were
conducted to evaluate our systems feasibility and usability.
The Cornell Scale for Depression in Dementia was adminis-
tered pre and post intervention to evaluate its effectiveness
on mental health. The majority of participants successfully
used K-TaiChi. Results revealed improvements in depression
and physical activity levels of those that completed all 18 ses-
sions. Because of its user-friendliness and its effects on activ-
ity levels, depression, and perceived health, K-TaiChi holds
promise for community-residing mild to moderate persons
with dementia who are unable to participate in traditional
Tai Chi programs.
TENACIOUS GOAL PURSUIT AND LIFE-SPACE
MOBILITY AMONG OLDER PEOPLE WITH WALKING
DIFFICULTIES
M.Saajanaho, K.Kokko, M.Rantakokko, E.Portegijs,
J.Eronen, T.Poranen-Clark, T.Rantanen, Health Sciences,
University of Jyvskyl, Muurame, Finland
Life-space mobility, defined as the spatial extent of move-
ment in daily life, is strongly dependent on functional ability.
However, active striving to reach ones goals might inspire
older people to move in a larger life-space regardless of their
physical abilities. We aimed to study whether tenacious goal
pursuit differs according to walking difficulties and whether
it is associated with life-space mobility in old age.
The participants were 186 community-dwelling older
people between 79 and 93years of age from the Life-Space
Mobility and Active Aging study. Life-space mobility was
assessed with the Life-Space Assessment. The Tenacious Goal
Pursuit (TGP) scale was used to assess the tendency to be
persistent in goal pursuit (range 15, higher scores indicate
higher tenaciousness). Linear regression model adjusted for
age, sex, years of education and self-rated health was used in
the analysis. The analysis was stratified based on reporting
vs. not reporting at least minor difficulties in walking two
kilometers.
Participants who reported walking difficulties were less
tenacious in goal pursuit compared to those who did not
report such difficulties (Mean TGP score=3.45, SD=0.80
vs. M=3.71, SD=0.66; p=.018). Furthermore, tenacious
goal pursuit was associated with higher life-space mobility
only among those with walking difficulties (B=5.47, SE 2.6,
p=.040).
This study indicated that tenacious goal pursuit may serve
as a striving force for older people with walking difficulties
to move in a larger life-space. Therefore, tenaciousness may
be a key factor in counteracting the negative influences of
functional decline in old age.
HELPING ELDERS LIVING WITH PAIN (HELP):
ARANDOMIZED CONTROLLED PILOT STUDY
T.You1, E.Ogawa1, S.Thapa1, S.Nagae1, G.Yeh2, one older adults with mild SIVCI were randomly assigned
P.Wayne3, L.Shi1, S.G.Leveille1, 1. University of
Massachusetts Boston, Boston, Massachusetts, 2. Beth
Israel Deaconess Medical Center, Boston, Massachusetts,
3. Brigham and Womens Hospital & Harvard Medical
School, Boston, Massachusetts
Accumulating evidence supports that chronic pain is asso-
ciated with poorer cognitive function and mobility, and fall
risk in older adults. This study investigated the feasibility of a
Innovation in Aging, 2017, Vol. 1, No. S1
randomized controlled trial of a Tai Chi intervention in older
adults with multisite pain who are at risk for falls. Adults
aged 65y with multisite pain ( 2 sites) who reported fall-
ing in the past year or using a cane or walker were recruited
from the Boston area communities through mailed invita-
tions, community flyers, local newspaper and TV ads, and
social media. Participants were randomized to either a light
physical exercise (stretching, walking and weight training)
program or a mind-body exercise (Tai Chi) program, offered
twice weekly for 12 weeks. The primary outcomes were fea-
sibility, acceptability and efficacy of the Tai Chi intervention.
Of the 176 adults screened, 85 were eligible, and 54 enrolled
(average age=758y; 96% white; 76% female). The drop-
out rate was 15% (12% for light physical exercise and 18%
for Tai Chi). For those completing the study, exercise class
attendance rate was 79% (82% for light physical exercise
and 76% for Tai Chi). The main reasons for dropouts and
absences included family obligations, transportation chal-
lenges, difficulty performing Tai Chi movements, muscu-
loskeletal pain, falls, and other health complications. This
study demonstrated the feasibility and acceptability of con-
ducting a larger randomized controlled Tai Chi trial in older
adults with multisite pain and at risk for falls. Data collected
and challenges encountered will inform future research.
(Supported by NIH Grant R21 AG043883)
AEROBIC EXERCISE PROMOTES EXECUTIVE
FUNCTIONING AND ASSOCIATED FUNCTIONAL
NEUROPLASTICITY
C.Hsu1,2,3, J.Best1,2,3, J.C.Davis1,3,4, L.Nagamatsu5,
S.Wang1,2,3, R.G.Hsiung1, M.Voss6, T.Liu-Ambrose1,2,3,
1. Rehabilitation Science, University of British Columbia,
Vancouver, British Columbia, Canada, 2. Aging,
Mobility,and Cognitive Neuroscience Lab, Vancouver,
British Columbia, Canada, 3. Djavad Mowafaghian Center
for Brain Health, Vancouver, British Columbia, Canada,
4. Center for Hip Health and Mobility, Vancouver, British
Columbia, Canada, 5. University of Western Ontario,
London, Ontario, Canada, 6. University of Iowa, Iowa City,
Iowa
Vascular cognitive ischaemia (VCI) is the second most
common type of cognitive dysfunction worldwide and is due
to cerebrovascular disease. While targeted aerobic exercise
is a promising approach to delay the progression of VCI by
reducing cardiometabolic risk factors, few randomized con-
trolled trials to date have specifically assessed the efficacy
of aerobic exercise on cognitive and brain outcomes in this
high-risk group. Thus, the goal of this secondary analysis
study was to examine the effect of moderate-intensity aero-
bic exercise training on executive functions and functional
neural plasticity among older adults with mild subcortical
ischaemic vascular cognitive impairment (SIVCI). Seventy-
to: 1) a 6-month, 3x/week aerobic training (AT; n=36) or
usual care (CON; n=35). This secondary analysis included
21 (mean age 71.5 years) participants; 10 from AT group
and 11 from CON group. All 21 participants completed
functional magnetic resonance imaging (fMRI) sessions at
baseline and trial-completion. During the fMRI sessions,
performance on the Eriksen flanker task and task-evoked
neural activity were assessed. At trial completion, after
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
adjusting for baseline MoCA, baseline total white matter
lesion volume, and baseline performance, compared with
the CON group, the AT group significantly improved flanker
task performance. Moreover, compared with the CON, the
AT group demonstrated reduced activation in the left lateral
occipital cortex and right superior temporal gyrus. Reduced
activity in these brain regions was significantly associated
with improved (i.e., faster) flanker task performance at trial
completion, suggesting aerobic training increased neural effi-
ciency. Thus, aerobic training among older adults with mild
SIVCI can improve executive functions and neural efficiency
of associated brain areas.
SESSION 3100 (SYMPOSIUM)
RELOCATION DECISION MAKING: FACTORS
ASSOCIATED WITH DISPLACEMENT
Chair: K.DiazMoore, University of Utah, Salt Lake City,
Utah
One of the more complex dimensions of the aging expe-
rience is associated with environmental relocation. Not all
relocation is equivalent, but rather the decision-making
process is often quite nuanced. Conceptualizing relocation
decision-making in a coherent yet parsimonious manner
would guide not only future research in this important ger-
ontological topic, but also inform a constellation of interven-
tions to ease place integration. The first presentation extends
Antonuccis Convoy Model of Social Support to the role
material objects in social support and discusses the difficul-
ties associated therein with relocation and downsizing. The
second presentation addresses the confound of disability and
the impact its trajectory has upon relocation decision-mak-
ing as found in Sweden. This is followed by a presentation
that applies the theory of planned behaviour to understand-
ing the appraisals of home modifications by older adults in
the Netherlands. The final presentation explores the role that
connectivity plays in relocation decisions through the lens
of the theory of residential normalcy. The symposium as a
whole illustrates the multidimensional nature of the environ-
mental decision-making at the time of relocation/displace-
ment and illuminates the critical role the environment plays
as a barrier or prosthetic. It enlightens the differences found
in third age versus fourth age moves and how the increas-
ing awareness of the role urban design plays in health out-
comes are likely to increasingly influence decision-making
patterns and it does so involving a variety of international
perspectives.
MOVING THE MATERIAL CONVOY
D.J.Ekerdt, University of Kansas, Lawrence, Kansas
Moving residence calls the question on the entirety of
ones possessions, putting up for evaluation the status and
placement of every object from the all of the homes recesses.
Because elders typically move to smaller quarters, the mate-
rial convoy will need pruning, setting in motion the physi-
cal, cognitive, social and emotional tasks of divestment.
Interviews with 100+ American households within a year
of relocation indicate that moving and downsizing play out
in three basic ways. First, de-accumulation prudently spans
months or years in advance of a move (not the likely course).
IAGG 2017 World Congress
663
Second, downsizing occurs proximate to a move; for good
reasons this is the usual course, but stressful. Third, one
moves and then empties the household afterward, a solution
only if elders can bear the expense of two homes. In practice
downsizing and moving are temporally intertwined, one pre-
ceding the other, precipitating the other, awaiting the other,
interrupting the other.
RESIDENTIAL REASONING IN THE LIGHT OF
DISABILITY IN OLD AGE: HOUSING ADAPTATIONS
CLIENTS IN SWEDEN
M.Granbom1, L.Ekstam1, A.Malmgren-Fnge1,3, 1.
Department of Health Sciences, Lund University, Lund,
Sweden, 3. Department of Community-Public Health, Johns
Hopkins School of Nursing, Baltimore, Maryland
Housing preferences and residential reasoning in later
life are closely related to older peoples present health care
needs and thoughts of the future. For community-living older
people with disabilities in Sweden tax-based housing adapta-
tions (HA) are offered as a strategy to enable aging-in-place.
However, it is not known how the residential reasoning pro-
cess changes for older people undergoing adaptations to their
home. The aim was to explore how thoughts on relocation
and aging in place changes over time for housing adaptation
clients in Sweden. Longitudinal qualitative data from 17 HA
clients and 9 partners were utilized. The results show that the
residential reasoning changed during the housing adaptation
process but were to a large extent influenced by the couples
changing health than the alteration of the home. The find-
ings contribute to empirical knowledge on HA as well as to
the theoretical development on relocation decision-making
in later life.
OLDER HOME OWNERS AWARENESS AND
APPRAISAL OF RESIDENTIAL ENVIRONMENTAL
MODIFICATIONS
D.Lager, A.Brouwer, G.de Kam, E.Kibele, Economic
Geography, University of Groningen, Groningen,
Netherlands
Ageing-in-place policies have been implemented by many
Western governments in order to delay and decrease the reli-
ance on expensive institutionalised care. While such policies,
as well as a large body of research, support the idea that
ageing-in-place contributes to the wellbeing of older adults,
ageing-in-place also has its downsides. Health problems and
physical limitations can pose hazards within residential envi-
ronments, such as falling or house fires. One way of dealing
with incongruences between older persons and their housing
situation is the physical adaptation of the residential envi-
ronment; either through home modifications or relocation.
The Dutch government wants older adults to anticipate on
incongruences in the residential environment by making
timely changes in order to prevent incidents from happening.
However, insight is lacking in older adults awareness and
perception of such modifications as a strategy to age safely
in place and how they view timeliness in this respect. The
objective of this paper is to understand Dutch older home
owners appraisal of residential environmental modifications.
The results of this research are based on a survey and semi-
structured interviews with nine older home owners (aged 55
and above). We use Ajzens theory of planned behaviour as
664
an interpretative framework for the analysis of the results.
The insights provided by this study can provide input for
policy makers and professionals in designing interventions
to raise awareness amongst older adults about the possi-
bilities for and benefits of timely residential environmental
modifications.
AGING IN THE RIGHT PLACE COPING
REPERTOIRES: THE SUBSTITUTABILITY OF
CONNECTIVITY ALTERNATIVES
S.M.Golant, Geography, University of Florida, Gainesville,
Florida
Older people often feel incompetent and out of con-
trol when they cannot easily reach destinations to achieve
their shopping, social, recreational, and health care needs.
Consequently, they have more difficulty aging in place when
they lack easy-to-use transportation options. However, the
availability of traditional auto and transit modes of trans-
portation is becoming a less predictive residential relocation
influence. Rather, the coping repertoires of older people now
include alternative connectivity options such as demand-
responsive auto services like Uber, home-delivered products
and services, elder villages, new urbanism communities, hous-
ing with services, and telemedicine, smart home, and robotic
information and communication technologies. Driverless
cars will be available in the near future. This papers theo-
retical analysis considers the psychological, social, economic,
and political benefits and costs of substituting these connec-
tivity options. Explaining the future aging in the right place
behaviors of older people will require a greater understand-
ing of these tradeoffs.
SESSION 3105 (SYMPOSIUM)
THE MOLECULAR AND ORGANISMAL BASIS OF
RESILIENCE AND FRAILTY
Chair: J.D.Walston, Johns Hopkins University School of
Medicine, Baltimore, Maryland
Co-Chair: M.Fain, University of Arizona
A major goal of global aging research is to prevent frailty
and promote resilience in aging in older adults around the
world. Key to this effort is the identification of physiologi-
cal and molecular etiologies that impact the health and well-
being of older adults. Over the past two decades, increasing
evidence suggests that age and environment related impaired
stress response systems such as the innate immune system
and the renin-angiotensin system, as well as neuroendo-
crine and endocrine system changes help to drive organis-
mal frailty and related vulnerability to chronic diseases and
adverse health outcomes. Maintenance of these same sys-
tems promotes resiliency and robustness. Specific age-related
molecular changes are thought to drive these declines, includ-
ing the development of senescent cell populations, mitochon-
drial dysfunction, and altered autophagy. In this symposium,
speakers will 1) describe the conceptualization of frailty
and resiliency with aging and provide an overview of the
physiological systems thought to be most influential to these
processes, 2) describe the endocrine changes and how they
influence mitochondrial, autophagy, and mTOR pathways,
3)describe the role of cellular senescence to these processes,
Innovation in Aging, 2017, Vol. 1, No. S1
4) review the animal models used for biological discovery
in this area, and 5) outline the novel biological discoveries
from the European FRAILOMICS consortium. At the end
of this symposium, the audience will be able to describe age-
related frailty and resiliency, their biological and physiologi-
cal underpinnings, and the use of animal models and omic
strategies that will further that biological understanding.
CONCEPTUALIZING FRAILTY AND RESILIENCY
AND THEIR PHYSIOLOGICAL BASIS
J.D.Walston, Medicine/Geriatrics, Johns Hopkins
University School of Medicine, Baltimore, Maryland
The prevention of age-related frailty and the promo-
tion of resiliency will depend on more basic biological etio-
logic discovery. The biology that underlies both frailty and
resiliency in older adults is complex and multisystemic and
linked to physiological stress response systems. This session
will provide a brief overview of the conceptualization of
physical frailty and resiliency in both clinical and in research
models and how they have been used for biological discov-
ery. Examples of how the innate immune system, the hypo-
thalamic pituitary adrenal axis, and the renin-angiotensin
system drive frailty and multisystem decline will be provided.
Aconceptual model of how age-related biological changes in
cells and tissues sets the stage for subsequent physiological
change will also be described. This will set the stage for a
subsequent series of talks that will connect age-related cel-
lular and molecular changes back to these physiological sys-
tems and to biologic discovery around frailty and resiliency.
HORMONAL IMPACT ON MEASURES OF FRAILTY
AND RESILIENCE
H.M.Brown-Borg, University of North Dakota School of
Medicine & Health Sciences, Grand Forks, North Dakota
The factors that regulate aging processes are poorly under-
stood however, the endocrine system has been shown to be
a major regulator of aging, age-related disease and lifespan.
The mammalian hormonal system is highly integrated and
impacts metabolism, protein synthesis, stress resistance, and
reproduction among other major physiological processes.
Animals with altered endocrine profiles have been shown to
resist musculoskeletal frailty, cognitive decline, accumulation
of senescent cells, insulin resistance and cancer. The underly-
ing molecular mechanisms responsible for susceptibility or
resistance to this array of aging-related dysfunctional out-
comes will be discussed such as mitochondrial function, sign-
aling through mTOR and autophagy. The positive news is
that genetic, dietary and drug interventions have been shown
to affect these systems and extend health span.
THE POWER OF ANIMAL MODELS TO DISCOVER
THE BIOLOGY OF FRAILTY
L.V.Thompson, Boston University, Boston, Massachusetts
Fighting frailty requires insight into the biological con-
nections between aging, physiological system changes, and
disease states, as well as an understanding of the molecular
and cellular processes underlying each of these contributing
factors. In order to study these processes and connections, the
frailty researchers began developing animal models over the
past decade. The most studied mouse model is the IL-10(tm/
tm) mouse, a model with mild activation of inflammation,
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Innovation in Aging, 2017, Vol. 1, No. S1
which mimics frail humans. Frailty has also been modelled
in naturally aging mice (C57BL/6) using a frailty-phenotype
score, graded by a broad range of performance measures
such as grip strength, walking speed, activity levels, endur-
ance, and body weight. This presentation highlights how
these and other relevant models are forging biological dis-
coveries in the field of frailty.
CONTRIBUTION OF THE FRAILOMIC INITIATIVE
TO THE BIOLOGICAL UNDERSTANDING OF
FRAILTY AND RESILIENCY
L.Rodrguez-Maas, Hospital Universitario de Getafe, Health Care Research.
Getafe, Spain
Frailty is complex in its pathophysiological basis but also
in terms of the prognostic and diagnostic clues it provides us
with. Traditionally, clinical and anthropological characteris-
tics have been used to provide a diagnosis of frailty and an
assessment of a patients overall prognosis. Little attention
has been given to the use of laboratory parameters as bio-
markers that might improve on the discriminative power and
accuracy of the current frailty criteria. Clinical studies have
tended to focus on the association between isolated systems
and/or single biomarkers with frailty scores. This approach
overlooks the complex nature of a syndrome that involves
the concomitant participation of several impaired systems.
FRAILOMIC adopts a unique clinical approach to the study
of frailty. Not only does our study assess the role of sets
of biomarkers that span several systems but it also includes
assessment of the involvement of novel omics (genomics,
proteomics and metabolomics) indicators.
SESSION 3110 (SYMPOSIUM)
AGEING IN CHINA AND AUSTRALIA: SOCIAL,
ECONOMIC, AND HEALTH IMPLICATIONS
Chair: J.Byles, The University of Newcastle, Newcastle,
New South Wales, Australia
Co-Chair: V.Yiengprugsawan, The Australian National
University
Discussant: M.Silverstein, Syracuse University, Syracuse,
New York
Population ageing in China and Australia are presenting
significant challenges and opportunities in both countries in
planning for and adjusting proactively to social and policy
change. Led by a multi-disciplinary team of cross-national
researchers, this Symposium will present comparative find-
ings on determinants of health, productivity, and wellbeing
in the context of each countrys cultural and social structural
context, drawing from a range of large scale studies from
China and Australia, followed by discussion on policy impli-
cations within these contexts.
The panel themes consist of quantitative results and
policy discussion. Based on the Household Income and
Labour Dynamics in Australia (HILDA) survey and the
China Health, Ageing, and Retirement Survey (CHARLS),
Kendig and Gong will present findings on the pattern of car-
egiving, living standards, and life satisfaction; and Nazroo,
Gong, and Kendig will discuss their comparative results on
workforce engagement in later life between the two coun-
tries. Yiengprugsawan, DEste, and Byles will investigate
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665
socio-geographical variations on health and wellbeing based
on the China component of the World Health Organizations
Study on global AGEing and adult health (WHO-SAGE).
Browning, Thomas, Chapman and their Chinese colleagues
including Yang and Zeqi will discuss primary health care
reform in China and the links to Australian approaches with
a specific emphasis on the management of chronic illnesses
in older people.
The Symposium is supported by the Australian Research
Council Centre of Research Excellence in Population Ageing
Research and Shenzhen International Institute for Primary
COMPARATIVE STUDY OF CAREGIVING IN CHINA
AND AUSTRALIA
H.L.Kendig1,2, C.Hong Gong1,2, M.Silverstein3,2, 1. Centre
for Research on Ageing, Health and Wellbeing, Australian
National University, Canberra, ACT, Canberra, Australian
Capital Territory, Australia, 2. ARC Centre of Excellence in
Population Ageing Research (CEPAR), Canberra, Australian
Capital Territory, Australia, 3. Aging Studies Institute,
Syracuse University, Syracuse, New York
Drawing on the nationally representative CHARLS and
HILDA 2013, we examined patterns of caregiving by men
and women aged 45 and over in both China and Australia.
Caregiving is defined as ongoing care for a household or
non-household member with health conditions or frailty in
Australia; and care for parents or grandchildren under 16 in
China.
Ageing Chinese are contributing more caregiving to par-
ents (9%) or grandchildren (30%) although they rarely care
for non-family members or do voluntary work and care rates
varied significantly by age, gender and residence. In Australia
only 13% provided ongoing caregiving (average 18 hours
per week) while 34% did voluntary work. In contrast to
Australia, overall no significant negative impacts of caregiv-
ing were identified for caregivers health, living standards
and life satisfaction in China.
The implications will be discussed for China in develop-
ing its sustainable workforce and aged care systems in con-
trast to Australia.
PAID WORK IN LATER LIFE IN CHINA AND
AUSTRALIA: EVIDENCE FROM CHARLS AND HILDA
J.Nazroo1,3, C.Hong Gong2,3, H.L.Kendig2,3, 1. Cathie
Marsh Institute and Sociology, School of Social Sciences,
The University of Manchester, Manchester, United
Kingdom, 2. Centre for Research on Ageing, Health and
Wellbeing, The Australian National University, Canberra,
Australian Capital Territory, Australia, 3. ARC Centre
of Excellence in Population Ageing Research (CEPAR),
Canberra, Australian Capital Territory, Australia
Drawing on the nationally representative CHARLS 2013
and HILDA 2011 data, we examined patterns of paid work
(including agricultural work) by men and women aged 45 to
64 in both China and Australia.
When compared to Australians, mature aged Chinese had
a slightly smaller proportion in paid work while more also
were informal caregivers. About 68% of the Chinese were
in paid work with significant variation by age, gender, resi-
dence and health. The average working hours for those still
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working was 45 hours per week. Only 11% of the mature
age Chinese with health conditions were still working. In
Australia 71% of the mature age population were working,
dropping to 47% among those with health conditions.
The discussion will consider the varying socio-economic
influences on workforce participation in the two countries;
workplace flexibility and policy directions, and the conse-
quences of paid work on wellbeing and living standards.
GEOGRAPHICAL VARIATIONS IN HEALTH,
DISABILITY, AND ACTIVITIES OF DAILY LIVING
AMONG OLDER CHINESE
V.Yiengprugsawan1,2, C.Deste3, J.Byles2,4, 1. Centre for
Research on Ageing, Health and Wellbeing, Australian
National University, Canberra, Australian Capital Territory,
Australia, 2. ARC Centre of Excellence in Population
Ageing Research (CEPAR), Canberra, Australian Capital
Territory, Australia, 3. National Centre for Epidemiology
and Population Health, The Australian National University,
Canberra, Australian Capital Territory, Australia, 4.
Research Centre for Generational Health and Ageing, The
University of Newcastle, Newcastle, New South Wales,
Australia
The proportion of population ageing in China will grow
significantly in the next few decades but the pace of pop-
ulation ageing and social change vary considerably across
regions. For example, eastern coastal areas are economically
more advanced compared to the western region. These eco-
nomic disparities could result in differing impacts on health.
This presentation will investigate geographical variations
in self-rated health, disability, and limitations in activities of
daily living among national representative samples of Chinese
aged 50years and older (n= 13,396) based on the WHO Study
on global AGEing and adult health (WHO SAGE). Study
areas include Guangdong, Hubei, Jilin, Shaanxi, Shandong,
Shanghai, Yunnan, and Zhejiang. Findings highlight patterns
of adverse health outcomes among older Chinese, especially
in economically disadvantageous areas.
Empirical evidence on such health patterns by socioeco-
nomic development of geographical areas could help inform
policy development and national investment to improve
equity in population health.
PRIMARY HEALTH CARE IN CHINA: ADDRESSING
CHRONIC ILLNESS MANAGEMENT IN OLDER
PEOPLE
C.Browning1,2,3, S.Thomas2,3, H.Yang2,3, Q.Zeqi4,
A.Chapman1,2, 1. RDNS Institute, St Kilda, Victoria,
Australia, 2. School of Primary Health Care, Monash
University, Clayton, Victoria, Australia, 3. Shenzhen
International Primary Health Care Research Institute,
Shenzhen, China, 4. Center for China Sociological Research
and Development Studies, Peking University, Beijing, China
Over the last decade there has been significant focus on
reforming the primary health care system in China to imbed
a stepped care approach whereby patients can be treated in
the community with appropriate referral to services to match
their medical needs.
Chinas health policies now strongly promote the imple-
mentation of this approach particularly in response to the
increasing burden of chronic disease and population ageing.
Innovation in Aging, 2017, Vol. 1, No. S1
Affordable and accessible primary health care services are
critical to promote healthy ageing and the health of the
Chinese community more broadly.
This presentation will discuss the implications of recent
aged care and health policy reforms in China and their
potential impact on the health of older people. The presenta-
tion draws on analysis of key policy documents and inter-
views with informants including government officials, health
professionals and older consumers and data from a major
chronic illness management trial implemented in Beijing.
SESSION 3115 (SYMPOSIUM)
CAREGIVER ADJUSTMENT, INVOLVEMENT, AND
SUPPORT
Chair: K.Pfeiffer, Robert Bosch Hospital, Stuttgart,
Germany
Co-Chair: G.Wilz, Friedrich Schiller University Jena, Jena,
Germany
Most health systems are based on the premise that fami-
lies will assume responsibilities for day-to-day care to per-
sons with chronic or disabling conditions. The past three
decades of research in this field have been focused on under-
standing caregivers adjustment, consequences of providing
protracted care as well as on developing and testing inter-
ventions. In contrast to our recent knowledge about effective
strategies to support families and diminish the burdens only
very few programs have been translated for delivery in ser-
vice contexts. Two presentations (Wilz, Pfeiffer) of the sym-
posium address this gap. In two randomized trials registered
psychotherapists and care counselors from long-term care
insurances were trained and supervised in a telephone-based
cognitive-behavioral intervention (Tele.TAnDem study) or
problem-solving (PLiP study). Both randomized studies eval-
uated the effects of the interventions on family caregivers.
The data are compared with the results of previous efficacy
studies. A further aspect that is covered in this symposium
is the lacking empirical-based theoretical foundation of car-
egiver resilience concepts. Using data from a national lon-
gitudinal study, personality prototypes are extracted and
compared between caregivers and non-caregivers (Elliott).
Finally, qualitative data on beneficial and limiting factors
affecting the inclusion of family caregivers and nursing home
residents with dementia in shared-decision making are pre-
sented (Vernooij-Dassen).
CBT-BASED TELEPHONE INTERVENTION FOR
FAMILY CAREGIVERS OF PEOPLE WITH DEMENTIA
G.Wilz, Institute of Psychology, Friedrich-Schiller-
Universitt Jena, Jena, Germany
To prevent caregivers from the development of stress
related health impairments, effective interventions are still
needed. This presentation focused on the evaluation of a
telephone intervention for family caregivers of people with
dementia in Germany. The individual intervention (12 ses-
sions in 6 months, each 50 minutes) uses cognitive-behav-
ioural therapy adapted to specific problems of the caregivers.
The intervention aims to improve well-being, quality of life
and to reduce body complaints and depressive symptoms.
A randomized controlled trial (N = 322 primary family
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Innovation in Aging, 2017, Vol. 1, No. S1
caregivers) was conducted and the intervention was imple-
mented by cognitive-behavioural therapists. Compared with
caregivers in the control condition, caregivers who received
Tele.TAnDem demonstrated significantly greater improve-
ments in well-being, depressive symptoms (CES-D), body
complaints (GBB-24) and quality of life (WHO-Qol-Bref) at
post treatment measurement. Regarding the achievement of
caregivers individual goals, results showed that 77% achieved
complete goal attainment. Findings support the acceptability
and effectiveness of the Tele.TAnDem intervention.
PROBLEM-SOLVING IN CAREGIVER-COUNSELLING
(PLIP STUDY): ACLUSTER RANDOMIZED
PRAGMATIC TRIAL
K.Pfeiffer1, D.Albrecht1, A.Pendergrass2, C.Becker1,
M.Hautzinger3, 1. Clinic of Geriatric Rehabilitation,
Robert-Bosch Hospital, Stuttgart, Germany, 2. University
of Erlangen, Erlangen, Germany, 3. University of Tbingen,
Tbingen, Germany
Despite the evaluation of more than 200 dementia car-
egiver interventions over the past three decades, only very
few programs have been translated to delivery in service
contexts. In this study (05/201310/2016) we evaluated if
structured problem-solving is feasible to implement in a rou-
tine setting and effective compared to statutory care counsel-
ling of German long term care insurances (www.isrctn.com/
ISRCTN86289718). Fifty-six care counselors were rand-
omized (with district offices as clusters) from three long term
care insurances with 9 million assured members. The inter-
vention group was trained in an initial two-day workshop,
a follow-up day after 4 months, and individual bi-weekly
telephone supervision contacts over six months. The impact
of this additional problem-solving counseling component on
depressive symptoms (main endpoint) of burdened caregiv-
ers (N=138) was measured at baseline, after 3, and 6months.
Study results are presented and challenges in implementing
the trial are discussed.
THE RESILIENT CAREGIVER: PERSONALITY
PROTOTYPES AND DIFFERENTIAL PATTERNS OF
ADJUSTMENT
T.R.Elliott, M.Walsh, Educational Psychology, Texas
A&M University, College Station, Texas
Despite the popularity of resilience in studies of caregiv-
ers, many measures of resilience lack theoretical models with
testable hypotheses or meaningful recommendations for psy-
chological interventions. Studies guided by the Block model of
the resilient personality reveal consistent differences between
resilient individuals and those with overcontrolled or under-
controlled prototypes. Moreover, individuals who are not
resilient lack social and psychological resources that could
be addressed with empirically-based interventions. We exam-
ined the existence of the three personality prototypes in the
most recent phase of the Midlife in the United States project
(MIDUS; conducted 20132014) in the United States. Big
Five factor scores were cluster analyzed. Consistent with
prior work, the three prototypes were evident in the sample
with useable data (N=2715). Of the 333 individuals in car-
egiving roles, 52.3% were in the resilient prototype. We will
report the different patterns of adjustment observed between
these prototypes and between caregivers and non-caregivers.
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667
SHARED DECISION MAKING IN DEMENTIA CARE
PLANNING: INVOLVING FAMILY CAREGIVERS
M.Vernooij-Dassen1, E.Mariani2, Y.Engels1, R.Chattat2,
1. IQ Healthcare, Radboud University Nijmegen Medical
Centre, Nijmegen, Netherlands, 2. University Bologna,
Bologna, Italy
Shared decision-making (SDM) allows people with
dementia to participate in making choices. Including fami-
lies and dementia residents in SDM can be challenging for
nursing home staff. The objective of this study was to iden-
tify barriers and facilitators regarding the implementation
of an SDM framework for care planning in an Italian and
Dutch nursing home. Focus group interviews were con-
ducted with professional caregivers who applied the SDM
framework. Content analysis was used to analyze the data.
This study is part of a controlled trial. The results of focus
group interviews (n=10 in Italy; n=10 in the Netherlands)
revealed 6 overarching themes and 16 categories. Within
these themes, facilitators as well as barriers were identified.
Communication skills training for professionals, training of
family caregivers and involvement of the management level
in the implementation process, seem to be crucial factors to
implement SDM in nursing homes.
SESSION 3120 (SYMPOSIUM)
SELF-NEGLECT: BUILDING EVIDENCE AND
LEARNING TO INFLUENCE POLICY AND PRACTICE
Chair: M.Day, University College Cork
Globally self-neglect is a significant international pub-
lic health issue that is associated with serious adverse out-
come. Approximately one million cases arise each year in
the United States; in England the recent inclusion of self-
neglect within adult protection has resulted in heightened
concern and awareness. The focus of this symposium is an
international perspective on interdisciplinary responses to
self-neglect. The objective is to bring together experts from
Ireland, United States, Israel and England, and illustrate
how research evidence can inform learning and changes
to policy and practice. Self-neglect creates a myriad of
challenges daily for health and social care practitioners. It
also exposes flaws in how professions and organizations
work together, and requires careful attention to build-
ing an organizational and interagency infrastructure that
supports collaboration. As a phenomenon that is severely
under studied, this symposium provides an unique oppor-
tunity to discuss empirical evidence and interventions in
the context of legislative and policy contexts that differ
across jurisdictions. The four presentations within this
symposium will provide the backdrop for the critical
examination and discussion on self-neglect. Discussions
will focus on the fine balance from the initial assessment to
diagnosis, responses and management of self-neglect (Day
etal., Ireland); home care nurses observations and views of
self-neglect (Johnson, United States), practice wisdom used
by social workers in the encounter and choice of interven-
tion with self-neglect phenomenon (Ban-Winterstein etal.,
Israel), and the organizational learning that emerges from
reviews of serious cases (Braye etal., England).
668
SELF-NEGLECT: AFINE BALANCE FOR
PROFESSIONALS
P.Leahy-Warren, H.Mulcahy, G.McCarthy Haslam,
M.Day, School of Nursing & Midwifery, University College
Cork, Cork, Cork, Ireland
Self-neglect (SN) is a serious public health issue that is
largely hidden. Ageing demography will
increases the significance of self-neglect for community
professionals. The aim of this qualitative study was to explore
perceptions of self-neglect among Community Nurses (CNs),
Public Health Nurses (PHNs), and Social Workers (SWs).
Open-ended questions, reported here were part of a large
quantitative cross sectional descriptive study. From overall
sample of 566, recruited from community health organisa-
tion in Ireland, 25.6% (n=87) of participants responded. The
framework method was used for analysing the cross-sectional
descriptive data. Findings revealed one overarching theme:
Fine Balance and four subthemes: Complexity of self-
neglect; Personal Health Care Professionals response to SN;
Challenges in Managing the case; and, Recommendations for
Practice. An effective approach to self-neglect was perceived
by participants to be a fine balance from initial assessment to
diagnosis, responses and management. Needs of the person
were central to intervening effectively.
PRACTICE WISDOM: PROFESSIONAL RESPONSES TO
SELF-NEGLECT IN ISRAEL
T.Band-Winterstein1, I.Doron1, S.Naim2, 1. University of
Haifa, Haifa, Israel, 2. Ben Gurion University of the Negev,
Beer Sheva, Israel
Self-neglect amongst older adults is a social and health
phenomenon that is attracting increased research inter-
est in recent years. Very little empirical attention has been
devoted to evaluating intervention programmes in this field.
The aim of this qualitative study was to explore the mean-
ing attributed to elder self-neglect by social workers (n=16)
in their encounters with self-neglecting elders professionals
(n=16) using a practice wisdom model. Data collected
via in-depth semi-structured interviews, which were later
transcribed and content was analyzed. Four key scenarios
emerged: Immediate threat to life; potential future threat to
life; avoiding deterioration in the absence of imminent risk
and addressing environmental nuisance. In order to provide
appropriate intervention, the social workers developed inter-
vention strategies based on the tension and the need for bal-
ance between preserving autonomy, protecting human rights
and respecting the older persons wishes versus paternalism
and client safety.
PROMOTING ORGANIZATIONAL LEARNING IN
SELF-NEGLECT: EVIDENCE FROM REVIEWS OF
SERIOUS CASES
S.Braye1, D.Orr1, M.Preston-Shoot2, 1. Social Work,
University of Sussex, Haywards Heath, United Kingdom, 2.
University of Bedfordshire, Luton, United Kingdom
When an adult experiencing abuse or neglect dies, English
statute requires the Safeguarding Adults Board (the intera-
gency adult protection committee) to conduct a case review
establishing what went wrong, and to ensure that learning is
applied to how organizations and professions work together.
Over 60 review reports were analysed. Initial analysis of each
Innovation in Aging, 2017, Vol. 1, No. S1
case (characteristics, recommendations and themes) was fol-
lowed by cross-case analysis to construct a systemic learn-
ing framework. Emergent learning themes related to four
domains: the adult, the interprofessional team around the
adult, the organisations surrounding the team, and the adult
protection committee coordinating those organisations.
Effective practice requires alignment between all domains,
ensuring organizational support for trust-based relationships
with individuals, strong legal literacy, detailed staff guid-
ance and training, mechanisms for resolving differences, and
arrangements for coordinating intervention. Reviews pro-
vide important learning for policy and practice development,
adding to the evidence base on achieving positive outcomes
in self-neglect work.
SESSION 3125 (SYMPOSIUM)
INNOVATIVE USES OF TECHNOLOGY IN ASSESSING
PHYSICAL PERFORMANCE OF OLDER PERSONS
Chair: C.C.Quinn, University of Maryland School of
Medicine, Baltimore, Maryland
The purpose of this symposium is to present use of tech-
nology to translate the assessment of physical functioning in
older adults to clinical practice. Previous studies confirm the
relationship of physical performance measures to disability
onset, hospitalization, nursing home admission, falls, mor-
tality and other outcomes. While performance measures are
being used more frequently in aging research, their uptake in
clinical practice has been slow, in part because of the added
burden in clinical care of geriatric patients. Using technology
to improve the simplicity and efficiency of these measures
could have a major impact on their use in clinical practice.
In this symposium Dr. Charlene Quinn, will provide an
overview of the translation of technology to clinical care.
Dr. Jack Guralnik will describe the development of a
smart phone app for the administration of the Short Physical
Performance Battery, a widely used assessment of gait,
strength and balance.
Dr. W.Jack Rejeski will present the mobility assessment
tool-short form (MAT-sf) which uses video animations to
improve accuracy and precision measurement of mobility.
Dr. Miriam Morey will discuss walking speed in the 6th
Vital Sign research project to establish community popula-
tion walking speed norms and promote walking speed as a
vital sign.
Dr. Lisa Barry will discuss use of an RFID (small elec-
tronic chip) device to measure gait speed in the clinic setting.
Dr. Antoine Piau will present the RESPECT study of a
shoe insole to monitor frailty, assessing gait characteristics
and transmit data for the use of patients and physicians.
A SMARTPHONE APP FOR THE SHORT PHYSICAL
PERFORMANCE BATTERY
J.M.Guralnik1, D.Rooks2, T.Webb3, 1. University of
Maryland School of Medicine, Chevy Chase, Maryland, 2.
Novartis Institutes of Biomedical Research, Cambridge,
Massachusetts, 3. GE Healthcare - Lunar, Madison,
Wisconsin
The Short Physical Performance Battery (SPPB) is a stand-
ardized assessment of lower extremity physical performance.
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Innovation in Aging, 2017, Vol. 1, No. S1
It has undergone extensive methodological testing, has been
used throughout the world and in high profile observational
studies and clinical trials in aging research. Testing takes
about 10 minutes, requires the use of paper, pencil and a
stopwatch, and requires that results be transcribed into a
database or clinical record. Anewly developed smart phone
app contains the text of the instructions read to the subject,
has skip patterns built in, uses the phone as the stopwatch
and records and transmits results. This makes administration
much easier and quicker, helps retain standardized admin-
istration over long periods of time and eliminates errors in
recording and transferring results. Results of pilot work with
this app will be presented. It is expected that this technology
will greatly expand the use of this battery in research and
clinical practice.
ANIMATED VIDEO TECHNOLOGY: ADVANCING THE
ASSESSMENT OF MOBILITY
W.Rejeski, A.Marsh, R.Barnard, J.Fanning, E.Ip, Wake first 2 days, we recruited 8 participants (6 female; mean
Forest University, Winston-Salen, North Carolina
Within the past 10 years, our research group has used
Animated Video Technology as a means of enriching assess-
ment stimuli when evaluating various aspects of physical
function. This session focuses on the mobility assessment
tool-short form (MAT-sf) and also briefly illustrates how
we have applied this methodology to a virtual assessment
of the SPPB and in evaluating physical activity behavior. The
MAT-sf has excellent content validity and reliabilityan
ICC=0.93. Within the LIFE study, we recently showed that
rates of 24-month major mobility disability were 51% for
those within the lowest quartile of the MAT-sf and just 10%
for those with the highest quartile. Furthermore, the MAT-sf
has been found to be predictive of post-surgical complica-
tions including length of hospital stay and rates of nursing
home placement.
THE 6TH VITAL SIGN: AMOBILE APP FOR
POPULATION HEALTH SURVEILLANCE OF WALKING
SPEED
M.C.Morey1, S.Ryan2, J.Kelly2, C.Liu2, K.Hawkins2, senior health improvement program sponsored by the
K.Schwartz2, J.Prvu Bettger2, 1. Medicine, VAMC and
Duke Medical Centers, Durham, North Carolina, 2. Duke
University Medical Center, Durham, North Carolina
Smartphone applications (apps) are a novel technique
to directly reach people for research and health promotion.
The 6th Vital Sign is an iPhone app designed using Apples
Researchkit to enroll and consent adults in a study that meas-
ures a 2-minute walk test using the phones accelerometer,
self-reported health, and demographics. On April 11, 2016
the app was uploaded into the iTunes store and was viewed
in iTunes by 1,111 people during the first 50days. There were
771 downloads, with 398 adults consenting to participate;
90.7% completed the walk test and 63.1% completed the
health assessment. Median age of participants was 54 years,
25% were over 65years, 58% were female, 89.2% White, and
76.1% were living with a chronic health condition. Participants
spanned 27 states. This early phase of the 6th Vital Sign study
demonstrates the feasibility of designing and disseminating a
smartphone-based app to assess population health.
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TESTING AGAIT VELOCITY DETECTION DEVICE IN
AREAL -WORLD CLINICAL SETTING
L.C.Barry1, L.Hatchman2, Z.Fan3, R.Gao4, G.Kuchel1,
1. University of Connecticut Center on Aging, Farmington,
Connecticut, 2. UConn School of Medicine, Farmington,
Connecticut, 3. UConn School of Engineering, Storrs,
Connecticut, 4. Case School of Engineering,
Cleveland, Ohio
Routine, objective, and unobtrusive measurement of
gait velocity in clinical settings is required to translate
this research measure into practice. Our multidisciplinary
team developed a wearable radio-frequency identification
device (RFID) for measuring gait velocity in a typical out-
patient clinical setting. ARFID reader/antenna installed on
the wall of a UCONN Geriatrics Clinic walkway assesses
gait velocity as patients walk to exam rooms. On July 11,
2016, we began recruiting patients for validity and feasibil-
ity testing (target population N=50 clinic patients). In the
age 78.63years) and compared gait velocity measured via
RFID with stopwatch measurements. Staff noted device
acceptance, participants either agreed (n=5) or strongly
agreed (n=3) that they felt comfortable wearing the device,
and 7 participants would like their medical providers to
track walking speed over time. Routine gait velocity assess-
ments could provide more personalized guidance for clini-
cal decision-making.
SESSION 3130 (PAPER)
HEALTH PROMOTION AND PREVENTION IN AGING
A STATEWIDE COMMUNITY-BASED PROGRAM
FOR IMPROVING SENIOR HEALTH: OKLAHOMA
HEALTHY AGING INITIATIVE
A.N.Dentino, C.Dowers, L.Z.Rubenstein, Geriatric
Medicine, University of Oklahoma, Oklahoma City,
Oklahoma
The Oklahoma Healthy Aging Initiative (OHAI) is a
Donald W.Reynolds Department of Geriatric Medicine at
University of Oklahoma. Established in 2011, OHAI has
regional education centers and senior health clinics across
the state for improving access to geriatric care, increasing
health literacy, promoting healthy lifestyles and preventive
practices, and training both family and paraprofessional
caregivers. An underlying goal is to improve health and
aging policy, particularly focusing on rural settings and
American Indian populations. This symposium will high-
light several OHAI components that demonstrate program
vitality and effectiveness. These components include the
caregiver training program, the telemedicine network of
rural hospitals, and several evidence-based senior educa-
tion and health promotion activities. A statewide needs
assessment provided a framework for program planning
and evaluation and documented crucial deficits that OHAI
is working to improve.
670
SCALING AN EVIDENCE-BASED DIABETES
PREVENTION PROGRAM TO ADDRESS THE NEEDS
OF AN AGING POPULATION
H.Hodge, K.H.Hohman, M.Longjohn, Membership &
Programs, YMCA of the USA, Chicago, Illinois
In an effort to bridge science into practice, the Y is lev-
eraging its vast network to deliver the Diabetes Prevention
Program to those individuals at risk for type 2 diabetes. The
original NIH trial of the DPP lifestyle intervention reduced
the number of new cases of type 2 diabetes among adults
aged 60years or older by 71%. These results prompted the Y
to undertake a concerted effort to test the intervention with
Medicare beneficiaries with a goal of improving care and
health outcomes while lowering costs.
To date the Y has served 19,141 adults ages 60 or older.
Participants aged 60 or greater on average attend 1 more
core instructional session than those participants who are
younger than 60 years old (82% of core sessions vs 76%,
p=<0.001). Similarity, older participants lose on average 1%
more of their body weight than younger participants (5.1%
vs 4.2%, p=<0.001).
Beyond older participants experiencing positive results
from participating in the Diabetes Prevention Program, col-
lectively the Ys national network gained incredible knowl-
edge in how to best deliver the program to older adults.
Learnings from this concerted effort to serve older adults
have included the need to bridge the clinic to community
gap, identifying engagement methods that produce the great-
est yield of participants, removing cost as a barrier to partici-
pation, and tailoring messages to attract participants.
THE ORAL HEALTH STATUS OF OLDER PATIENTS
IN THE ACUTE CARE HOSPITAL SETTING: APILOT
STUDY
C.McNally1,2, K.Khow1,4,5, P.Shibu3,4,5, S.Liberali2,
R.Adams7,6, R.Visvanathan3,4,5, 1. School of Medicine,
The University of Adelaide, Adelaide, South Australia,
Australia, 2. Special Needs Unit, Adelaide Dental Hospital,
South Australian Dental Service, Adelaide, South Australia,
Australia, 3. NHMRC Centre of Research Excellence
Transdisciplinary Frailty Research To Achieve Healthy
Aging, Adelaide, South Australia, Australia, 4. Adelaide
Geriatrics Training and Research with Aged Care Centre,
Adelaide, South Australia, Australia, 5. Aged and Extended
Care Service, The Queen Elizabeth Hospital, Adelaide,
South Australia, Australia, 6. General Medicine, The Queen
Elizabeth Hospital, Woodville, South Australia, Australia,
7. Discipline of Medicine, The University of Adelaide,
Adelaide, South Australia, Australia
Oral health is known to be of low priority to older people
with many people not seeking care until they are in pain.
The acute hospital setting provides a unique opportunity to
conduct a comprehensive dental assessment and develop dis-
charge oral care plans for patients who may otherwise not
seek dental care.
This cross-sectional study was implemented over a
12-month period at the Queen Elizabeth Hospital (TQEH),
Adelaide. Patients were recruited from the Fracture Ward
and Geriatric Evaluation and Management Unit (GEMU).
General health data was collected from patient interviews
Innovation in Aging, 2017, Vol. 1, No. S1
and medical records and a comprehensive dental assessment
was conducted.
Seventy-five patients aged 84.26.7 (mean SD) years
agreed to participate. Fifty-five (71%) female Twenty-
two (29%) experienced a hip fracture, the remaining were
admitted for worsening of their general health. Patients had
6.252.9 medical comorbidities and were taking 8.64.4
medications. Twenty-four (32%) patients wore full dentures,
21 (28%) had natural teeth. One quarter (n=19) reported
difficulty chewing and swallowing their food. Over half of
the patients had not seen a dentist for more than two years
yet 55 (73%) patients were considered in need of referral.
It is evident from this pilot work, that older people have
significant dental problems and are not seeking regular den-
tal care. It appears prudent to consider the inclusion of a den-
tal health assessment as part of general inpatient care. The
results of this study also indicate the need for intervention
studies that incorporate preventive and restorative manage-
ment of oral health prior to discharge.
ELDERLY WITH NATURAL TEETH REPORTED LESS
FRAILTY AND BETTER QOL WHEN COMPARED TO
EDENTULOUS ELDERLY
A.R.Hoeksema1,2, S.S.Spoorenberg1,2, L.L.Peters1,2,
H.J.Meijer1,2, G.M.Raghoebar1,2, A.Vissink1,2, K.Wynia1,2,
A.Visser1,2, 1. University Medical Center Groningen, the
Netherlands, 2. University of Groningen, Groningen,
Netherlands
Background: Poor oral health influences food intake,
social wellbeing and general health.
Objectives: To assess oral status and self-reported oral
health in home-dwelling elderly (=non institutionalized)
(75 years of age) and to associate findings with reported
frailty, general health status and quality of life (QoL).
Methods: Oral status, oral health/dental care, frailty
(Groningen Frailty Index), activity daily living (ADL)(Katz-
15), complexity of care needs (IM-E-SA), general health and
Quality of Life (QoL) (EQ5D) were assessed. Oral status
(viz, remaining teeth, implant supported overdentures, and
edentulous) and case complexity (viz, complex care needs,
frail, or robust) were determined and associated.
Results: In total 1026 (77%) elderly persons (median age
80 years, IQR 7784 years) were included in the analysis:
39% had remaining teeth, 51% was edentulous and 10%
had an implant-supported overdenture. Elderly with com-
plex care needs and frail elderly were more often edentulous
and had more oral problems than robust elderly. Elderly per-
sons with remaining teeth reported more oral health prob-
lems but less frailty, better QoL, better ADL, and used less
medicines than edentulous elderly. Next they continued to
visit the dentist more often when compared to edentulous
elderly (90% versus 20% resp).
Conclusions: Elderly with complex care needs and frail
elderly experienced more oral health problems and are more
often edentulous than robust elderly. Elderly with remain-
ing teeth and implant-supported overdentures reported less
frailty, better QoL and used less medicines when compared
with edentulous elderly and better QoL.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 3135 (SYMPOSIUM)
AGEING, DEMENTIA, AND THE SOCIAL MIND
Chair: P.Higgs, University College London, London,
United Kingdom
Co-Chair: C.J.Gilleard, University College London, United
Kingdom
The sociology of dementia has been a relatively neglected
but increasingly important topic in studies of health and ill-
ness. The theme of dementia, its diagnosis and its cultural
role intersects with a number of important concerns within
sociology and aligned disciplines. The symposium addresses
gaps in our sociological knowledge of dementia and provides
a forum for the development of new themes and perspectives
within social gerontology. All of the papers presented locate
dementia within the context of ageing societies. The papers
range in scope from an overview of the classed nature of
dementia, its diagnosis and treatment to a study of embodied
citizenship in long term care. The underlying theme is to inte-
grate concepts such as class, citizenship and social exclusion
with the specific effects of dementia and societal responses to
what the American Psychiatric Associations Diagnostic and
Statistical Manual (DSM) now calls major neuro-cognitive
disorder.
The first paper is concerned with the complex relation-
ship between dementia and social class found in both epide-
miology and social gerontology. This is followed by a paper
examining whether issues surrounding dementia might better
be understood in terms of the concept of precariousness. The
third presentation engages with the contemporary debate
about the relationship between embodiment and citizenship
in long term care. The concluding contribution focusses on
the social location of personhood within debates occurring
in dementia care policy and practice. Taken together these
papers map out key dimensions in the sociology of dementia
DEMENTIA, CLASS, AND SOCIAL RELATIONS
I.R.Jones, WISERD, Cardiff University, Cardiff,
United Kingdom
Studies have shown higher risk of dementia in those with
lower Socio-economic status. But socio-economic status is
used and defined in different ways and it is difficult to untan-
gle effects and causal properties. This paper discusses how
the relationship between social class and dementia may be
problematic in epidemiological terms but goes on to argue
that social relations underpin the diagnosis, care pathways
and experience of dementia and that sociological research
still has an important role to play in interrogating how class
and class relations influence the everyday experiences of peo-
ple with dementia.
PRECARITY IN LATE LIFE: RETHINKING DEMENTIA
AS AFRAILED OLD AGE
A.M.Grenier1, C.Phillipson2, E.Lloyd3, 1. McMaster
University, Hamilton, Ontario, Canada, 2. The University
of Manchester, Manchester, United Kingdom, 3. University
of Bristol, Bristol, United Kingdom
This paper analyses the extent to which frailty and demen-
tia are better understood in the context of new forms of inse-
curity affecting the life course. Approaches to ageing that
IAGG 2017 World Congress
671
are organized around productivity, success, and active late
life have contributed to views of dementia as an unsuccess-
ful, failed or frailed old age. Operating through dominant
frameworks, socio-cultural constructs and organizational
practices, the frailties of the body and mind are often used
to mark the boundaries of health and illness in late life, and
shape responses accordingly. Our concern is that whether
taken for granted, or imagined, ideas that couple dementia
and frailty can marginalize persons who occupy the locations
of dementia and disablement. In this paper, we draw on the
concept of precarity to reconsider debates, and shift inter-
pretations of the fourth age away from age- or stage-based
thinking into a recognition of the shared vulnerability and
responsibilities for care. We conclude with a call to acknowl-
edge the fragility and limitations which affect human lives,
and argue that this recognition be grounded in an inclusive
form of citizenship.
A RELATIONAL MODEL OF CITIZENSHIP: INSIGHTS
FROM ASTUDY OF ELDER-CLOWNING
P.Kontos1,2, K.Miller1, A.Kontos3, 1. Toronto
Rehabilitation Institute-University Health Network,
Toronto, Ontario, Canada, 2. Dalla Lana School of Public
Health, University of Toronto, Toronto, Ontario, Canada,
3. Human Rights Law Section, Department of Justice
Canada, Ottawa, Ontario, Canada
The citizenship perspective in dementia has redressed
some of the gaps inherent in personhood- and relationship-
centred approaches to dementia care by contextualizing
individuals in terms of their relationships with the state and
its institutions. However, this perspective has yet to be influ-
enced by the emerging theoretical subfield of embodiment,
which places the body and embodied practices at the centre
of dementia representations and care. We draw on findings
from a study of elder-clowns in a long-term care facility to
advance a model of relational citizenship for individuals
with dementia. Relational citizenship foregrounds the recip-
rocal nature of engagement and the centrality of capacities,
senses, and the experiences of bodies to the exercise of human
agency and interconnectedness. Relational citizenship offers
an important rethinking of selfhood, entitlement, and reci-
procity. It also provides new ethical grounds to explore how
residents creative and sexual expression can be cultivated in
the context of long-term care.
THE SOCIAL LOCATION OF PERSONHOOD IN
DEMENTIA CARE, POLICY, AND PRACTICE
C.J.Gilleard, P.Higgs, University College London, London,
United Kingdom
The use of the term personhood has become central in
defining key aspects of policy and practice in dementia care.
While much has been made of its philosophical status, rather
less attention has been paid to sociological approaches to
concepts such as self and personhood. The present paper
argues that a return to the classical debates within sociology
over self and society offers a useful avenue for rethinking
the role of personhood in dementia care. Rather than essen-
tialising the concept of personhood, we argue that a greater
consideration needs to be given to the social realisation both
of dementia and of dementia care.
672
SESSION 3140 (SYMPOSIUM)
PHYSICAL FRAILTY, ATARGET FOR THE
PROMOTION OF HEALTH AND SOCIAL OUTCOMES
Chair: T.Lum, The University of Hong Kong, Pokfulam,
Hong Kong
Co-Chair: J.Tang, The University of Hong Kong, Hong
Kong
Physical frailty is increasingly identified as an important
intervention target in older adults. The status and impact of
physical frailty in Asian populations is less well known. In
this symposium, Lum and colleagues surveyed the preva-
lence frailty status in a random sample of 1,612 community-
dwelling elders residing in public rental housing estate, and
explored how frailty status might relate to the older adults
aging-in-place intention. They found that the prevalence of
frailty did not change over 1year. Pre-frail and frail elders
showed greater intention of community living after the
implementation of an ageing-in-place scheme. These are the
first larger-scale data on frailty in Hong Kong to inform inter-
vention design with implication on social and long-term care.
Choy and colleagues further examined how different types of
activities of the aging-in-place scheme affected elders pref-
erence for aging-in-place through modifying physical frailty
and other outcomes. Liu and colleagues explored the differ-
ential roles of physical frailty and chronological age in gen-
eral and everyday cognition. Luo and colleagues investigated
frailty in 2,380 nursing home residents using a frailty meas-
ure based on the Minimum Data Set, and show high predic-
tive value for major adverse health outcomes over 9 years.
To target this potentially modifiable risk factor significantly
affecting long-term care considerations in older adults, Wong
and colleagues developed an exercising habit formation pro-
tocol tailored for community-dwelling elders in Hong Kong,
using an empowerment-based framework. The intervention
protocol to be tested in a randomized controlled trial will
provide insight on sustainable frailty intervention.
FRAILTY IN ACOMMUNITY-DWELLING COHORT
OF OLDER ADULTS AND THEIR PREFERENCE FOR
AGEING-IN-PLACE
T.Lum1,2, G.Wong1,2, J.Tang1, M.Lau1, D.Kwok1, 1. day cognitive function were measured by Cantonese Chinese
Sau Po Centre on Ageing, The University of Hong Kong,
Pokfulam, Hong Kong, 2. Department of Social Work and
Social Administration, Pokfulam, Hong Kong
Frailty is a dynamic clinical state that may influence elders
preference for aging-in-place. Method: The study examined
the prevalence of frailty in 1,612 elders living in public
housing estates, where an aging-in-place scheme was intro-
duced. We used the FRAIL scale to classify elders into three
groups: frail, pre-frail, and robust before the implementation
of the Scheme and 1 year later. Results: The prevalence of
frailty states remained the same over 1year: robust (51.0%
to 50.7%), pre-frail (37.9% to 38.1%), and frail (11.1%
to 11.2%). There were 22.3% and 12.6% of frail and pre-
frail elders who were contemplating moving into an elderly
home, but the respective percentages dropped to 16.4% and
10.7% at 1year, respectively. Similarly, fewer frail and pre-
frail elders preferred to move should their health condition
deteriorated (dropping from 28.7% to 22.6% and 30.2% to
Innovation in Aging, 2017, Vol. 1, No. S1
13.4%). Implications: The AIP Scheme modifies ageing-in-
place intention among frail elders.
DISSECTING AN AGING-IN-PLACE SCHEME:
ACTIVITIES CONTRIBUTING TO POSITIVE
OUTCOMES
J.Tang1, J.Choy1, G.Wong2,1, M.Lau1, T.Lum1,2, 1. Sau Po
Centre on Ageing, The University of Hong Kong, Pokfulam,
Hong Kong, 2. Department of Social Work and Social
Administration, The University of Hong Kong, Pokfulam,
Hong Kong
This study aimed to examine of the type and intensity
of activities of an ageing-in-place (AIP) Scheme that might
contribute to the positive outcomes of elders. Method:
Acohort of 2,081 elders from 11 AIP housing estates and 1
control estate were randomly selected within each age stra-
tum: 6574 years, 7584 years, and 85 years. Elders were
interviewed face-to-face at baseline and 1 year and their
participation in the AIP Scheme activities was recorded.
Results: Structured small group intervention and activities
that improved the frailty states, mood, and cognitive func-
tion increased the likelihood of elder tenants to age in place.
Implications: Group activities that promote physical, psycho-
logical and cognitive outcome all contribute to the positive
change in elders preference for aging-in-place. Promotion of
positive social interaction is crucial in the development of an
AIP program.
DIFFERENTIAL PREDICTION OF GLOBAL AND
EVERYDAY COGNITION BY PHYSICAL FRAILTY AND
CHRONOLOGICAL AGE
T.Liu1, G.Wong2,1, J.Tang1, J.Xu1, T.Lum1,2, 1. Sau Po
Centre on Ageing, The University of Hong Kong, Pokfulam,
Hong Kong, 2. Department of Social Work and Social
Administration, The University of Hong Kong, Pokfulam,
Hong Kong
The present study explores whether physical frailty and
chronological age independently predicts global cognition
and everyday cognitive function. Data came from 1,668 com-
munity-dwelling older adults in Hong Kong. Physical frailty
was measured using the fatigue, resistance, ambulation, ill-
ness, and loss of weight and grip strength. Global and every-
Montreal Cognitive Assessment and 4-item short Lawton
Instrumental Activities Daily Living scale, respectively. After
controlling for education, chronological age explained a
larger variance than physical frailty in global cognition in
women. Physical frailty, in contrast, had more predictive
power than chronological age in estimating everyday cogni-
tive function in both genders. While the unmodifiable chron-
ological age predicts global cognition, physical frailty has
a greater contribution to everyday cognitive function. Our
findings warrant further investigation of an integrated bio-
cognitive model that underpins the linkage between everyday
cognition and physical frailty.
PREDICTING ADVERSE HEALTH OUTCOMES IN
NURSING HOME: AFRAILTY MEASURE USING
MINIMUM DATA SET 2.0
H.Luo1,2, T.Lum1,3, G.Wong1,3, J.Kwan1,4, J.Tang1, 1.
Sau Po Centre on Ageing, The University of Hong Kong,
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
Pokfulam, Hong Kong, 2. Department of Sociology,
Tsinghua University, Beijing, China, 3. Department of
Social Work and Social Administration, The University
of Hong Kong, Pokfulam, Hong Kong, 4. Department of
Medicine, The University of Hong Kong, Pokfulam, Hong
Kong
This study was to create a simple frailty measure for nurs-
ing home residents using the Minimum Data Set (MDS).
Method: MDS items comparable with the FRAIL-NH scale
were extracted. Frailty status was calculated based on the
following eight components: fatigue, resistance, ambula-
tion, incontinence, polypharmacy, loss of weight, nutritional
approach, and help with dressing. We included 2,380 elders
residing in six nursing homes in Hong Kong between 2005
and 2013 to test the predictive validity of the resulted scale
against major adverse health outcomes. Results: The pro-
posed frailty scale was independently predictive of incident
falls, worsening function, incident hospitalization, and mor-
tality, with hazard ratios ranging from 2.00 to 3.73, adjust-
ing for gender, age, education, cognitive performance, and
the presence of prevalent diseases. Implications: We provided
a simple and reliable scale to identify frail persons in nursing
homes and for developing effective intervention schemes.
EXERCISING HABIT FORMATION FOR FRAILTY
INTERVENTION IN THE COMMUNITY
G.Wong1,2, M.Shum1, T.Lum1,2, 1. Department of Social
Work and Social Administration, The University of Hong
Kong, Pokfulam, Hong Kong, 2. Sau Po Centre on Ageing,
The University of Hong Kong, Pokfulam, Hong Kong
Physical frailty and prefrailty is common and can be
intervened or prevented with structured exercise. With lim-
ited resources, however, professional exercise training pro-
grammes are of short supply. The sustainability of the benefits
beyond the programme is also unclear. Nearly 80% of older
adults in Hong Kong do not engage in regular exercise at
moderate level or above. From an implementation science
perspective, the key issue is not about providing the exercis-
ing intervention per se, but to design a programme with com-
ponents that will shift health behaviour. Older adults who
are more deprived and have lower education would need
more help from health promotion programmes with respect
to self-efficacy to engage in exercising. We have developed
a programme model that targets exercise habit formation,
using design elements The model is being evaluated in an
18-month randomized, single-blind, multicentre controlled
trial of 390 community-dwelling older adults. We present
here the pilot results.
SESSION 3145 (SYMPOSIUM)
EMERGING TRENDS IN MIDUS RESEARCH
Chair: J.E.Stokes, Boston College, Chestnut Hill,
Massachusetts
Discussant: M.E.Lachman, Brandeis University
Since its inception in 19951996, the National Survey of
Midlife Development in the United States (MIDUS) project
IAGG 2017 World Congress
673
has developed into one of the most important and popular
sources of data on mid- and later-life in the social and behav-
ioral sciences. Now entering its third decade, the MIDUS
study has greatly expanded, as well. This includes a recently
released third wave of follow-up MIDUS data; daily stress
and biomarker studies; and the MIDUS Refresher sample
expansion. The four papers comprising this symposium use
different modules of recent MIDUS data in order to inves-
tigate developmental, personality, and psychosocial aspects
of adults lives and their associations with health and well-
being across the life course. Sin and colleagues use MIDUS
Refresher data to examine the role age plays in adults
exposure and emotional responses to daily positive experi-
ences. Lee and Cichy use NSDE II diary data to investigate
day-to-day fluctuations of risk appraisal and negative affect,
and the influence of individuals neuroticism. Graham and
Mroczek analyze three-wave longitudinal MIDUS data to
track long-term trajectories of the Big Five personality traits,
while Stokes and Moorman use the same three-wave data
in order to examine links between age discrimination, psy-
chosocial well-being, and physical health over a two-decade
span. Lastly, Lachman a MIDUS Investigator will assess
the various strengths, limitations, and implications of these
papers, and discuss the potential contributions of these and
future MIDUS projects to life course research.
AGE DIFFERENCES IN EXPOSURE AND EMOTIONAL
RESPONSES TO DAILY POSITIVE EVENTS
N.L.Sin1, T.L.Gruenewald2, A.D.Ong3, D.Almeida1,
S.T.Charles4, 1. Center for Healthy Aging, The Pennsylvania
State University, University Park, Pennsylvania, 2. University
of Southern California, Los Angeles, California, 3. Cornell
University, Ithaca, New York, 4. University of California,
Irvine, Irvine, California
Positive events may facilitate aging-related improvements
in emotional well-being. This study examined age differ-
ences in exposure and responses to daily positive events. In
the MIDUS Refresher Study, 782 participants ages 2677
completed telephone interviews about their daily experi-
ences for 8 days. Age was associated with more frequent
positive events, occurring on 67% of days among younger
adults (ages 2639), 76% of days among midlife adults (ages
4059), and 81% of days among older adults (ages 6077).
Older adults were more likely to enjoy nature and report
network events (i.e., events that happened to family/friends);
there were no age differences in positive work, home, or
social interaction events. Older adults rated their events as
more pleasant and calm, whereas younger adults felt more
surprised and close to others. Consistent with theories of
emotional aging, findings suggest older adults experience
more daily positive events and derive low-activation positive
emotions from these events.
NEGATIVE AFFECT AND RISK APPRAISAL IN
THE CONTEXT OF DAILY LIFE: THE ROLE OF
NEUROTICISM
J.Lee, K.E.Cichy, Kent State University, Kent, Ohio
Prior studies have investigated the linkages between
stressor appraisal and negative affect (NA), but have neglected
674
the dynamic aspects of risk appraisal in daily life. This study
examines associations between day-to-day fluctuations in sub-
jective risk appraisals and NA and individual differences in
neuroticism. Daily risk appraisals (e.g., risk to self) and daily
NA were modeled using diary data from the National Study
of Daily Experiences (NSDE II), where respondents completed
8 days of interviews (N = 1012). Multilevel models revealed GERONTOLOGY
substantial within person variation in both risk appraisal
including self and NA. Higher levels of neuroticism were asso-
ciated with higher levels of and instability of risk appraisal and
NA. In addition, the covariation between risk appraisal and
NA was greater among individuals with higher neuroticism
(p < .05). Findings add to research suggesting higher levels of
neuroticism increase individuals vulnerability to the negative
effects of daily stressors through stressor appraisal.
TRAJECTORIES OF BIG FIVE PERSONALITY CHANGE
IN MIDUS
D.K.Mroczek, E.Graham, Psychology, Northwestern
University, Evanston, Illinois
We modeled long-term trajectories of the Big Five person-
ality traits using the MIDUS data. MIDUS recently acquired
a 3rd wave of data, allowing estimation of fixed effects
parameters of 20-year trajectories as well as random effects
for intercept and slope. The multilevel model for change was
utilized, with centered (chronological) age as the time met-
ric. With respect to the overall trajectory (fixed effects) all of
the Big Five traits showed decline over the age range 25 to
100. With regard to the random effects, particularly the slope
variances, only neuroticism and openness showed evidence
of individual differences in rate of change (slope).
AGE DISCRIMINATION AND HEALTH:
ALONGITUDINAL STUDY OF MIDLIFE AND OLDER
ADULTS IN THE UNITED STATES
J.E.Stokes1, S.M.Moorman2, 1. Illinois State University,
Normal, Illinois, 2. Boston College, Chestnut Hill,
Massachusetts
Unfair treatment of people based on their age, or age
discrimination, limits peoples access to opportunities and
resources and increases their levels of stress. However, lit-
tle is known about the long-term repercussions of day-to-
day age discrimination for physical health. This study uses
three waves of data from the National Survey of Midlife
Development in the United States (MIDUS, 19952014)
to examine whether perceived day-to-day age discrimina-
tion impacts adults physical health via their psychological,
emotional, and social well-being. Using 13,098 observations
from 6,456 participants, we estimated multilevel generalized
structural equation models (GSEM) to test both direct and
indirect effects of age discrimination on self-rated health,
chronic conditions, and IADL. Age discrimination had signif-
icant direct and indirect between-persons effects on all three
health outcomes, and significant indirect within-persons
effects on all three health outcomes. This suggests psychoso-
cial well-being acts as a mechanism whereby age discrimina-
tion gets under the skin and harms health.
Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 3150 (PAPER)
AGE-FRIENDLY COMMUNITIES AND HOUSING
AGE-FRIENDLY COMMUNITIES AND DIVERSITY OF
AGEINGLINKING ENVIRONMENTAL AND SOCIAL
J.Stiel, 1. Technical University Dortmund, Dortmund,
Germany, 2. FH Dortmund - University of Applied Sciences
and Arts, Dortmund, Germany
One of the major challenges in modern society is popu-
lation ageing and therefore the development of age-friendly
communities receives attention. Such a transdisciplinary
topic requires a more holistic approach in contrast to the
current models. Even within the field of gerontology, much
of the research on ageing and community occurs in isolation
from other subareas. Few research projects, mainly interna-
tional ones, focus on developing age-friendly communities in
a transdisciplinary way (e.g. WHO Age-friendly Cities Guide
2007) or linking corresponding subfields of gerontology to
one another (e.g. Provencher etal. 2013 link social gerontol-
ogy and social psychology). And while environmental geron-
tology is well established in Germany, it only seems to slowly
regain interest internationally also due to a lack of new
theoretical developments.
This presentation proposes a theoretical model link-
ing environmental and social gerontology. Environmental
gerontologists like Lawton and Saup contributed greatly
to our understanding of person-environment-interaction
and there is also modern research in person-environmen-
tal views of aging (Wahl & Oswald 2016). Combining
environmental gerontology with concepts of diversity
and exclusion from social gerontology allows us to bet-
ter understand which (age-friendly) environmental fea-
tures may benefit certain subgroups of older adults or risk
excluding others. Such an approach is in contrast to the
prevailing homogenous views in German concepts and also
the WHO-concept.
Identifying the distinct characteristics, interests and needs
of older adults a very heterogenous group in relation to
their environment enables us to improve the established con-
cepts for the development of age-friendly communities by
targeting diversity as well as mainstream needs.
ENABLING ENVIRONMENTS: EFFECT OF LOCAL
AREA ON PHYSICAL ACTIVITY IN THE OVER 55S IN
IRELAND
S.Gibney1, M.Ward2, S.Shannon1, 1. Department of
Health, Dublin, Ireland, 2. Trinity College Dublin, Dublin,
Ireland
The Age-friendly Cities and Counties Survey (2016)
was a population-representative cross-sectional survey of
community-dwelling adults aged 55+ in 21 Local Authority
areas. It measured individual-level positive ageing outcomes
and attributes of the local built and social environment to
provide a baseline estimate of spatial and socio-economic
differences in positive ageing and local factors that support
positive ageing.
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
This study examined the effect of perceptions of local area
safety and accessibility of recreational spaces, on physical
activity. Data was from the Age Friendly City and Counties
survey, in ten counties in Ireland (n=4,765). A random-
effects logit model was used to estimate the effect of 1)per-
ceptions of the accessibility and availability of recreational
green areas, 2) experience of crime, and 3) perceptions of
safety while out and about in the local area, on the odds of
meeting national physical activity guidelines (>= 150 minutes
per week). Age, sex, education, limiting illness and location
(urban/rural) were adjusted for.
Difficulty accessing a recreational green space (OR=0.74,
p=<0.01), or the unavailability of such a space (OR=0.80,
p=0.04), was associated with reduced odds of meeting physi-
cal activity guidelines. Respondents who had an experi-
ence that left them concerned about their safety (OR=0.78,
p<0.01), who felt unsafe out and about during the day
(OR=0.61, p=0.04) or at night (OR=0.82, p=0.02) were also
less likely to meet physical activity guidelines.
Improvements to the local environment may be useful for
promoting increased physical activity, in addition to individ-
ual-level behaviour change interventions.
LIVING THROUGH LANDSCAPES: DESIGNING
AND EVALUATING THE IMPACT OF DEMENTIA-
FRIENDLY GARDENS
H.J.Swift1, A.Towers1, J.Babaian1, J.Hollyhock2, 1. SESSION 3155 (SYMPOSIUM)
University of Kent, Canterbury, United Kingdom, 2.
Learning through Lanscapes, Winchester, United Kingdom
Most dementia care settings have an outside space but
many are underused because they are not suitable for peo-
ple living with dementia or because providers lack the con-
fidence and resources to optimize use. The Living through
Landscapes project intends to a) improve and transform the
outside spaces of 30 care settings across the UK to make
them dementia-friendly, and b) deliver training and resources
to staff and management teams to promote the beneficial
impact of regular and frequent access to the natural environ-
ment. This paper introduces the project and the research con-
ducted by the authors to evaluate the functionality, use and
impact of the re-designed spaces. Results for the first year of
the project (approx. 10 settings) are presented on qualita-
tive (interviews with people living with dementia using talk-
ing mats, focus groups with service staff) and quantitative
(an adapted Sheffield Care Environment Assessment Matrix,
quality of life i.e DEMQoL and DEMQoL proxy) measures.
Pre (baseline) and post assessments (after the garden rede-
sign) reveal improvements in use and functionality of the
outside spaces, which are discussed in relation to the health,
wellbeing and quality of life of service users living with
dementia. The theoretical, practical and policy implications
of designing and evaluating the impact of dementia friendly
spaces are also discussed.
SELF-MANAGED HOUSING AS AMEANS TO
DECREASE LONELINESS AND INCREASE WELL-
BEING IN LATER LIFE
O.H.Jolanki2, O.Teittinen2, 2. University of Jyvskyl, nisms. Together, these papers provide a contemporary and
Jyvskyl, Finland, 2. GeroCenter, Jyvskyl, Finland methodologically advanced evaluation of religiositys role
This study looks at housing and moving decisions of older
people and their experiences of a new living environment.
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675
Data come from qualitative face-to-face interviews (N=18)
collected in Central Finland. Majority of the interviewees
were 70+. The study has adopted a longitudinal approach.
First interviews were conducted a month prior to moving
(2014), 1st follow-up interviews 2015, 2nd follow-up inter-
views 2016. The interviews will be collected annually in the
future. The focus of the analysis was on the participants
reasons to move to a communal type of housing and their
experiences of a life in this type of self-managed housing. The
reasons to move were linked to factors like health problems,
feeling lonely and unsafe, impractical apartment and inacces-
sible environment and long distance to amenities. However,
the reasons to move were also linked to the doubts about
availability of informal help and public services and wishes
to find a new life and new social contacts in a new living
environment. The participants experiences were largely met
and the new living environment offered new social contacts
and social activities, a sense of belonging and company of
likeminded people and reciprocal help and support. In con-
clusion, while many older people value their old home they
are capable and willing to leave home and settle to a new
home in their quest for a better life in old age. The results call
for more positive view towards relocation in later life and
more flexible interpretation of ageing in place policy goal.
RELIGIOSITY, HEALTH, AND AGING IN
INTERNATIONAL AND CROSS-CULTURAL
PERSPECTIVES
Chair: C.Jagger, Newcastle University
This symposium consists of four papers that employ
robust data from different countries worldwide to examine
associations between religiosity and health among older per-
sons. Globally, older persons are experiencing gains in life
expectancy. Whether gains represent healthy years is in dis-
pute. External factors such as advances in treatments contrib-
ute to healthy aging, but evidence suggests factors internal
to the individual are also influential. One such, religiosity, is
increasingly recognized as a potential contributor to longer
and healthier lives. Although there is wide intra-country vari-
ation in the percent that report being religious, religion is a
component in the lives of a great many older persons in most
countries. Moreover, evidence shows older persons engage
in religious activity more frequently than younger. Given the
ubiquity of religiosity in lives of elders globally, we can learn
much by examining associations in international and cross-
cultural perspective. Chiu etal. investigate religious activity,
life and active life expectancy across a number of European
countries, whilst Saito etal. report similar analyses but for
Singapore, a country with diverse cultural and religious pop-
ulations. Cartwright reports on aging immigrants in the U.S.,
representing a wide range of cultural and religious traditions.
Taking the discourse to the cellular level, Hill et al. exam-
ine biomarker data from the U.S., linking religiosity and
telomere length, while exposing potential intervening mecha-
in health and aging within and across national and cultural
environments.
676
THE IMPACT OF RELIGIOUS ACTIVITY ON LIFE
AND ACTIVE LIFE EXPECTANCY IN THE EUROPEAN
UNION
C.Chiu1, Z.Zimmer2, C.Jagger3, M.B.Ofstedal4, Y.Saito5,
1. Academia Sinica, Taipei, Taiwan, 2. Mount Saint Vincent
University, Halifax, Nova Scotia, Canada, 3. Newcastle
University, Newcastle, United Kingdom, 4. University
of Michigan, Ann Arbor, Michigan, 5. Nihon University,
Tokyo, Japan
We examine whether religious activity is associated with
longer life expectancy and active life expectancy in European
Union countries using data from the first five waves of
the Survey of Health and Retirement in Europe (SHARE,
20042011). Life expectancy and active life expectancy by
gender, religious activity, and country were calculated from
incidence-based multistate life tables that were constructed
based on estimated transition probabilities. Measures of
six activities of daily living (ADLs) and seven instrumental
activities of daily living (IADLs) are used to define active and
inactive life with inactivity defined as having difficulty or
requiring help in any one of the ADLs or IADLs. Our results
show that religious activity is strongly related to life expec-
tancy and active life expectancy at age 50. Older people who
take part in religious activities live longer and spend more
years active than those who do not take part.
DIFFERENTIALS IN ACTIVE LIFE EXPECTANCY BY
RELIGION/RELIGIOSITY AMONG OLDER ADULTS IN
SINGAPORE
Y.Saito1, A.Chan2, R.Malhotra2, M.B.Ofstedal3,
C.Jagger4, C.Chiu5, 1. Nihon University, Tokyo, Japan,
2. Duke-NUS Medical School, Singapore, Singapore, 3.
University of Michigan- Ann Arbor, Ann Arbor, Michigan,
4. Newcastle University, Newcastle, United Kingdom, 5.
Academia Sinica, Taipei, Taiwan
Previous studies have indicated a relationship between
religiosity, various aspects of physical and mental health and
mortality. This paper expands the connection by quantifying
the effect of religion and religiosity on life, active life and inac-
tive life expectancy. Data are from a nationally representative
longitudinal survey of older adults conducted in Singapore
in 2009, 2011 and 2015. Health status focuses on disability,
specifically defined as ability or difficulty performing ADLs
and IADLs. The denominational distribution at baseline indi-
cates: Christianity (756, 16.3%), Buddhism / Taoism (2448,
56.5%), Islam (999, 11.6%), other (358, 4.8%), no religion
(439, 10.8%). Frequency of attending religious services is:
every week (1589, 29.9%), every month (721, 16.0%), less
than once a month (1018, 22.2%), not at all (1672, 31.8%).
This paper will estimate life and active life expectancy across
these religious denominations, level of religious activity, and
demographic covariates such as age and sex.
RELIGION AND HEALTH OF U.S. IMMIGRANT
ELDERS: ACCULTURATION, SOCIAL SUPPORT AND
HEALTH BEHAVIOR BUFFERS
K.Cartwright, University of New Mexico, Albuquerque,
New Mexico
This paper tests theoretical frames including social sup-
port, health behaviors, and acculturation to identify mecha-
nisms through which religion affects immigrant health in the
Innovation in Aging, 2017, Vol. 1, No. S1
US. Studies investigating immigration and acculturation indi-
cate that religion serves as a bridge and a barrier to American
culture. Studies also indicate that US immigrants are more
religious than their native-born counterparts, although sim-
ilarly to the native born population, older immigrants are
more likely to be religious. This paper uses multiple waves
of the New Immigrant Survey (NIS) to explore the relation-
ship among religion, health behaviors, and health outcomes
of aging immigrants. Where prior studies mainly focus on
specific religious traditions and immigrant health, the NIS
enables comparative analyses inclusive of religions beyond
the Judeo-Christian scope. The findings confirm that religion
is a social determinant of immigrant health and identify rela-
tionships between various religious traditions and health of
older immigrants.
PROCESSES LINKING RELIGIOUS ATTENDANCE AND
TELOMERE LENGTH
T.Hill1, P.Vaghela2, C.G.Ellison3, S.Rote4, 1. University
of Arizona, Tuscon, Arizona, 2. Florida State University,
Tallahassee, Florida, 3. University of Texas- San Antonio,
San Antonio, Texas, 4. University of Louisville, Louisville,
Kentucky
Although numerous studies show that religious involve-
ment is associated with favorable health outcomes, it is
unclear whether this general pattern extends to cellular aging.
The mechanisms linking religious involvement and indicators
of cellular aging are also undefined. We employ data from
the 2008 Health and Retirement Study, a national probabil-
ity sample of Americans aged 50 and older, to test whether
leukocyte telomere length varies according to level of reli-
gious attendance. We also test several potential mechanisms
linking religious attendance with telomere length, including
stressful life events, depression, and smoking. Although we
find that religious attendance is not directly associated with
telomere length, our mediation analyses revealed significant
indirect effects through depression and smoking, but not
stressful life events. Religious attendance may indirectly pro-
mote telomere length by reducing the risk of depression and
smoking, but there is no evidence to support stressful life
events as a mechanism of religious attendance.
SESSION 3160 (SYMPOSIUM)
EXPANDING USE OF UNIVERSAL ASSESSMENTS
FOR LONG TERM SUPPORTS AND SERVICES:
CHALLENGES AND BENEFITS
Chair: C.Wendel-Hummell, University of Kansas,
Lawrence, Kansas
Co-Chair: B.Fries, University of Michigan, Ann Arbor,
Michigan
Discussant: R.K.Chapin, University of Kansas
Many countries are now recognizing the need for uniform
assessment instruments across populations, settings and pro-
grams. Motivated by federal recommendations as well as
by knowledge of global best practices and trends, several
states in the United States are adopting a uniform assessment
instrument for their publicly funded long term support and
services, particularly Medicaid waiver programs. A univer-
sal, standardized assessment is a critical tool for streamlining
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
access to care for people seeking services. A well-designed
assessment instrument can be used to determine eligibility for
public programs, care planning, data collection, rate setting,
and quality assurance. Auniversal assessment can also: pro-
mote choice for customers when the assessment determines
eligibility for multiple programs; reduce administrative bur-
dens by using one assessment for multiple purposes; promote
equity by using the same assessment criteria for all individu-
als in need of services; and capture standardized data to help
policymakers do longitudinal analysis of client outcomes and
program effectiveness.
Participants will overview key factors that informed
selection of a base instrument in their states and outline key
policy decisions regarding implementation, including level of
care determinations and how outcome measures can be used
to improve quality of care. Participants will also demonstrate
how standardized data can be used to compare populations
across states and countries, and thus inform key LTSS policy
decisions. Strategies for overcoming challenges in imple-
menting uniform assessments, which could help other states
as well as international entities considering adopting univer-
sal assessment instruments, will be detailed.
CHARACTERISTICS OF PERSONS USING
LONG-TERM SERVICES AND SUPPORTS: AN
INTERNATIONAL PERSPECTIVE
B.Fries, M.James, M.Thomasson, University of Michigan, with physical disabilities, traumatic brain injuries, or intel-
Ann Arbor, Michigan
The interRAI Home Care assessment was developed by
an international consortium to inform evidence-based clini-
cal practice and policy decisions through the collection and
interpretation of standardized data about the characteristics
and outcomes of persons served across a variety of settings.
The Home Care tool is used by Medicaid agencies in 24
states in the United States and in more than 37 countries
worldwide. In this session, we highlight the ability to com-
pare populations across states and countries, using these data
to profile the characteristics of home- and community-based
(waiver) participants in five US states and show substan-
tial inter-state variation despite similar program objectives.
When compared with participants in 11 European countries
included in the Aged in Home Care (AdHOC) Study, how-
ever, the waiver populations are relatively less varied and
more disabled.
CREATING AND TESTING CONNECTICUTS
UNIVERSAL ASSESSMENT TOOL ACROSS MULTIPLE
POPULATIONS
N.A.Shugrue1, D.Charles1, C.Gruman2, R.McManus2, gling to identify outcome-based measures (e.g., social isola-
T.Tsay2, C.Bredfeldt2, D.Lambert3, J.T.Robison1, 1. tion and decline in activities of daily living). On behalf of
University of Connecticut Center on Aging, Farmington,
Connecticut, 2. The Lewin Group, Falls Church, Virginia,
3. Connecticut Department of Social Services, Hartford,
Connecticut
In order to increase access to non-institutional long-term
services and supports and facilitate level-of-need determina-
tions, Connecticut developed a Universal Assessment (UA)
for use across multiple populations through an intensive,
multi-stakeholder process including a cross-walk of existing
assessment tools (n=10) across the domains of ADLs, IADLs,
medical/psychiatric conditions, behavior, and cognition.
IAGG 2017 World Congress
677
Additional analysis of approaches taken by other states
(n=15) and other standardized tools (n=7) included item-by-
item selection across domains. Screens included relevance,
person-centeredness, validity, and reliability. The UA tool
selected was the interRAI Home Care Assessment, modified
for Connecticuts needs. An algorithm to determine level-of-
need and budgetallocation from UA data was developed and
tested across populations, modified from the intellectual/
developmental disability population (n=~10,000) and cross-
applied to data for elder/disabled individuals (n=~5300) to
compare 8 levels of need. Average costs lined up as expected,
but variation within each level required further refinement
and testing.
IMPLEMENTING KANSASS UNIVERSAL
ASSESSMENT IN AMANAGED LONG-TERM
SERVICES AND SUPPORTS ENVIRONMENT
C.Wendel-Hummell, A.Sellon, H.Kang, H.Lassmann,
L.Swartzendruber, C.Holmes, D.Nary, T.A.LaPierre,
University of Kansas, Lawrence, Kansas
The state of Kansas partnered with the University of
Kansas to develop and implement a universal assessment
instrument for Medicaid services in a managed LTSS envi-
ronment. After consulting stakeholders and best practices,
the interRAI-Home Care and interRAI-Intellectual Disability
tools were selected for use with frail older adults and people
lectual/developmental disabilities. InterRAI assessments are
designed to contribute to both eligibility screening and care-
planning. However, in a Medicaid managed LTSS environ-
ment, level-of-care (LOC) eligibility determinations must be
completed by an independent assessor, whereas plans-of-care
are developed by MCO care coordinators. We will discuss
the process of testing the draft instrument for translating
state LOC policy into the new assessment instrument and
developing a state-specific LOC screen. We will also detail
strategies used to overcome challenges encountered in plan-
ning the interface between conflict-free LOC determination
and MCO careplanning, and successfully transitioning to a
new instrument.
USING ASSESSMENT DATA TO PERFORM
OUTCOME-BASED QUALITY MEASUREMENT
M.Mccaffrey, University of Massachusetts Medical School,
Shrewsbury, Massachusetts
Outcome-based measures are an essential but often miss-
ing puzzle piece for assuring the quality of home-based
services. Like many states, Massachusetts found itself strug-
Massachusetts, the University of Massachusetts Center for
Health Law and Economics turned to 16 validated outcome-
based measures based on the Minimum Data Set Home Care
assessment (MDS-HC) developed by InterRAI, an interna-
tional quality measurement collaborative. The measures are
readily available and published in peer-reviewed journals.
Responses to fifty-six questions from assessments conducted
over a two-year period were evaluated to determine data
quality and completeness. Preliminary findings show the
feasibility of constructing many of the measures. InterRAIs
outcome-based measures can be used to create benchmarks
678
for participant outcomes, help service providers identify best
practices, align service offerings with clients needs, and pro-
mote advanced payment models.
USING STANDARDIZED DATA TO COMPARE ACCESS
TO LONG-TERM SERVICES AND SUPPORTS IN FIVE
U.S. STATES
M.Thomasson, M.James, B.Fries, University of Michigan,
Ann Arbor, Michigan
In the United States, access to long term services and sup-
ports is restricted, rather than a universal health care right.
State governments are responsible for setting level of care
(LOC) policy to identify the persons eligible to receive publicly-
funded services. These policies can exert powerful effects on
states budgets and individuals access to care. Standardized
assessment data is now being used for LOC determinations,
with the hope that objective measurement will ensure the con-
sistent application of these criteria. We compare LOC policies
across four US states that have adopted the interRAI Home
Care instrument, thus permitting head-to-head comparisons.
While states systems have the same overall goals, individual
states vary in their interpretation of LOC policy, using state-
specific algorithms created from different combinations of
these standardized assessment items. We will apply these sev-
eral algorithms to data from a fifth state to demonstrate sub-
stantial inter-state differences in access.
SESSION 3165 (SYMPOSIUM)
LABOR FORCE AND HEALTH IN LATER LIFE FROM
ACROSS-NATIONAL PERSPECTIVE
Chair: E.Calvo, UDP / Columbia University, RM, Chile
This symposium will feature cross-national studies on
labor-force and health in later life. Drawing on current inter-
nationally harmonized data, this symposium will present
papers exploring cross-national variations and group differ-
ences in labor-force participation rates and health at older
ages, as well as in the relationship between the two.
LABOR FORCE PARTICIPATION RATES OVER 65:
WHAT IS THE RIGHT LEVEL?
R.Finkelstein, Robert N.Butler Columbia Aging Center,
New York, New York
An analysis of the labor force participation rates for people
65+ (LFPR65+) by country-income revealed a strong inverse
relationship between participation and countrys income.
Globally, countries with lower income levels have much
higher labor force participation in old age. In general, high
income countries have lowest LFPR65+ rates, though there is
variability across countries, between genders, and a generally
upward trend through time. We use the International Labor
Organizations definition of labor-force participation and The
World Banks classification of countries into high-income,
upper middle income, lower middleincome, and low-income
in our analyses. This analysis highlights the centrality of policy,
economic, and cultural context in influencing peoples deci-
sions about when to stop working. This supports the need to
go beyond individual-level factors and microeconomic context
Innovation in Aging, 2017, Vol. 1, No. S1
in analyzing work decisions and disrupts over-simplified calls
for people to work longer since they are living longer.
DO ACTIVITY PATTERNS ACROSS TIME PREDICT
COGNITIVE AGING?
Y.Yu, U.M.Staudinger, Columbia Aging Center, Columbia
University, New York, New York
We investigated how engagement in mentally stimulating
activities in the domains of work, volunteering, and leisure
across time influence longitudinal change in cognitive perfor-
mance during adulthood via novel information processing.
Two aspects of this approach are innovative: (1) Focusing spe-
cifically on the degree to which activities require novel infor-
mation processing, and (2) studying the three activity domains
conjointly to ascertain their respective unique and interactive
contributions. The focus on novelty allows studying the effects
of mental stimulation across different levels of education rather
than being confounded with it. Given that the majority of a
given population will never achieve higher levels of education,
this is crucial knowledge for maintaining productivity in the
face of an aging population. Initial longitudinal analyses of the
HRS data set including information from O*Net seem to con-
firm the hypothesis that at all levels of education the degree of
novelty processing predicts better cognitive aging.
MARRIAGE, STRENGTH, AND MORTALITY RISK
AMONG SUCCESSIVE COHORTS OF NORWEGIAN
OLDER ADULTS
V.Skirbekk1,2, B.Strand2, 1. Columbia Aging Centre, New
York, New York, 2. Norwegian Institute of Public Health,
Oslo, Norway
Low grip strength is a major health concern, but being
married can offset some of the negative effects as spouses
may help and support each other when ones partner does not
manage alone. Growing shares of older adults are unmarried,
and we aim to study how their their low grip strength relates
to the risk of mortality. Inequality in life expectancy at older
ages have been demonstrated for both marital status and grip
strength, but the joint effects have not been focused on. Our
research was carried out from a population based survey and
register study, including residents in the Norwegian city of
Troms aged 5971 in period 1994/5 to 2007/8. We found
that that differentials in life expectancy by marital status and
strength became greater over time. Both greater strength and
being married were associated with longer lives.
GENDERED LATE CAREERS IN THE UNITED STATES
AND THE UNITED KINGDOM: ASEQUENCE
ANALYSIS
M.van der Horst3, D.Lain4, I.Madero-Cabib2,5, E.Calvo1,2,
S.Vickerstaff3, 1. Columbia University, New York, New
York, 2. Universidad Diego Portales, Santiago, Chile,
3. University of Kent, Canterbury, United Kingdom, 4.
University of Brighton, Brighton, United Kingdom, 5.
Universidad de Chile, Santiago, Chile
Numerous policy reforms in the 21 century have tried
to extend working lives without paying enough attention to
the gendered nature of late careers. Combining a life-course
approach with sequence analysis techniques, this study empiri-
cally explores how gendered are late careers in the United
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Innovation in Aging, 2017, Vol. 1, No. S1
States and the United Kingdom. Drawing on data for the last
decade from the Health and Retirement Study (HRS) and the
English Longitudinal Study on Ageing (ELSA), we identify mul-
tiple types of labor force sequences. Preliminary results suggest
that labor force sequences five years before and after the legal
retirement age are more unstable and diverse for women in the
United Kingdom. In contrast, labor force sequences for males
are similarly stable and homogenous in both countries. We dis-
cuss the policy implications of these results for the financial
security and health of both females and males in old age.
LATE CAREERS AND HEALTH: APANEL STUDY IN
THE UNITED STATES AND THE UNITED KINGDOM
E.Calvo1,2, I.Madero-Cabib2, U.M.Staudinger1, 1.
Columbia University, New York, New York, 2. Universidad
Diego Portales, Santiago, Chile
Using a life course approach to look at trajectories and
transitions in context, this study explores the association
between late careers and health in the United States (US) and
the United Kingdom (UK). We hypothesize that precarious
retirement sequences are associated with worse health in old
age and that this correlation is stronger in the US than in the
UK. Drawing on panel data from the Health and Retirement
Study (HRS) and the English Longitudinal Study on Ageing
(ELSA), we use sequence analysis to construct labor force
sequences five years before and after the legal retirement
age. We use discrete time models with Heckman correction,
survival models, and growth curve models to estimate the
association with mortality as well as objective and subjective
health outcomes. Preliminary results suggest that retirement
sequences characterized by full-time jobs, continued employ-
ment, and late retirements are associated with better health
outcomes, especially within the US.
SESSION 3170 (SYMPOSIUM)
FROM RESEARCH TO POLICY: ISSUES FOR THE
BUILT ENVIRONMENT
Chair: S.M.Schmidt, Lund University, Sweden
Co-Chair: B.Slaug, Lunds Universitet
Discussant: H.Chaudhury, Simon Fraser University, British
Columbia, Canada
The design of the built environment can enhance or
impede the activities of our aging society, and a well-designed
environment can help the aging population maintain a high
level of well-being throughout the life course. As the built
environment is highly regulated in most countries, policy
change presents a path towards implementation of research
results. In this symposium we will present empirical exam-
ples of research from five countries that are relevant for pol-
icy decisions in the built environment. Starting with outdoor
environments, researchers from Germany (Penger etal.) will
discuss the relationships among personal and environmen-
tal factors that influence out of home mobility. Colleagues
from Wales (Roberts etal.) will then present a tool that can
be used to identify targets to improve the age-friendliness of
neighborhoods. Switching to indoor environments, research-
ers from Japan (Hayashi etal.) will describe how the design
of nursing homes effects the health of the residents through
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679
indoor temperature. ASwedish research team (Slaug etal.)
will present a simulation that identifies the most severe envi-
ronmental barriers in ordinary housing among people with
different combinations of functional limitations. Finally, a
joint Italian-Swedish team (Chiatti et al.) will present the
implications of home monitoring technologies in ordinary
housing among people with dementia. A discussant from
Canada (Habib Chaudhury) will also tie the presentations
into the North American context. Hence, this symposium
will present a broad perspective on potential policy changes
to allow the built environment to better support the WHO
initiative for an Age-Friendly World.
SUMMER IN THE CITY: BEING OUT AND ABOUT IN
THE FACE OF FUTURE CLIMATE CHANGE
S.G.Penger1, F.Oswald1, K.Conrad2, S.Siedentop2,
D.Wittowsky2, 1. Frankfurt Forum for Interdisciplinary
Ageing Research (FFIA), Interdisciplinary Ageing Research
(IAW), Goethe University Frankfurt, Germany, Frankfurt
Main, Germany, 2. ILS-Research Institute for Regional
and Urban Development GmbH, Dortmund, Germany,
Germany
Western societies are facing major challenges, such as
urbanization, climate and demographic change. Therefore,
policy in communities has to be prepared to maintain mobil-
ity, social participation and well-being of older citizens in the
future of hot summers and dense inner city districts. The aim
of our study is (1) to identify personal (e.g., attitudes) and
environmental (e.g., climate) determinants of daily out-of-
home mobility and (2) to analyze how they may affect health
and well-being of elders. We developed instruments to assess
mobility-related behavioral flexibility and climate experience
that are used in a survey in two climatically different districts
of the city of Stuttgart, Germany. Data will be drawn from
face-to-face interviews and trip diaries with 200 community-
dwelling elders aged 65 years and older. Findings on out-
of home mobility in relation to personal and environmental
factors will be presented and furthermore be used to ensure
sustainable use of urban planning measures.
DOES GEOGRAPHIC SETTLEMENT TYPE
MODERATE THE ASSOCIATION BETWEEN
DEPRIVATION AND AGE-FRIENDLINESS?
V.Burholt, M.Roberts, C.Musselwhite, Centre for
Innovative Ageing, Swansea University, Swansea, United
Kingdom
The Older Peoples External Residential Assessment
Tool (OPERAT) enables the assessment of the residential
environment based on what is important to older people
as identified by older people themselves, providing a meas-
ure of age-friendliness. OPERAT scores are derived from
17 items distributed across four domains corresponding
to Natural Elements, Incivilities and Nuisance; Navigation
and Mobility; and Territorial Functioning. This presenta-
tion will show that an association between OPERAT scores
and broader area level deprivation scores varies according
to the nature of the geographic settlement type. We conclude
that although deprivation levels for a large area predict age-
friendliness for smaller constituent areas, this association
varies by rurality and population density. These results high-
light the variance in age-friendliness between different types
680
of area, and the utility of OPERAT in identifying these dif-
ferences. This information has potential application for plan-
ners, policy makers and practitioners, in correspondence to
the WHO drive for age-friendly environments.
REGULATING INDOOR TEMPERATURE AND
HUMIDITY: SUCCESSFUL CARE PREVENTION IN
WARMER NURSING HOMES IN JAPAN
Y.Hayashi1, T.Ikaga1, S.Ando2, S.M.Schmidt3, T.Hoshi4, den and allow people with dementia to live more indepen-
1. Graduate School of Science and Technology, Keio
University, Yokohama, Kanagawa, Japan, 2. University
of Kitakyushu, Kitakyushu, Fukuoka, Japan, 3. Lund
University, Lund, Sweden, 4. Tokyo Metropolitan
University, Tokyo, Japan
As society has aged in Japan, residents of nursing homes
are needing more advanced levels of care, which is increasing
costs. Accordingly, strategies to prevent further deterioration
of health are necessary. The effects of indoor air temperature
on health aspects such as blood pressure and mortality have
recently attracted attention. We measured indoor air tempera-
ture and assessed changes in the level of care needed among
1337 residents in 27 nursing homes during winter 2015. The
nursing homes were classified into two groups (warm or cold)
according to UK National Health Service guidelines regarding
indoor air temperature. Cox regression analysis revealed that
residents in warm nursing homes were less likely to deteriorate
to a higher level of care (HR=0.48, 95% CI 0.31 0.75). The Chair: C.Kelly, University of Manitoba, Winnipeg,
result suggests that policies to regulate indoor temperature
may be one ingredient to delay declines in health of nursing
home residents and reduce care costs.
INVENTORY OF BARRIERS AND ACCESSIBILITY
PROBLEMS IN ORDINARY HOUSING: IMPLICATIONS
FOR POLICY-MAKERS
B.Slaug, M.Granbom, M.Kylberg, C.Pettersson, codes, policy frameworks and even international relations in
S.Iwarsson, Lunds Universitet, Lund, Sweden
Promotion of accessible housing for senior citizens gains
increased attention by policy-makers. Housing environments
which make activity performance difficult and impede social
participation, increase risks of isolation and higher health
care needs and costs. The appropriateness of the ordinary
housing stock for accommodating senior citizens is there-
fore important to examine from a public health perspective.
Utilizing existing databases of environmental barriers in the
Swedish ordinary housing stock (N=1,021), the aim was to
survey environmental barriers (EB) and housing accessibil-
ity problems for senior citizens with different complexity of
functional limitations. Type profiles of functional limitations
prevalent in the aging population were targeted by simulated
analyses. Both one-family houses and multi-dwellings had
substantial proportions of EB. The EB generating the most
severe accessibility problems varied depending on type pro-
file, and the problems were considerable also for less com-
plex profiles. Large-scale and systematic efforts are required
to promote accessible housing for senior citizens.
TECHNOLOGY IN DEMENTIA HOME CARE: LEGAL,
ETHICAL, AND POLICY ISSUES
S.M.Schmidt1, A.Malmgren-Fnge1, M.H.Nilsson1, This model of home care provides funds to individuals to
G.Carlsson1, C.Dahlgren Bergstrm1, P.Olivetti2, hire, train and manage workers who assist them with daily
P.Johansson3, C.Chiatti2, 1. Lund University, Lund,
Innovation in Aging, 2017, Vol. 1, No. S1
Sweden, 2. Italian National Research Institute on Ageing,
Ancona, Italy, 3. Region Skne, ngelholm, Sweden
People with dementia and their informal caregivers are at
risk from other physical, psychological and social problems
beyond the dementia. As society is ageing and with a push to
age in place, informal caregiving is common. We are evalu-
ating an information and communication technology (ICT)
home monitoring kit to see if it can reduce caregiver bur-
dently. We will show results from two clinical trials in Italy
and Sweden (namely Up-Tech and Tech@Home), preliminary
showing that caregiver burden can be reduced and that those
using the ICT kits generally are satisfied with them. These
devices generate large amounts of personal data, and they
are potentially invasive, while those with dementia may have
minimal capacity to decide if they want to have their homes
monitored. Therefore, even with positive findings, we must
resolve important legal, ethical, and policy questions before
implementing such solutions.
SESSION 3175 (SYMPOSIUM)
CONFLICTING MEANINGS OF CARE: INSIGHTS
FROM CULTURAL GERONTOLOGY AND CRITICAL
THEORY
Manitoba, Canada
Multiple and conflicting meanings of care circulate in an
array of social sciences and humanities disciplines. In varied
theorizing and empirical studies, care refers to a gendered form
of labour that is socially devalued and poorly compensated.
In the lively feminist ethics of care scholarship, care refers to a
relational ethics that can radically transform individual moral
contrast to prevailing justice-based ethics systems. It is also fre-
quently used without reflection in many healthcare contexts to
refer to the material tasks of healthcare as well as an indicator
of quality. Perhaps most controversially, in disability studies and
activism care is regarded a complex form of oppression with
roots and ongoing links to mass institutionalization, paternal-
ism, and other systemic exclusions of differing embodiments.
This symposium draws on cultural gerontology and critical
theory to consider the contested terrain around care in relation
to aging in conceptual, policy and practices settings. In doing
so, we help to both complicate and clarify care to challenge
theorists, practitioners and researchers to consider the weighty
history and implications of terminology that often circulates
without pause. Further, we call on the audience to consider
what these conflicting and complex meanings of care might
mean for their own practice and work.
EXPLORING DISABILITY POLITICS IN DIRECT-
FUNDED HOME CARE FOR OLDER ADULTS
C.Kelly, Community Health Sciences, University of
Manitoba, Winnipeg, Manitoba, Canada
Directly funded home care has long been connected to dis-
ability activism in North America and the United Kingdom.
life. While sometimes critiqued for advancing a neoliberal
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
rhetoric of individual responsibility, direct funding programs
are also seen as flexible, empowering, and culturally sensi-
tive-- setting up a contemporary paradox. The roots of these
programs can be found in disability activism, particularly
in messages that reject a patronizing, charitable or medical-
ized concepts of care. This presentation aims to uncover
and trace the legacies of disability activism in a context of
expanding direct funding programs more explicitly to older
people in Ontario, Canada. Through presenting the results of
a public domain analysis, this presentation argues disability
movements have fundamentally changed the ways we under-
stand care beyond the context of physical disability.
THE POLITICS OF CARE AND AGING FOR DISABLED
ONTARIANS UNDER AUSTERITY
M.Hande, University of Toronto, Toronto, Ontario,
Canada
As Canadas population ages and public policies are
increasingly structured by financialized debt and auster-
ity, policy makers are scrambling to find innovative and
cost-effective ways to provide care for older Canadians.
Similarly, healthcare entrepreneurs are developing ways of
capitalizing on the aging market. Innovations include
public-private partnership financing for healthcare infra-
structure and expanded direct funding home care program
for older people. Many disabled Ontarians, however, do
not have the resources to access these individualized care
options and so are forced to cobble together entrepreneur-
ial and community-based survival strategies. Based on a
review of current provincial policy and extensive qualita-
tive focus group data from aging disabled Ontarians, this
presentation reviews how austere public policy innovations
are shaping the politics of aging and care for older disabled
Ontarians. Key care strategies and political responses are
analyzed thematically.
BRINGING AGING TO THE FOREFRONT IN
INTERSECTIONAL DISABILITY STUDIES
K.Aubrecht, Mount Saint Vincent University, Halifax, Nova
Scotia, Canada
Although there is impressive intersectional disability
studies scholarship and activism that explores heterosex-
ism, racialization, disablement and transinstitutionalization
(e.g., Ben-Moshe, 2011), analyses which include a consid-
eration of aging are virtually absent. Genealogical research
makes the absence of aging and older adults within inter-
sectional disability studies scholarship and activism more
present. In this presentation I share findings from a gene-
alogy of nursing homes in Nova Scotia which traces their
appearance to the English Poor Laws. Documents from the
Nova Scotia Archives, and secondary research that included
peer-reviewed academic publications and publicly available
information, were analyzed to understand the social and
historical emergence of nursing homes as a form of care for
older adults. This work sought to identify and understand
the dominant ideologies that shape current policies and
popular understandings of nursing homes, and that organ-
ize practices and perceptions of people who live in nursing
home settings.
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681
SESSION 3180 (SYMPOSIUM)
OPTIMIZING THE NURSING HOME ENVIRONMENT
FOR PEOPLE LIVING WITH DEMENTIA
Chair: O.F.Jarrin, Rutgers, The State University of New
Jersey, Devon, Pennsylvania
Co-Chair: S.Crystal, Rutgers University, New Brunswick,
New Jersey
Discussant: V.Mor, Brown University, Providence, Rhode
Island
This symposium explores interventions to improve care and
reduce the use of antipsychotic medication for nursing home
residents with dementia. Behavioral and psychological symp-
toms of dementia (BPSD) are the leading causes for assisted
living or nursing home placement. While non-pharmacologic
management of BPSD are universally recommended and antip-
sychotic medications carry a black-box warning for treatment
of dementia, they are prescribed to more than half of patients
with dementia in the United States. We begin with an overview
of public policy and advocacy efforts at the state and national
level to reduce antipsychotic use in nursing home residents
with dementia and the effectiveness of these programs. We
then describe the relationship between nursing home staffing,
staff education, and resident outcomes including infections,
pain, depression, and use of antipsychotic, antianxiety or
hypnotic medications in long-stay residents. Next we shift the
research approach from big data to stakeholder perspectives
of medical directors, physicians, consulting pharmacists, and
directors of nursing in facilities that have been successful in
reducing antipsychotic medication prescribing patterns across
the country. Finally implementation research on two differ-
ent facility-level interventions to improve nursing care will
be described that reframe behavioral symptoms of dementia
as a form of communication. M.Powell Lawtons ecological
theory of aging and environmental press model provide a lens
for discussing policy and practice patterns that aim to reduce
negative and maladaptive behavior of nursing home residents
living with dementia. Taken together the papers in this session
present a comprehensive overview of dementia intervention
and evaluation efforts at the individual, interpersonal, facility,
societal, and public policy level.
ANTIPSYCHOTIC USE TRENDS IN U.S. NURSING
HOMES AND IMPACT OF IMPROVEMENT
CAMPAIGNS
S.Crystal1,2, S.Neese-Todd1, A.Akincigil1,2, 1. Institute for
Health, Health Care Policy and Aging Research, Rutgers
University, New Brunswick, New Jersey, 2. School of Social
Work, Rutgers, The State University of New Jersey, New
Brunswick, New Jersey
Use of antipsychotic medication to manage behavioral and
psychological symptoms of dementia, associated with signifi-
cantly increased mortality, represents an international quality
and safety challenge. In the US, state and national campaigns
for reduced antipsychotic use in nursing homes were launched
beginning in 2012. Antipsychotic use for long-stay residents
declined from 23.9% in 2011 to 17.0% in 2015 (fourth quar-
ter), a relative decrease of 28.8%. State quality improvement
strategies varied widely, some relying more on education and
others on regulation. In this presentation, we will discuss the
682
approaches taken by several of the state initiatives, and impacts
to date. We will discuss the effectiveness of different states
improvement strategies, and provide updated regression analy-
ses on the impact of staffing and other facility characteristics
on antipsychotic use and on improvement rates. Implications
for effective, large-scale, sustainable quality improvement strat-
egies, and roles of educational and regulatory components, will
be discussed.
VALUING INVESTMENTS IN NURSING HOME
STAFFING AND STAFF EDUCATION FOR RESIDENTS
AND PAYERS
O.F.Jarrin2,3, D.Francel Bautista1, C.Cho1, W.Tay1, University, College of Nursing, Greenville, North Carolina,
R.Hermida1, 1. School of Nursing, Rutgers, The State
University of New Jersey, Devon, Pennsylvania, 2. Rutgers,
The State University of New Jersey, School of Nursing,
Newark, New Jersey, 3. University of Pennsylvania, School
of Nursing, Philadelphia, Pennsylvania
This session will describe the relationship between nursing
home staffing, staff education, and resident outcomes includ-
ing infections, pain, depression, and use of antipsychotic,
antianxiety or hypnotic medications in long-stay residents.
Staff education variables include nurse-level and facility-level
credentialing programs in addition to mandatory education
at the state-level. Nursing home staffing variables, facil-
ity demographic variables and primary facility-level, risk-
adjusted resident outcomes are drawn from the most recent
(2015) Center for Medicare and Medicaid Services (CMS)
Nursing Home Compare dataset that includes 15,000 nurs-
ing homes. Economic costs and potential cost savings are
estimated from Office of Inspector General (OIG) reports.
The relationship between nursing home staffing, staff educa-
tion, resident outcomes and costs of care will be discussed
with policy recommendations.
REDUCING ANTIPSYCHOTIC USE IN NURSING
HOMES: PRESCRIBER AND FACILITY PERSPECTIVES
M.Rosenthal1, B.Angell2, S.Crystal1,2, J.Poling3, A.Wec3, T.Yap1, S.Kennerly2, 1. Duke University, School of
1. Institute for Health, Health Care Policy and Aging
Research, Rutgers University, New Brunswick, New Jersey,
2. School of Social Work, Rutgers, The State University of
New Jersey, New Brunswick, New Jersey, 3. Department of
Sociology, Rutgers, The State University of New Jersey, New
Brunswick, New Jersey
Since 2012, some states have reduced inappropriate pre-
scription of APs in nursing homes (NHs) by 2025%, while
others show little change. To assist attendees in replicating
quality improvement across facilities and states, case studies
from the field will provide successful facility-level dementia
care strategies. As part of an AHRQ-funded study, administra-
tors and prescribers (medical directors, physicians, consult-
ing pharmacists, and directors of nursing) are interviewed by
phone at 14 NHs in 7 states. They describe the decision pro-
cess for prescribing APs, and issues prescribers face includ-
ing how they are affected by changes in regulations, barriers
to change, and sources of improvement. Their descriptions
cover a range of NHs by facility size, organizational status
(for profit/not-for-profit), proportion of Medicaid-covered
residents, and progress in reducing AP use. These case studies
of high success vs. limited success will provide examples of
Innovation in Aging, 2017, Vol. 1, No. S1
points of intervention, and effective alternative strategies for
addressing dementia in NHs.
HOW NURSING HOME STAFF MANAGE
CHALLENGING FEEDING BEHAVIORS IN RESIDENTS
WITH DEMENTIA
M.Batchelor-Murphy1, E.S.McConnell2,3, R.A.Anderson6,
A.Barnes1, T.Yap1, S.Kennerly4, C.Colon-Emeric3,5,
1. Duke University, School of Nursing, Durham, North
Carolina, 3. Geriatric Research, Education and Clinical
Center (GRECC) of the Department of Veterans Affairs
Medical Center, Durham, North Carolina, 4. East Carolina
5. Duke Medicine, Durham, North Carolina, 6. University
of North Carolina Chapel Hill, School of Nursing, Chapel
Hill, North Carolina
This session will describe the adaptive challenges nursing
home (NH) staff experience when residents with advanced
dementia exhibit feeding behaviors (e.g., turning head away)
during meals. As part of a larger mixed methods study to
re-design a dementia feeding skills training program, ten
focus groups were conducted with NH staff (N = 52) in 8
NHs. Transcripts were analyzed using four a priori codes:
dementia skills training, feeding behaviors, interventions,
and communication. NH staff report no formal dementia
feeding skills training, but did report training for dealing
with aggressive behavior during other daily care activities
(e.g., bathing). Transferring this training to feeding behav-
iors, NH staff reported their most frequent intervention is to
walk away. Mealtime challenges included feeding behaviors,
including behaviors perceived as aggressive. Implications of
this emerging work include reframing feeding behaviors as
communication, and training staff to respond appropriately
to these behaviors to promote meal intake.
THE USE OF MUSICAL CUEING TO FACILITATE AND
IMPROVE CARE PRACTICES IN NURSING HOMES
Nursing, Durham, North Carolina, 2. East Carolina
University, College of Nursing, Greenville, North Carolina
This session will describe use of a musical cueing inno-
vation to facilitate nursing staff in their implementation of
care for nursing home (NH) residents observed. Staff per-
ceptions of innovation characteristics and sustainability were
collected via focus group interviews held in each of eight
intervention NHs using a semi-structured interview proto-
col. Transcripts were analyzed using thematic content analy-
sis, and summaries for each category were compared across
groups. Responses to the musical cueing and the impact of
this environmental stimulation on behaviors of staff and
residents with dementia and overall nursing home culture
demonstrated that cueing NH staff using music offers an
environmentally friendly approach to prompting staff and
resident interaction and improving care practices. Exemplars
of how the innovation was tailored to fit individual NH
needs, such as music choices and cueing times will be pre-
sented along with lessons learned about integrating and sus-
taining practice change.
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Innovation in Aging, 2017, Vol. 1, No. S1
SESSION 3185 (SYMPOSIUM)
GERONTECHNOLOGY ACROSS THE CONTINUUM:
FROM INDEPENDENT TO ASSISTED LIVING
Co-Chair: C.R.Bolkan, Washington State University,
Oregon
R.Fritz, Washington State University, Vancouver,
Washington
Discussant: K.A.Hooker, Oregon State University
The dramatic growth in the worlds older population will
have a significant effect on healthcare, social services, commu-
nities, and families; it will require innovative interdisciplinary
solutions. The emergence of gerontechnology may address
many aging-related challenges in the continuum of care for
older adults. Telehealth, combined with patient education,
engages independent community-dwelling chronically ill older
adults in their own care. Health-assistive smart homes assist
independent and assisted-living older adults with safety and
health via ambient motion sensors and machine learning algo-
rithms that may identify and predict health events, as well as
provide timely alerts to facilitate earlier interventions. Mindful
implementation and evaluation of the efficacy of gerontechnol-
ogies will be needed as more technological solutions become
available and are employed. A focus on personhood and an
emphasis on patient-centered care will help ensure safe and
ethical use of technology, which is designed by digital natives
for use by a non-digital native older adult population. In this
symposium, we will present research findings from four dis-
tinct studies that describe: (a) the implementation and evalua-
tion of smart home sensors or telehealth technology for remote
patient monitoring in community and institutional settings
and (b) the challenges to adoption of such technologies among
older adults. We will also discuss the need for health care and
human service professionals to be cognizant of technological
resources in order to increase adoption and implementation.
Gerontechnology may improve quality of life among older
adults, increase their ability to age-in-place, and decrease health
care costs while maintaining function and dignity.
HEALTH-ASSISTIVE SMART HOMES WITH
ACLINICIAN-IN-THE-LOOP
R.Fritz2, M.Schmitter-Edgecombe1, A.Crandall1, D.Cook1, of care. Fifty participants aged 60+, diagnosed with heart
1. Washington State University, Pullman, Washington, 2.
Washington State University, Vancouver, Washington
Smart homes using ambient sensor monitoring and
activity-aware algorithms designed to assist older adults
with maintaining health and extending their independence
are under development. In this ongoing 5-year pilot study,
we deploy five smart homes each year to independent older
adults with chronic illness and add a nurse-clinician to the
motion sensor, data collection, and machine learning algo-
rithm loop. A nurse conducts a complete medical record
review, weekly telehealth assessments, and monthly in-home
health assessments and compares health information along-
side raw sensor data as well as data tagged by machine
learning algorithms with higher-level information including
resident activity. Data patterns are evaluated for their rela-
tionship to known or discovered changes in health. Findings
are reported to a team of software engineers who specialize
in machine learning and who train the algorithms to identify
IAGG 2017 World Congress
683
changes in health status. Formative findings reveal algo-
rithms may accurately detect changes in health status.
CHANGES IN ACTIVITY PATTERNS AND HEALTH
OF OLDER ADULTS CAPTURED WITH IN-HOME
SENSOR NETWORKS
M.Yefimova1, D.Woods2, J.C.Mentes1, M.Rantz3, 1.
UCLA School of Nursing, Los Angeles, California, 2. Azusa
Pacific University School of Nursing, Azusa, California, 3.
University of Missouri, Columbia, Missouri
Remote monitoring technology may enable proactive care
by alerting health providers to early signs of health decline
in frail older adults with multiple chronic conditions. Devices
embedded in the living environment may identify prodromal
symptoms based on deviations from in-home activity patterns
that comprise an individuals daily routine. A retrospective
multiple case study used secondary data from TigerPlace, a
retirement facility that evaluates health technology. Ten par-
ticipants lived in apartments equipped with networks of unob-
trusive motion and bed sensors. Thirty months of continuous
sensor data were analyzed in the context of clinical notes in
the electronic health record. Individuals routine activity pat-
terns were affected by temporal and environmental factors.
Adjusted for personalized baselines, changes in time spent in
various apartment areas were associated with geriatric syn-
dromes. These preliminary insights may guide further devel-
opment of in-home health monitoring to support clinical
decisions about timely and effective care for frail older adults.
TECHNOLOGY TO SUPPORT AGING IN PLACE:
ACOMMUNITY-BASED PILOT PROJECT
C.R.Bolkan, E.Kim, R.C.Hoeksel, Washington State
University, Vancouver, Washington
Low-income older adults in poor health often require
intensive in-home services and are at greater risk of morbid-
ity and mortality. We evaluated a pilot educational program
implemented by a community-based organization (Area
Agency on Aging/AAA) in partnership with local clinics/
hospitals. Program aims were to reduce hospital readmis-
sions, enhance chronic illness self-management among high-
risk clients, maintain aging-in-place, and improve quality
failure, enrolled in a Care Coordination program with AAA,
and living in the community each received a Bluetooth-
enabled smart scale, blood pressure cuff, electronic journal,
and medication management system for six months. Daily
health monitoring data were accessible to participants and
their Care Coordinators in an effort to prevent health status
declines. Initial results underscored challenges in implemen-
tation (e.g., partnering with health care clinics and specialty
providers; training staff), but also highlighted improvements
in client care and health outcomes.
PROVIDER KNOWLEDGE REGARDING ASSISTIVE
TECHNOLOGIES THAT SUPPORT OLDER ADULTS
INDEPENDENCE
C.R.Van Son1, A.Weakley2, M.Schmitter-Edgecombe2,
J.Tam2, 1. Washington State University, Vancouver,
Washington, 2. Washington State University, Pullman,
Washington
684
Aging Services Technologies (ASTs) can assist older adults
to maintain their highest level of functioning in the least
restrictive environment. However, the adoption of ASTs is
poor among older adults. Healthcare providers are a trusted
resource for health education and must be aware of and rec-
ommend available ASTs for their patients. Sixty-five health-
care providers completed an AST related questionnaire to
assess their knowledge about ASTs. More than 60% reported
that they have clients who need additional assistance with
instrumental activities of daily living and at least 78%
reported their clients would benefit from ASTs. However,
42% of the providers had little to no familiarity with ASTs.
Only 37% were able to correctly identify up to six AST items
from a 12-item visual identification tool. Additional results
from this assessment demonstrates the need for interventions
that promote provider knowledge of ASTs to facilitate maxi-
mum function and safety in older adults.
SESSION 3190 (SYMPOSIUM)
PRESIDENTIAL SYMPOSIUM: AGE-FRIENDLY
ENVIRONMENTS: CRITICAL DISCUSSIONS ON
PRESENT PRACTICES AND FUTURE PATHWAYS
Chair: T.Moulaert, iUT 2 Universit de Grenoble Alpes,
Ramillies, Belgium
Discussant: C.Phillipson, The University of Manchester
Age-Friendly Cities and Communities (AFCC) and Age-
Friendly Environments (AFE) initiatives and practices offer
significant potential for improving social inclusion, health
and wellbeing of older people worldwide. With the support
of the World Health Organization, they present an experi-
mental landscape for municipalities to adapt physical and
social environments and a platform for researchers to discuss
age friendliness.
A. Scharlach presents the complexities and controversies
regarding the concept of age friendliness and its implications,
including potential benefits and limitations of an emphasis
on individual health and functional ability, as embodied
in WHOs 2015 World Report on Ageing and Health as
opposed to social inclusion and community well-being.
AFCC and AFE initiatives have expanded worldwide.
However, little is known about their effects, their embedded-
ness in existing policies and their sustainability, or how best
to adapt to local needs. Meeting these challenges, S.Garon
and colleagues present data from Quebec and use three
theories of evaluation (experimental, logic model, participa-
tory) adapted to distinct variable contexts. At a global level,
A.Ross similarly exposes the need to critically consider such
contexts as a key factor in adapting a global WHO moni-
toring framework and core indicators to measuring age-
friendliness of places. With a focus on dementia, S.Biggs and
I. Haapala offer a complementary view on the competing
narratives at stake within age friendliness in Australia.
In conclusion, T. Moulaert uses comparative material
from Quebec, France and Belgium to advocate for the need
for theory to understand local mediations and how they are
embedded in shared values, language and interests.
Innovation in Aging, 2017, Vol. 1, No. S1
AGE FRIENDLINESS: ACRITICAL ANALYSIS OF ITS
HISTORY AND FUTURE
A.E.Scharlach, University of California at Berkeley,
Berkeley, California
This paper addresses complexities and controversies
regarding the concept of age friendliness, and its impli-
cations for creating age-friendly environments. The pres-
entation begins by examining current perspectives on age
friendliness, and their conceptual and empirical under-
pinnings. It then reviews a brief history of age-friendly
approaches, from segregated communities to age-inte-
grated environments to social inclusion, accompanied
by a critical examination of existing evidence regarding
three types of systemic approaches for helping cities and
communities become more age-friendly. The presentation
concludes with an analysis of unresolved issues concern-
ing age friendliness, including the potential benefits and
limitations of an emphasis on individual health and func-
tional ability, as embodied in WHOs 2015 World Report
on Ageing and Health, as opposed to social inclusion and
overall community well-being, as reflected in social devel-
opmental perspectives on social capital formation.
THEORIES OF EVALUATION AND THE MEANING OF
ASUCCESSFUL AFCC PROGRAM
S.Garon1,2, A.Veil1, M.Paris1, S.Vallette1, 1. cole de tra-
vail social, Universit de Sherbrooke, Sherbrooke, Quebec,
Canada, 2. Research Centre on Aging, Sherbrooke, Quebec,
Canada
This presentation aims to describe the experience of the
Age-Friendly Cities and Communities in Quebec, Canada
(AFCC-QC), in order to contribute to knowledge building
related to the evaluation process and to reflect on the pat-
tern of evidence of what could mean a successful AFCC pro-
gram regarding to different contexts. AFC-QC started with 7
pilot projects in 2008 and is now in implementation in 766
municipalities in 2016. Its based on a mixed methods design,
which provides an important body of data. This experience
raises the question of how do we evaluate an AFCC pro-
gram? There are more than a dozen of affiliated programs
in the WHO Global Network of Age Friendly Cities and
Communities (GNAFCC). Each of them takes place in dif-
ferent contexts. The theory of evaluation states explicitly the
importance of these contexts. Through the lens of three dif-
ferent types of evaluation models (experimental, logic model,
participatory), well discuss how these models can or cannot
address the different realities of AFCC.
THE SECRET OF SUCCESSFUL AGE-FRIENDLY CITIES
AND COMMUNITIES: MEASUREMENT
A.Ross, Centre for Health Development, World Health
Organization, Kobe, Hyogo, Japan
Key to garnering political and financial support for pro-
grammes to achieve age friendly cities and communities is the
availability of information on the impact and cost of various
interventions, access, and population inequities. The WHO
Centre for Health Development (Kobe) researched, devel-
oped, tested and disseminated a Monitoring Framework and
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Innovation in Aging, 2017, Vol. 1, No. S1
Core Set of Indicators for cities and communities to monitor
and measure their age friendliness. Evidence enables cit-
ies to set targets and policy, and to enhance collaboration
between governments, researchers, non-profits, and other
members of communities concerned about our health and
well-being as we age.
The Framework and indicators are grouped into physi-
cal environment, the social environment, impact and equity.
They were robustly tested in 15 cities worldwide, and are
designed to be tailored to local conditions. We will discuss
the indicators, examples of metrics, and the empirical results
from a number of cities that have used the Guide.
COMPETING NARRATIVES ON DEMENTIA
FRIENDLINESS: THE AUSTRALIAN CASE STUDY
S.Biggs1,2, I.Haapala1, 1. University of Melbourne,
Melbourne, Victoria, Australia, 2. The Brotherhood of St
Laurence, Melbourne, Victoria, Australia
The growing numbers of people living with dementia and
a progressive trend toward age friendliness in urban neigh-
borhoods raises the issue of how dementia is perceived in
the public domain. This paper critically addresses competing
narratives on dementia arising from professions and from
the growing voices of consumers and dementia activists in
Australia. The interconnection between narratives, public
perceptions and public interventions will, it is argued have
implications for policy, the co-creation of community and
future conceptions of citizenship. Empirical material from
Australia consequently addresses global discussion and
potential relation between dementia / age friendliness.
UNLOCKING THE BLACK BOX OF AGE-FRIENDLY
CITIES AND COMMUNITIES: CONTEXTUALISATION
AND MEDIATION
S.Garon2,3, T.Moulaert1, 1. PACTE, iUT 2 Universit de
Grenoble Alpes, Ramillies, Belgium, 2. cole de Travail
Social, Universit de Sherbrooke, Sherbrooke, Quebec,
Canada, 3. Research Centre on Aging, Sherbrooke, Quebec,
Canada
Age-Friendly Cities and Communities (AFCC) practices
have emerged as an appealing field for experimentations,
local initiatives, and they, sometimes, received the support
of social research. Today, there is a need to critically discuss
their development in different parts of the world and to sup-
port more theoretical perspectives.
The Programme dEtude International sur le Vieillissement
(PEIV) led by REIACTIS (www.reiactis.com) in 20132016
offers empirical observations and interviews with stakehold-
ers from AFCC in France (N=18) and Quebec (N=29); fur-
thermore, we observe the long-term evolution of a Walloon
program on AFCC in Belgium since 2002, where we are now
leading a pilot project in 6 municipalities offering stronger
methodological directions.
Inspired by critical gerontology and sociology of public
policies, we theoretically propose to insist on the variety of
contexts and mediations between local stakeholders, includ-
ing researchers, when present, to better understand how
practices are deeply embedded in shared values, language
and interests.
IAGG 2017 World Congress
685
SESSION 3195 (SYMPOSIUM)
ACTIVE AGING IN ASIA: COMMUNITY CARE
POLICIES AND PROGRAMS IN HONG KONG, JAPAN,
KOREA, AND SINGAPORE
Chair: K.L.Braun, University of Hawaii at Manoa,
Honolulu, Hawaii
Discussant: C.Conybeare, University of Hawaii West Oahu,
Kapolei, Hawaii
Counties across Asia are experiencing rapid growth of
the number and percent of older adults in their societies.
Although several countries have looked at paying for nurs-
ing home care, Hong Kong, Japan, Korea, and Singapore
have realized the creating home and community-based
services will maximize independence and minimize costs.
The purpose of this symposium is to share practices and
policies from these four countries as they develop and test
policies and programs that favor home and community
services over nursing home care. Presenters are country
representatives of ACAP (Active Aging Consortium Asia
Pacific) who work within their countries to educate and
facilitate change. The moderator (Braun, USA) will pro-
vide a brief overview of the trends that have led to rapid
aging in Asia and describe ACAPs individual-family-com-
munity-social policy framework. Dr. Han (South Korea)
will describe South Koreas efforts to build an active aging
society, with specific examples from Busan city, as well as
the national policy level. Dr. Ogawa (Japan) will intro-
duce several initiatives from Fukuoka Prefecture, includ-
ing Fukuoka Citys active aging plan and efforts of the
Asia Aging Business Center to promote a community-
based comprehensive care system. Ms. Kay (Singapore)
will discuss community-based initiatives in Singapore to
support older adults in an inclusive nation for all ages.
Ms. Tsien (Hong Kong) will describe Hong Kongs com-
munity-based work with older adults and policy makers
to improve the age-friendliness of selected neighborhoods.
Dr. Conybeare will discuss the similarities and differences
in country approaches.
COMMUNITY MODEL OF CARE AND SERVICES IN
SINGAPORE: ANATION FOR ALL AGES
T.Kay, Consultant, Singapore, Singapore
In rapidly ageing Singapore, 1 in 4 Singaporeans will
be over 65 by 2030. Efforts are being taken to build an
inclusive Nation for All Ages, and several initiatives
are underway to enable older persons to age-in-place and
within the community. For example, Singapore is develop-
ing age-friendly communities of care through integrated
health and social services, home services and home visita-
tions. Continued participation is being facilitated through
senior activity centres, community clubs, senior volunteer-
ism, lifelong learning, community kitchens, and multigen-
erational activities. Age-friendly environments are also
fostered, especially in housing, public spaces and transport
services. Innovative community-based programmes are
being implemented, such as care integration in a commu-
nity model of care, community rehabilitation (for recov-
ery and re-ablement), dementia-friendly communities and
686
the Singapore Programme for Integrated Care for the
Elderly (SPICE). Singapores Smart Nation initiative
will also leverage technology to enable older people to age
actively and productively.
INTEGRATED COMMUNITY CARE IN FUKUOKA:
APARADIGM SHIFT FOR AHYPER-AGED SOCIETY
T.Ogawa, 1. Fukuoka Asian Urban Research Center,
Fukuoka, Japan, 2. (NPO) Asian Aging Business Center,
Fukuoka, Japan
In Japan, the demographic transition of rapid aging is
considered a hindrance to economic growth. Neither pub-
lic nor private sector will be able to survive using busi-
ness as usual models in the coming future. Therefore,
every sector must modify its planning framework, from
forecasting to backcasting and from division of labor to
collaboration. The Japanese government is now engaged
in planning process to expected futures for 2025 and
2035, and working backwards to see how to best inter-
vene to keep people healthy and independent in old age.
An integrated community care system is being developed
to reduce costs associated with long-term care, which
has been institution based. More, less expensive options
of paraprofessional and family care are being developed.
Within this framework, the specific work of Fukuoka-city
to enhance health and social programs as an Advancing
Healthy City will be shared.
BEST PRACTICES OF ACTIVE AGING AS
ACOMMUNITY MODEL IN KOREA
D.Han, Research Institute of Science for the Better Living
of the Elderly, Busan, Korea (the Republic of)
South Korea is rapidly aging society. The proportion of
adults age 65+ in Korea will be 40% by 2060. To find best
practices for community-based active aging in Korea, data
were collected from older adults and providers affiliated with
welfare centers for the elderly in Yangsan and Busan. Data
on values, needs, and preferences for senior services were
gathered. The result suggest the importance of the concept
of active aging among elders and providers. Older persons
overwhelmingly saw value in being active, staying healthy,
and engaging in positive social participation in their older
years. Program providers felt maintaining respected social
roles and participation were important for older adults. The
findings underscore the need for more community-based
services to increase access to exercise, work opportunities,
volunteer opportunities, digital literacy, health literacy, and
intergenerational exchange. In Korea, community-based wel-
fare centers for the elderly are important platforms to spread
active aging.
BUILDING AN AGE-FRIENDLY HONG KONG:
ABOTTOMS-UP APPROACH
T.B.Tsien, Hong Kong Polytechnic University, Hong Kong,
Hong Kong
As many countries in Asia, Hong Kong is rapidly age-
ing. The Institute of Active Ageing of the Hong Kong
Polytechnic University has implemented research, funded
by the Hong Kong Jockey Club Charities Trust, to assess
Innovation in Aging, 2017, Vol. 1, No. S1
the current age-friendliness in two districts with high pro-
portions of older adults and to identify appropriate action.
The research has shed light on three priority directions for
action, namely building Hong Kong into a friendly city for
people of different ages; encouraging the elderly to partici-
pate in community activities; and promoting social inclu-
sion. Moving forward, the project team will work closely
with District Councils, mass media, and community part-
ners to develop three-year action plans with indicators to
monitor progress. This paper will discuss the experience
of this bottom-up and district-based approach and why it
proves to be an effective way of building an age-friendly
city and ensuring a long-lasting and sustainable impact on
local communities.
SESSION 3200 (SYMPOSIUM)
REALISING THE POTENTIAL OF ACTIVE AGEING IN
EUROPE
Chair: A.C.Walker, University of Sheffield
Discussant: J.Beard, World Health Organization
This symposium reports the findings of the most com-
prehensive scientific investigation of the challenges pre-
sented by population ageing undertaken so far in Europe.
The MOPACT (Mobilising the Potential of Active Ageing
in Europe) was a four year multi-disciplinary collabora-
tion involving 13 countries, which concluded in early
2017. Its objectives were to conduct systematic reviews
of the social and economic challenges of ageing, generate
new knowledge on key policy-related dimensions such as
late working lives and healthy ageing, collect and analyse
social innovations and policy initiatives and map the steps
required to realise active ageing. As well as investigating
the most important social and economic aspects of age-
ing, from pension system sustainability to social cohesion,
MOPACT also included research on the built and tech-
nological environments and biogerontology. The major
objectives of the symposium are to report findings from
specific parts of this comprehensive project, namely new
evidence on extending working lives and the challenge of
increasing healthy life expectancy, and to provide a pic-
ture of the policy regimes that are associated with differ-
ent degrees and forms of active ageing. In addition there
is an overview of the MOPACT project and the strategy
it adopted to enhance the policy relevance of its research.
Symposium participants will encounter clear and concise
summaries of the key findings from this unique project
and take away fresh ideas about the promotion of active
ageing in policy and practice.
THE MOPACT PROJECT
A.C.Walker, Sociological Studies, University of Sheffield,
Sheffield, United Kingdom
This paper will provide an overview of the MOPACT
project. Specifically it will outline the mission and objec-
tives of the project and the strategies it developed to link
scientific research to real world policy questions and,
then, to ensure that the research findings were as policy
IAGG 2017 World Congress
Innovation in Aging, 2017, Vol. 1, No. S1
relevant as possible. It will explain too why the active age-
ing concept was central to the project. This overview will
be followed by a summary of the key findings not covered
by other papers in the symposium. The main topics cov-
ered are national variations in the achievement of active
ageing, the projected increase in the numbers of people
aged 80+ living alone, measures required to improve pen-
sion system sustainability, the potential of biogerontology
to increase healthy life expectancy, the barriers to take-up
of ICT products, the need to transform long term care and
the political gerontocracy question.
REALISING ACTIVE AGEING IN EUROPE
A.Zaidi1,2, A.C.Walker3, 1. Ageing/ Gerontology, University
of Southampton, Southampton, United Kingdom, 2.
London School of Economics and Political Science, London,
United Kingdom, 3. University of Sheffield, Sheffield,
United Kingdom
The potential of older people to contribute to societal
progress is now widely accepted. The active ageing para-
digm has encouraged policymakers to generate additional
opportunities for older people, to be successful in their
active and healthy experiences of ageing. The MOPACT
project operationalised the concept of active ageing to
generate evidence highlighting the optimistic view on age-
ing, taking the Active Ageing Index AAI as its starting
point. This paper will report the results of this work, with
a particular focus on identifying contexts and strategies
across European countries that stimulate and sustain the
activity, health, independence, and security of people of
all ages. It combines the AAI evidence with the findings of
rigorous scientific reviews undertaken across MOPACT
WPs to develop an understanding about the active ageing
regimes. It highlights key strategies required in promot-
ing active and healthy ageing in different institutional and
cultural contexts of the European countries.
SOCIAL PARTICIPATION AND HEALTHY LIFE
EXPECTANCY OF OLDER PEOPLE IN POOR HEALTH:
ASENARIO ANALYSIS
D.J.Deeg1, B.C.Smid2, B.Wouterse2, 1. VU University
Medical Center/Dept. of Epidemiology & Biostatistics,
Amsterdam, Netherlands, 2. CPB Netherlands Bureau for
Economic Policy Analysis, The Hague, Netherlands
The European Union has formulated an increase in healthy
life expectancy (HLE) by two years as one of the Horizon
2020 goals. Given the increasing prevalence of multimorbid-
ity, it is important to limit the disabling effect of chronic dis-
eases, and thus increase disability-free life expectancy. This
MOPACT-study considers the promotion of social participa-
tion among older individuals with multimorbidity as one of
the tools to do so. Three scenarios that foster social engage-
ment in older people with multimorbidity are generated, and
the effects of these scenarios on HLE are assessed for sixteen
European countries. We found only very modest effects on
HLE. Our most realistic scenario results in improvements in
HLE between 0 and 0.1years. We conclude that substantial
increases in HLE cannot be expected to come from a single
IAGG 2017 World Congress
687
intervention alone but will have to be the result of combined
efforts on several fronts.
LONGER WORKING LIVES IN EUROPE: THE
WIDENING GAP BETWEEN FINANCIAL INCENTIVES
AND ENABLING STRATEGIES
G.Naegele, J.Bauknecht, Institute of Gerontology at TU
Dortmund University, Dortmund, Germany
Based on MoPAct research, this paper provides an
overview and discussion of European macro and meso
level measures aimed at higher older worker labor supply
and later labor market exit. On the macro level, political
reforms in the fields of pensions, unemployment and dis-
ability were implemented similarly in Western Europe and
Central and Eastern Europe (CEE) with merely marginal
differences despite significant lower employability (espe-
cially health-wise) in CEE. In contrast, on the meso level
pro-employability measures on the level of employers and
social partners are far more innovative and widespread
in Western Europe. Against this background, the gap
between financial incentives for older people to extend
working lives and insufficient pro-employability meas-
ures will exist in Western Europe only to some extend,
yet be far more widespread in CEE. In combination with
the adverse initial situation this will exacerbate the exist-
ing problem of work despite low employability/bad health
especially in CEE.
SESSION 3205 (SYMPOSIUM)
GSA M.POWELL LAWTON AWARD LECTURE: USING
SCIENCE AS EVIDENCE TO INFORM PRACTICES
AND POLICIESEXAMPLES FROM NUTRITION AND
AGING
Chair: J.L.Locher, University of Alabama at Birmingham,
Birmingham, Alabama
As a scholar committed to the goal of translating sci-
entific evidence into real world applications designed to
improve the lives of older persons, M. Powell Lawton
confronted multiple challenges along the way to fully
realizing his goal. The challenges he encountered in mak-
ing seminal contributions to gerontological treatment,
service, and policy include those related to the methods,
validity, and scope of research that are not unique to
either the environmental and aging studies in which he
was a pioneer or the twentieth century in which he lived.
In fact, one might speculate that within the past decade:
1) the greater role of the media in the communication
of science to the public, 2)the increased politicization of
science (especially as it relates to nutrition), and 3) the
decreased resources available for aging services may have
amplified those challenges. This talk will address chal-
lenges and opportunities related to applied gerontological
research with examples used from the field of nutrition
and aging. Two themes will be emphasized: 1) In the
absence of scientific evidence, why are unproven prac-
tices and policies adopted and maintained? And 2)In the
688 Innovation in Aging, 2017, Vol. 1, No. S1

presence of scientific evidence, why are decision makers Surya will focus on the latest research showing the impor-
unwilling to implement the results of science that could tance of staying healthy and not becoming a burden
benefit the lives of older adults? on families and how those priorities relate to financial
planning.
SESSION 3210 (SYMPOSIUM)
INNOVATIVE TOOLS FOR MORE EFFECTIVE CARE:
ACHIEVING 21ST CENTURY FUNCTIONAL ABILITY REMOTE PATIENT MONITORING
THROUGH MORE EFFECTIVE ELDER CAREGIVING D. Ryan, Health & Life Sciences Sector, Internet of Things
Chair: M. Hodin, Global Coalition on Aging, New York, Group Intel Corporation, San Francisco, California
New York Dave will introduce the role of technology, and specifically
Discussant: J.Beard, Ageing and Life Course Department, proof points from RPM, as a valuable tool for monitoring
World Health Organization, Geneva, Switzerland health and wellness and providing more efficient and effective
The 2015 World Health Organization World Report on care.
Ageing and Health defined Healthy Ageing as the process of
developing and maintaining the functional ability that ena-
bles well-being in older age. This new public health guide-
SESSION 3215 (SYMPOSIUM)
line focused on functional ability serves as a call-to-action
EARLY CAREER SCIENTIST OPPORTUNITIESU.S.
aligned with 21st century longer lives, and it requires an
NATIONAL INSTITUTE ON AGING, NIH
innovative view of wellness and prevention, in addition to
Chair: M.A.Bernard, NIA NIH, Maryland
more effective treatment paradigms, as core focus areas of
Co-Chair: R.J.Hodes, National Institutes of Health
health.
Discussant: R.A.Barr, National Institute on Aging
The symposium will present the public policy and busi-
The U.S. National Institute on Aging (NIA) at the
ness imperatives of making functional ability a priority in
National Institutes of Health, Department of Health
public health.
and Human Services, supports biomedical and behavio-
The focus on better elder caregiving aims to reveal
ral research with a life-span focus. There is attention to
unique opportunities to reduce hospital visits, limit re-
understanding basic processes of aging, improving preven-
hospitalization and address the impact of healthy aging on
tion and treatment of diseases and conditions common in
family and friends mental and physical health. The sym-
later years, and improving the health of older persons. It
posium will identify opportunities to improve caregiving
is the federally designated lead in research on Alzheimers
practices that pursue a more active aging, thereby adding
disease. The NIA also supports the training and career
quality to longer lives. It will further identify key areas